Assessment of a Tertiary Hospital’s Systems Thinking Approach Using the World Health Organization Health System Framework in Response to the COVID-19 Pandemic in Nigeria

Background: The coronavirus disease 2019, (COVID-19) pandemic dealt a catastrophic blow to health systems globally, especially those of middle and low-income-countries, whose health systems were already frail, pre-pandemic. The World Health Organization (WHO) recognizes six building blocks (BBs) for a sturdy health system, whose synergistic interaction, through a systems thinking approach, guarantees optimal and equitable health outcomes for the populace, while shielding them from financial risk.  Objectives: To showcase a Nigerian tertiary hospital’s response to the COVID-19 pandemic, through the application of systems thinking, to the WHO health systems BBs. Methods: A questionnaire-based survey (utilizing a Likert scale of 1=very poor; 2=poor; 3=fair; 4=good and 5=excellent) of the hospital-wide efforts, employed by the leadership of the University of Nigeria Teaching Hospital (UNTH) Enugu, utilizing the WHO BBs, during the COVID-19 pandemic, assessed the perceived impact of the individual BBs on the hospital system. Eighty key stakeholders (Females=55%), heads of departments and supervisors, comprising various categories of medical personnel, overseeing twenty critical service areas of the hospital undertook the survey. Results: Leadership/Governance ranked highest in impact among the BBs (68.6%), with the availability of Medical products/Technology (65.9%), and Service delivery (64.4%) trailing closely at second and third, respectively. Perceived robustness and overall motivation of the Health Workforce was least ranked at 57.1%, closely followed by Healthcare Financing (58.2%) and Health Information Systems (61.9%). Conclusion: At an average cumulative score of 62.7% for all the BBs, the UNTH leadership may be adjudged to have performed creditably in their efforts at COVID-19 containment. Staff welfare should be enhanced, to ensure a well-motivated staff which will likely translate to improved service delivery.