Understanding the experiences of frontline healthcare workers across different national and resource contexts is important for learning how to best support these providers to optimize their services during extended health emergencies. Using qualitative methods, we conducted 20 semi-structured interviews with frontline nurses and community healthcare workers to understand their working conditions, challenges, and supports during the COVID-19 pandemic. Ghana was selected as a leader in healthcare reform among African nations. Thematic analysis revealed the following themes: challenges and stressors, government support, overcoming challenges, and recommendations for leadership in healthcare organizations. Overall, healthcare workers experienced a plethora of challenges both at work and in their personal lives, including decreased access to food and medical care. They also contended with limited personal protective equipment and higher patient volumes. Despite these challenges, support from employers and the government remained limited. Participants provided several recommendations for healthcare systems and leadership to better support their workforce.

Introduction:The COVID-19 pandemic created new and exacerbated existing stressors for frontline healthcare workers. Despite being disproportionately affected by COVID-19, little is known about the experiences of frontline healthcare workers serving marginalized populations in community settings.Design:We used qualitative descriptive methods to understand the experiences of 12 frontline healthcare workers (HCWs) supporting primarily underserved populations in outpatient settings during COVID-19. Interviews were conducted from March to April 2021.Methods:Interviews were held virtually via Zoom using a semi-structured interview guide. Interviews were audio-recorded, transcribed verbatim, and uploaded into NVivo 12 qualitative data analysis software. The transcripts were dually coded by members of the research team and a thematic analysis was conducted.Results:Four major themes from the interviews were identified: stressors and burnout, coping strategies, organizational support, and recommendations. HCWs described how the early adjustment period to the pandemic created new challenges as they attempted to navigate changes in the workplace and altered responsibilities at home. HCWs felt largely unsupported by their organizations as they attempted to cope with stressors. Organizational support programs and resources often did not meet frontline workers' needs, and sentiments of unappreciation from leadership contributed to feelings of burnout and frustration as pandemic-related challenges persisted and evolved.Conclusion:Despite encountering numerous stressors at work and home, resulting from pandemic-related disruptions, frontline HCWs continued to provide care for their clients while navigating emerging challenges. Health organizations should include HCWs in decision-making processes when implementing support systems for workers during times of crisis.

Throughout the COVID-19 pandemic much attention has been given to addressing the needs of hospital-based healthcare professionals delivering critical inpatient care. At the same time, other groups of essential frontline healthcare workers have continued to serve low-income and underserved populations whose healthcare and nonmedical needs did not cease, and in many cases were exacerbated by factors associated with the pandemic shutdown. As these same factors also potentially impacted well-being and effectiveness of frontline healthcare workers, we sought to understand the organizational-level responses to the pandemic, including the support and preparation for frontline workers. As part of a larger study focused on reducing health disparities in hypertension, we conducted semi-structured individual interviews with 14 leaders from healthcare and health services organizations to explore how these organizations responded to accommodate frontline workers' needs. Findings from our sample show that healthcare and health service organizations made a range of major and timely modifications to clinic operations intended to address the needs of both employees and patients and strove to ensure continued patient services as much as possible. Nevertheless, our findings underscore the need for more attention and resources to support healthcare workers in primary care settings especially during emergencies such as COVID-19.