Financial issues in times of a COVID-19 pandemic in a tertiary hospital in Mali

Abstract

Abstract Background Health systems in many West African countries have suffered due to low public spending on health. Further, the requirement for high out-of-pocket payments by healthcare users accessing care has raised concerns about equitable access to COVID-19-related services. This study examines how the functioning of healthcare providers during the COVID-19 pandemic was affected by the government financing response to the pandemic, which itself is underpinned by existing healthcare financing systems. The analysis focuses on the key actor groups in healthcare service delivery, both providers and recipients of healthcare services at a tertiary hospital in Mali. Methods The study applied a single case study design. The case study was undertaken at a tertiary hospital in the Malian capital, Bamako, during the 1st and 2nd waves of the COVID-19 pandemic. Data were gathered through a total of 51 in-depth interviews with hospital staff, participatory observation, and the review of media articles and hospital financial records. Thematic analysis using pre-coded themes was applied. The study results were presented to hospital management to confirm the validity of the data analysis. Results The study highlighted the disruptions experienced by hospital managers, human resources for health and patients in Mali during the early stages of the pandemic. While the government aimed to support universal access to COVID-19-related services, efforts were undermined by issues associated with complex public financing procedures and the hospital experienced long delays in the government transfer of funds. Additionally, the hospital suffered a decrease in revenue during the early stages of the pandemic. The challenges faced by the hospitals led to the delays in promised bonuses and payment of salaries to individual hospital staff members, which created potential for unfair treatment of patients. Conclusions Preexistent issues in healthcare financing and governance constrained the effective management of COVID-19 related services and created confusion at the front-line of healthcare service delivery. There is a need to reflect on hospital operations and human resource management in Mali and learn from the experience of COVID-19 to create an environment in which hospitals and their staff can deliver quality services and where patients can access healthcare services in times of need.