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Research Article

Experiences of COVID-19 patients admitted in a authorities communicable diseases hospital in Nepal and its implications for health system strengthening: A qualitative study

• Anup Bastola,
• Rolina Dhital,
• Richa Shah,
• Madhusudan Subedi,
• Pawan Kumar Hamal,
• Carmina Shrestha,
• Bimal Sharma Chalise,
• Kijan Maharjan,
• Richa Nepal,
• Sagar Rajbhandari

x

• Published: December 30, 2021
• https://doi.org/10.1371/journal.pone.0261524

Figures

Abstract

Introduction

The COVID-19 pandemic has affected the health systems in many ways. It has put unprecedented strain on wellness systems worldwide and exposed gaps in public health infrastructure. A health organisation comprises all institutions and resources working towards improving and maintaining health. Amongst the dissimilar aspects of health system strengthening, a patient's experiences and expectations play a crucial office in determining how well the health facilities function. This study aims to explore wellness system strengthening'southward implications based on experiences and feedback provided past COVID-xix patients admitted to a regime tropical and infectious disease hospital in Nepal.

Methods

In this qualitative study, nosotros collected the voluntary handwritten feedback by the admitted COVID-19 patients to certificate the feedback and experiences from a book, maintained past the infirmary. Nosotros performed thematic content analysis using the World Health Organization's vi building blocks of wellness system equally a theoretical framework which included service delivery, health workforce, information, leadership and governance, financing, and access to medicines.

Results

Nigh patients in this study had positive experiences on service delivery and health workforce. Some also highlighted the gaps in infrastructure, cleanliness, and hygiene. Many suggested positive experiences on other dimensions of the wellness arrangement such as financing, governance and leadership, and admission to medicines reflected upon by the patients' thankfulness to the infirmary and the regime for the treatment they received. The responses as well reflected the inter-connectedness between the different edifice blocks of wellness organization.

Decision

This study approached a unique fashion to strengthen the wellness system by exploring patients' feedback, which suggested an overall positive impression on most building blocks of health system. However, information technology as well highlighted sure gaps in infrastructure, cleanliness, and hygiene. Information technology reinforces the hospital direction and government's role to continue its efforts to strengthen the health system.

Citation: Bastola A, Dhital R, Shah R, Subedi M, Hamal PK, Shrestha C, et al. (2021) Experiences of COVID-19 patients admitted in a regime infectious disease hospital in Nepal and its implications for health system strengthening: A qualitative study. PLoS ONE xvi(12): e0261524. https://doi.org/x.1371/journal.pone.0261524

Editor: Pathiyil Ravi Shankar, International Medical Academy, MALAYSIA

Received: April 11, 2021; Accepted: December 5, 2021; Published: Dec 30, 2021

Copyright: © 2021 Bastola et al. This is an open up access commodity distributed nether the terms of the Creative Eatables Attribution License, which permits unrestricted apply, distribution, and reproduction in whatsoever medium, provided the original author and source are credited.

Information Availability: The anonymized qualitative information is available at Figshare https://doi.org/ten.6084/m9.figshare.17013881.v1.

Funding: The author(south) received no specific funding for this work.

Competing interests: The authors have declared that no competing interests be.

Introduction

In the past year, the COVID-xix pandemic has affected the lives of people worldwide, with 253,420,051 confirmed cases and over 229,190,623 people recovered from the disease until 13 November, 2021 [one]. It has as well been over ane twelvemonth since Nepal had its get-go COVID-nineteen patient [ii]. As of 13 Nov, 2021, over 816,675 people had been infected by COVID-19 in Nepal, with a recovery rate above ninety% [1, 3].

The COVID-nineteen pandemic has affected the health systems in many ways. Information technology has led to a scarcity of human resources for wellness, disruption of the supply chain, increase in barriers to accessing healthcare, interference with service delivery, and spread of misinformation. They have eventually stressed the wellness systems and exposed gaps in public health infrastructure. It is pertinent to strengthen the health organisation to combat the electric current pandemic and set for future pandemics [four].

A health system comprises all institutions and resources working towards improving and maintaining health [5]. Health system strengthening involves actions taken to sustainably amend access, coverage, quality, efficiency, and accountability of the wellness system [half-dozen]. It also ensures that public health threats are controlled and whatever time to come outbreaks are prevented. The edifice blocks of health organization strengthening based on the Globe Health Arrangement (WHO) are service delivery, health workforce, information, leadership and governance, financing, and admission to medicines [7].

Nepal'due south health organisation and response to COVID-19

Nepal falls into the category of low- and middle-income countries [eight]. It transitioned to federalism in 2017 from a unitary regime which has provided a take chances to restructure the health system [9, 10]. The electric current COVID-xix pandemic has offered a further opportunity to adapt to the newly structured health system.

Nepal experienced its first example of COVID-19 infection on 23 January 2020 [2]. Since the first, the government of Nepal undertook serious actions to limit the spread of COVID-19. On March i, 2020, a high-level coordination committee for the prevention and control of COVID-19 was formed, which was then restructured as the COVID-19 crisis management center [11]. The authorities besides imposed a country-wide lockdown on March 24, 2020, which included a stay-at-abode order for all residents and a minimum of xiv days quarantine for the infected people and those who returned from a foreign country [12, 13]. RT-PCR tests were performed on all incoming passengers at the state's just international airport, and suspected patients were transported to COVID-xix designated hospitals [14]. The regime approaching the price for COVID-19 response which included hospital management. The government reimbursed hospitals for costless handling provided to COVID-xix patients [15].

Sukraraj Tropical and Infectious disease Hospital (STIDH) was the first hospital to be designated for the treatment of COVID-19 patients in Nepal [eleven]. It diagnosed and treated the first COVID-19 patient in the state [2]. As well, it is the merely central government tropical and communicable diseases hospital in Nepal. The infirmary has extensive experience in treating patients with infectious diseases such as HIV, malaria, diarrheal diseases, febrile illnesses, snake bites, and tetanus [16, 17]. It is also one of the centers involved in treating communicable diseases outbreaks in the past. STIDH has managed suspected cases of swine flu in 2009, dengue outbreak in unlike time periods, including the 2019 outbreak in Kathmandu, and cholera outbreak at dissimilar time period, including post-earthquake in 2015 [eighteen, xix].

The infirmary faced many challenges in the initial days of the pandemic. STIDH was originally a 100 bedded hospital with only two-bedded ICU. However, with the support from the government the hospital was able to upgrade its services in response to the COVID-nineteen pandemic in early 2020. As per the national report published in March 2021 on Nepal's response to COVID-19, the government had allocated a budget of approximately Height of Formthree million US dollars to STIDH [11]. By the fourth dimension of the publication of the written report, STIDH was able to apply 88% of the allocated funds for developing infrastructure, upgrading human resources, procuring medicines and instruments, capacity development, running prevention and control programs, and other activities as needed [11].

STIDH created a 54-bedded COVID-19 ward, and added x beds for COVID patients in the emergency room. Simultaneously, the general ward was converted into an ICU with 23 beds [11, 20]. The number of ventilators in ICU was upgraded from ii to vii [11]. Additional bilevel positive airway pressure (BiPAP) machines and high nasal flow cannulas (HNFC) were too added. A multidisciplinary team of experts in tropical and infectious diseases, internal medicine, anesthesiologists, pediatricians, orthopedic surgeons, dermatologists, and physiotherapists was formed for the management of inpatients. The infirmary recruited additional human being resources to sustain quality care which included engagement of three anesthesiologists for the ICU and 26 temporary nursing staff for the ICU and COVID-19 ward [11]. A counseling and a physiotherapy squad were too set up to provide patient centered care for COVID-19 patients [11]. The internet connections were upgraded to improve access to information and advice [11]. All laboratory and radiological tests, and medicines were provided free of cost to COVID-19 patients [xv]. The hospital also adopted a organization to gather patient feedback on hospital stay before discharge with the primary goal of quality improvement.

Among the different aspects of health system strengthening for hospital management, a patient'due south experiences and expectations play a crucial office in determining how well the health facilities role [7, 21]. Patients' feedback and suggestions are open and lived experiences and expressions related to their hospital stay. Such input and suggestions tin can help improve hospital services and public health response during and afterward pandemics [22]. Yet, patients' insights and reflections are not given equally much attention equally their disease outcomes [23]. The experiences of the patients admitted to a key hospital could provide valuable insights for infirmary administrators and policymakers [24]. Many health facilities from low resource settings tin can learn lessons from the experiences of STIDH during this pandemic.

Thus, this study's primary objective was to explore health system strengthening'southward implications based on experiences and feedback provided by COVID-xix patients admitted to a authorities communicable diseases hospital in Nepal. The secondary objectives were to depict the overall experience of the COVID-19 patients during their stay, explore areas of improvement in hospital care, and identify lessons for future pandemics.

Methods

Study pattern

This is a qualitative study where we performed thematic content assay using the WHO six building blocks of health system as a theoretical framework [7].

Study setting

We collected handwritten notes from the hospital register maintained to record patient feedback at STIDH, Kathmandu, Nepal. The infirmary has played a crucial function in treating a major proportion of COVID-19 patients in Nepal. As of March 2021 until the first wave, the hospital had treated 879 cases of which 408 were treated in ICU. The case fatality rate until Feb 2021 was 10.92.

Data collection

The recovered COVID-19 patients had written their reflections on their experiences of infirmary stay and provided feedback to the infirmary at the time of discharge. The researchers (AB, SR, BSC, KM and DN) collected the anonymized pictures of the patients' handwritten notes from the hospital register. The data collection was supervised by the showtime writer (AB) and the quality of data was ensured by other researchers non working in the hospital (RD, MS, and PKH). The included notes comprised 30 reflections of patients from the general ward and 27 from the Intensive Care Unit (ICU) and were written between January 2020 and Jan 2021.

The reflections were written voluntarily by the patients in Nepali and English languages. A few were also written in the Hindi language. There was no language barrier, word limit, or format for writing. All the information from the handwritten notes was transcribed to English digital text. The notes in Nepali and Hindi languages were translated to English by the research squad at the fourth dimension of transcribing (RD, RS, and CS). The researchers (MS and PKH) reviewed and ensured the quality of translations.

Data assay

The transcribed information in English was then imported to Dedoose software (version 8.3.45) for data analysis. Data assay was done through thematic content analysis using the half dozen building blocks of wellness system as a theoretical framework [seven]. The categories were identified by the researchers (RD, RS, and CS) from the coding of the transcripts, which were and so fitted into six major themes of building blocks of health system strengthening. The analyzed themes and categories were so shared with other authors (AB, MS, and PKH) for their review. The themes and categories were then finalized past all co-authors. Anonymous original quotes that reflected the real opinions of the respondents were chosen to give more insight.

Upstanding considerations

Ethical approving was obtained from Nepal Wellness Enquiry Council (Regd. 84/2021). The permission was also obtained from STIDH to employ the anonymized data of the handwritten notes of the patients from the infirmary annals. Informed consent from individual patients was waived every bit we only used anonymized data and no identifying information was included. The confidentiality of the anonymized information was strictly maintained past the enquiry team and the data was non accessible to others except for the research team.

Results

The findings of this study are structured around six major themes based on the WHO 6 core building blocks of the health system [7]. The categories for each theme included the positive reflections and feedbacks provided past the patients highlighting the areas that tin can be improved (Table 1).

Service delivery

The majority of the patients reflected positive experiences on service commitment. Almost all the patients expressed their satisfaction with the service they received in terms of quality of care, person-centeredness, and basic amenities.

Person-centeredness.

"Everything is very good. Fifty-fifty nurses provided a homely environment. I promise to come across and hear of like service being provided. I am thankful to the staff hither."–ICU patient

"It feels like I got a second life because I was timely transferred to this hospital.

I promise other patients in the future would continue to receive such dedication!

Bully salute to the ICU squad!"-ICU patient.

Quality of care.

"Good service A++, Food A++, Service A++, Behavior A++"–General ward patient

"I want to give thanks this hospital family unit. All staffs, healthcare workers are providing good service. The arrangement for food and stay is good. To continue oneself safe and take care of others is a very challenging job. This has been done well and I am grateful towards the services provided."–General ward patient.

Basic amenities.

Some patients had a positive experience regarding basic civilities such as food provided by the hospital.

"Food and hospital cleanliness was very skillful."-General ward patient.

A few had mixed responses regarding basic amenities such as nutrient and beverages provided by the infirmary.

"Food is ok simply has to be improved in quality every bit I myself institute hair and stones in information technology. Provision of tea, either milk or black, has to exist done because at that place's no age limit of COVID patients, so selection can be given."-ICU patient.

Cleanliness and hygiene.

At that place were mixed responses regarding cleanliness and hygiene.

Some patients had a positive impression near the cleanliness.

"The cleanliness of the toilet and the ward is very good."- General ward patient.

However, some highlighted that cleanliness and hygiene needed comeback.

"Hygiene of cabin should be properly maintained (information technology'due south not because of staff, information technology'south considering of old rooms which need proper maintenance). Cleanliness of ICU is very good and the cleaning staff should be encouraged equally much as possible."-ICU patient.

"Infirmary'due south bath and waste disposal area is very stinky. Unhygienic bathroom may pb to secondary infections for other patients, so it has to be cleaned routinely."-ICU patient.

Improving technologies.

A few also suggested solutions to improve timely responsiveness by the health workers.

"Even though with the excellent services by staffs I missed an emergency alert system which tin can be used by patients to telephone call the staff whenever they required. I would suggest to take a wireless switch in the wall of each bed and its indicators with mild sound and low-cal in the nursing station that will buzz forth with the sound."-ICU patient.

Health workforce

Teamwork, compassion and motivation.

The bulk of the patients reflected their positive experiences towards a dedicated team of wellness workers and expressed their gratitude for the personalized and empathetic intendance.

"After being admitted to the ICU of this infirmary, I saw that all the doctors and nurses assigned to this unit of measurement for patients' treatment and intendance were performing their duties honestly without whatsoever pressure or fear. Doctors and nurses behaved more than like a family rather than professionally towards the patients and provided handling and care because of which all patients, including me, are very happy. The kind of treatment and service patients should receive should exist just similar this, with promise and trust. I heard somewhere that doctors and nurses are like god but today I could experience very happy to feel it in reality."-ICU patient.

"I never felt there was any god. But now I feel I was wrong, there are then many people who are blessed with god hand. Despite all the difficulties and problems, they serve people. For me they are FARISTA (angels). YES, You Guys (doctors, nurses and helpers) who are devoting their twenty-four hour period and night during these pandemic situations are really the god easily. I feel this is my new life given by you guys. I wish I could be of any employ and I can do anything from my side to aid you. I have become salubrious because of you."- ICU patient.

"I will never forget the nurses who bathed me and shaved my bristles."- ICU patient.

Some were likewise sympathetic towards the difficulties faced past the wellness workers.

"I am glad that I got rid of COVID-19 and since the warm services of nurses towards patients are actually the best, the authorities should listen to their problems and obstacles as well.

Thank you lot (☺)"–ICU patient.

Communications.

Many were appreciative of the wellness provider's advice.

"The doctors who came on rounds were friendly and caring—exactly what every patient would want them to be. Thank you to all those working against COVID-19 directly or indirectly. We are very grateful."- Full general ward patient.

However, a few highlighted some discrepancies in the communications betwixt doctors which created confusions for the patients.

"I found doctors' counseling to me contradicting each other. Some said you lot can go home later on 14 days even with a positive written report and some denied the statement. This literally put me in dilemma."- ICU patient.

Information systems

Right information.

There were no reflections that directly addressed the wellness data system. However, some addressed the information in the social media regarding the health care for COVID-xix and compared the information they had with what they experienced.

"I had read nearly this hospital just a day dorsum on Facebook that all the health workers are skillful and all patients take also gone dwelling house in practiced wellness. After hearing this, I wanted to give thanks the hospital but as fate has it, I was meant to come up myself, I came to be admitted the next day."- General ward patient.

Access to information.

Some were also thankful to the infirmary for providing them admission to internet which kept them continued with others during the fourth dimension of isolation.

"The net facility helped me spend my time more comfortably."- Full general ward patient.

Misinformation.

A few also highlighted the misinformation regarding the health services provided for COVID-xix patients and shared their insights based on their ain experiences.

"The rumors against wellness workers not attending COVID patients at hospital were proven to be fake by all staff's (supporting, nursing staff, treating doctors) attitude, behavior and specific services provided here, 100% following the ethical part of medical service. You are corking! Go on with this motive, your service is ever appreciated by patients treated here."- ICU patient.

Governance and leadership

Accountability.

Many patients were appreciative of the authorities for their leadership and governance in providing them timely treatment.

"I came to realize that information technology's non only the wellness facility but the regime is with the states too."- General ward patient.

"I am very satisfied with the services of Teku hospital and the department of health services."- ICU patient.

Some as well highlighted that the regime must prioritize and pay more attending to this item infirmary.

"This hospital should go number i priority from the regime of Nepal to standardize the care and service delivery."-ICU patient.

Ways to better responses and strategies.

A few also highlighted how authorities should improve their responses to the pandemic and existing strategies.

"The probability of the infection entering the customs is increasing, so there should be suggestions and pressure level on the government to increment the charge per unit of COVID testing. The inadequacy in sourcing ways should be addressed timely to support the futurity challenges."-ICU patient.

Financing

Acknowledgment of positive support.

All the patients received treatment free of cost, including costless meals and medicines during their stay in the hospital. The government financed their treatment. Though none of the patients directly reflected on the costless of toll treatment, many acknowledged the service provided past the government and were thankful for the service they received.

"I am proud of Nepal Authorities that they looked after us for 15 days."- General ward patient.

"I have non a single sentence to comment or suggest considering the service this government hospital is giving to the patients is simply the best."-ICU patient.

"When nosotros were admitted to the ward, what we had in mind was that we would have to adjust to the government provided services- whatever quality those would exist. But information technology turned out unlike. We are actually very pleased with the services that were provided here."- Full general ward patient.

Access to medicines

Timely management.

As a key authorities communicable diseases hospital, all the patients had access to essential medicines. Still, just a few reflected upon their handling approaches.

"I was admitted to the hospital due to astringent pneumonia. Just I was treated successfully with plasma therapy and all other technologies. I am thankful to all the health workers for giving me a new life and for all the honey."–General ward patient.

Give-and-take

In this report, the experiences of the patients admitted to a authorities infectious disease hospital in Nepal provide an insight into the different dimensions of the building blocks of the health system [7]. The bulk of the patients in this study had positive experiences on service delivery and health resource reflected by the hospital teams' competent and compassionate intendance. Nonetheless, the study too highlights the gaps in infrastructure, cleanliness, and hygiene, which are also important elements of service delivery and the health system in general [six]. The study as well suggested positive experiences on other dimensions of the health system such as financing, governance, and leadership. The responses also reflected the interconnectedness between the dissimilar edifice blocks of the health organization.

The high level of satisfaction among the patients well-nigh the service delivery in this study reflects the hospital's efforts and preparation. Service delivery encompasses quality care, accessibility, and person-centeredness [24]. It also includes the provision of basic amenities, cleanliness, and hygiene [6]. Most LMICs accept suffered from poor service delivery during this pandemic attributed to the shortage in human resources, medicines, diagnostics, and other technologies [25]. STIDH, as a government hospital, had been facing similar challenges related to low resources for many years before the pandemic. However, under adept leadership, the hospital could efficiently upgrade the service delivery amid the pandemic and resource crisis in a brusk span of fourth dimension. The patients' experiences in the study reflected person-centered care provided in the hospital through proficient communication along with attention to patients' personal needs beyond regular treatment. Person-centered care enables shared decision-making through stronger provider-patient relationships and constructive communications. Such shared decision making and person-centered approach could play a crucial office in reducing health inequities which may somewhen meliorate the service commitment for COVID-19 patients [26].

However, the challenges related to infrastructures remained visible despite the efforts every bit highlighted past patients' mixed responses. Poor infrastructure has remained a major challenge even before the pandemic in most LMICs, including Nepal [27]. Earlier the pandemic, the hospital in this study was but equipped with bones facilities with merely two ICU beds and no isolation wards for a disease outbreak of such a massive calibration [11]. Even though the hospital could upgrade most of the services, more back up and efforts could be needed to further strengthen the infrastructure to improve ongoing services and gear up for futurity pandemics. The patients also reflected mixed responses on bones amenities such as nutrient and beverages. The government had allocated funds to provide food and beverages for the COVID-19 patients in the designated hospitals [28]. The hospital served nutrient four times a mean solar day, including breakfast with vegetarian and non-vegetarian options, and food customized based on patients' health condition. Such provision of gratuitous meals for the admitted patients in a government hospital is noteworthy. Yet, the feedback from the patients could provide an opportunity for the hospital to amend the shortcomings.

Some patients in this report also had complaints regarding cleanliness and hygiene, specially of the hospital toilets. Patients' satisfaction with the service delivery is largely influenced by their impression of the cleanliness of the hospital [29, 30]. They play an important office in sensitizing hospital administrators on the shortcomings of service delivery [31]. However, it is quite mutual for most hospitals to minimize the maintenance costs related to hygiene, cleaning products, and the training of their human being resource [31]. When the cleanliness and hygiene are compromised, the subsequent cost of its consequences could exist much higher as information technology may lead to many hospital-acquired infections including the spread of COVID-19. Coronavirus has been detected in stool samples; hence during flushing, the fecal matter may get aerosolized and tin can exist inhaled [32–34]. This aerosol can settle on surfaces which tin crusade transmission of the virus. This can be prevented by frequent cleaning and disinfection of surfaces, increasing ventilation, endmost the lid when flushing the toilet, and hand washing [34, 35]. The patients' feedback on cleanliness and hygiene also emphasizes grooming the cleaning staff on cleanliness, hygiene, and efficient disinfection procedures during the pandemic [36].

In this study, all the patients were happy with the services provided by the health workforce of the hospital and acknowledged the good teamwork. The wellness workforce comprises a diverse team of professionals who are integral to a health system's operation. Information technology includes the clinical staff such as doctors, nurses, pharmacists, laboratory scientists, and health technicians, and management and support staff who may not directly deliver the services [five]. Despite the scarcity of homo resources, the infirmary doctors conducted a minimum of iii rounds per mean solar day in-person and continuous monitoring remotely, and nursing intendance was bachelor all the time. Throughout Nepal, the healthcare staff accept worked selflessly, making the all-time utilise of available resources [37]. The healthcare providers faced a double brunt of increased workload considering of scarcity of health staff and exposure to COVID-xix infection [38]. The numbers of health workforce have a direct and positive association with people'south wellness outcomes [39, 40]. Fifty-fifty STIDH, a central infirmary, had to recruit temporary staff for the pandemic's peak elapsing to cater to patients' increased health needs [eleven]. Nevertheless, the recruitment of temporary staff could be considered a smart strategy to improve the hospital's health system as it helped deliver satisfactory services to the COVID-nineteen patients. This also brings low-cal to the need to acknowledge and motivate the human resources for the piece of work they accept been doing. Also, the healthcare staff should be trained and prepared for future pandemics with mock drills for emergency response [41].

The health information system also plays a crucial role in health organization through its key functions on data generation, compilation, analysis and synthesis, and communications [7]. While it was not possible to obtain much information on data generation through patients' perspectives, their reflections included positive experiences on access to communication. Nearly patients in the study had access to correct data, but some addressed the circulating misinformation in social media about healthcare staff not attending patients. Patients were grateful to have an internet connection during their stay at the infirmary, which helped them stay continued with their families and exist updated with the news. A systematic approach to communication is identified to improve the experience of COVID-19 patients significantly [21]. Receiving regular updates from nurses and physicians several times a twenty-four hours is one of the of import factors. Allowing internet connectedness and encouraging video chats can be some other way of improving patients' psychosocial issues. Reassurance to patients that the restriction is part of the job is another cistron that needs to be addressed. Encouraging patients not to hesitate to enquire for aid is another important domain that can assistance improve service delivery [21]. Communication with caretakers and relatives with improved access to internet could accept been key factors that were addressed at STIDH that led to more than patients' satisfaction.

As STIDH was the first designated COVID-19 infirmary and a central authorities hospital, patients' experiences from the hospital reflect the accountability and actual implementation of the wellness financing, leadership, and governance in Nepal. Health financing is fundamental to the operation and sustainability of health systems. It comprises a complex organization of collecting and allocating funds to ensure that all individuals can access effective public wellness and personal health care. Health financing is besides direct linked to leadership and governance [seven]. Leadership and governance involve ensuring the proper implementation of strategic policy frameworks, designing systems, coalition-building, and accountability [7]. The government had allocated a budget for the government health facilities across Nepal to provide handling to COVID-19 patients costless of cost [xv]. Although elaborate information was not available, almost patients were thankful to the hospital and authorities'southward leadership for their treatment. Patients admitted to COVID-19 designated hospitals did not confront financial catastrophe considering of out-of-pocket payments. The finding is a good indicator that financing, leadership, and governance in response to COVID-19 had been positive. However, because of a lack of hospital and ICU beds in these hospitals, many patients had to seek care in private hospitals, which led to loftier expenditure and, for some, inability to receive hospital intendance because of financial constraints [42–44]. This explains the importance of the government's role in pandemics and the need to focus on more than equitable financing and preparedness for future emergencies.

The regime of Nepal has been providing the essential medicines to government and public wellness facilities across the country fifty-fifty before the pandemic [45]. During the pandemic, the patients had timely admission to life saving medicines for COVID-19 complications, equally reflected in this study. A well-functioning health organization requires equitable admission to essential medical products, vaccines, and technologies. Moreover, the efficacy, cost-effectiveness, safe, and quality must exist ensured and should be evidence-based [11]. Though limited information is available on patient's individual experiences, the positive responses on timely access to medicines and treatment is encouraging. Government should continue to assure that all essential medicines are stockpiled and easily accessible for free by those in demand.

This study has some limitations. Every bit a qualitative written report from a single setting, the findings only reflect a smaller population'south perspective, which may not be generalized to the unabridged population. Every bit the patients were not directly interviewed, the reflections may not truly correspond their consummate feel of hospital stay. As well, the patients were aware that their reflections would exist read by others and they were not told to anonymize their names in the feedback register, which could have led to social desirability bias. Moreover, the findings don't reflect the experiences of the patients who did not recover. The perspectives of the deceased patients' families could also have been insightful which was not included in this report. Furthermore, this study but reflects the experiences of the patients and the hospital from the kickoff wave in Nepal until March, 2021. The wellness facilities faced astringent challenges in managing the patients during the second wave between April and June 2021 [46]. As this written report was already completed before the second wave, information technology was beyond the scope of this study to reflect the experiences of second wave. The experiences and challenges of the 2nd wave in Nepal warrants a separate study to wait deeper into different dimensions of managing the different peaks of a pandemic.

Despite the limitations, this study provides fresh insights as the patients reflected upon their experience during infirmary stay and treatment right before their belch. Thus, this study is not prone to recall bias. Few studies on COVID-19 have explored patients' perspectives and linked it to health organization strengthening.

It is axiomatic from this study that the leadership and management of the hospital had played an of import role for service delivery in the first wave of the pandemic. The findings too reflect the importance of focusing on all the 6 building blocks of health system strengthening to provide services to the patients [vii]. In particular, the availability of funding from the government, efficient implementation of plans, proper infrastructure, and motivated health workforce had been crucial for this central infirmary from a resource constraint setting to keep provide quality services amid the uncertainties of the pandemic.

Conclusion

This study approached a unique way to strengthen the health system by exploring patients' feedback from their experience of hospital stay during treatment for COVID-19. Information technology reinforces the office of the authorities to provide timely and necessary health services to the population in general and specifically during the pandemic.

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