Abstract
BACKGROUND: The COVID-19 pandemic exposed critical gaps in health system preparedness. This study, guided by a critical ecological model, examines the experiences of primary health and community services in Aotearoa New Zealand during the pandemic, focusing on their response to older people and their unpaid caregivers. The study aims to identify effective strategies for health system resilience. It addresses the question, what can we learn from the experiences of organisations supporting older people and caregivers during COVID-19, to prepare for other similar (emergency health) situations? METHODS: A multidisciplinary research team conducted cross-sectional qualitative research through semi-structured telephone interviews with service providers (SPs) delivering primary or community home-based services to older people and caregivers across Aotearoa New Zealand. SPs included national organisations, Māori, Pacific, or rural providers and dementia services. Data were collected between July and October 2020. Notes were taken during interviews using a Rapid Appraisal Procedure grid, which were later revised and validated by participants. Data were analysed using a hybrid deductive-inductive thematic analysis, following COREQ guidelines. RESULTS: Twenty staff (Chief Executive Officers and representatives) from national organisations (N = 4), Māori (N = 3), Pacific (N = 5), rural (N = 4), and regional dementia (N = 4) SPs were interviewed. SPs demonstrated resilience through collaboration, adapting delivery models, and upskilling staff. Key challenges involved inconsistent identification of vulnerable clients, limited access to aged residential care, and barriers relating to digital access which disproportionately affected older adults and staff, and clients in rural areas. Workforce shortages, and unclear public policy concerning travel across regions further complicated service delivery, highlighting the interaction between policy, community, interpersonal, and individual factors. CONCLUSIONS: Aotearoa New Zealand managed COVID-19 effectively, but the pandemic exposed areas for improvement in health system resilience. The government demonstrated absorptive resilience through swift actions, including lockdowns and clear communication, while SPs exhibited adaptive resilience by modifying service protocols. Knowledge gained from this study can contribute to transformative resilience. Long-term strategic changes are necessary to improve emergency planning, such as developing a unified framework to inform a 'Priority List', enhancing workforce capacity, and addressing digital exclusion. These steps can strengthen health system robustness and preparedness for future crises.