Self-organising in primary care in the first wave of Covid-19: a qualitative study conducted in Wallonia, Belgium

Background
The first wave of the Covid-19 pandemic demanded rapid adaptation to the delivery of routine, and covid-19 related, primary care. This study aims to describe the adaptations implemented at local level in primary healthcare centres in Wallonia, Belgium in response to the first wave of the evolving crisis.

Questions/Methods
Qualitative data were collected in the form of weekly semi-structured interviews with general practitioners, nurses and receptionists. Interviews focussed on evolving changes taking place in their practices between April and June 2020. The participants worked at three community health centres in the province of Liège, Belgium. Data were analysed using thematic content analysis through the lens of a complex adaptive system model focussing on the level of self-organisation.

Results
Nine participants participated in the study and 90 interviews were conducted. Adaptations described by the participants included the transition from in-person to telephone consultations, managing protective clothing stock, setting up testing procedures, following up on chronic patients, collaboration with pharmacists, specialists and local government actors.

Discussion
The results describe the way primary care in Wallonia, Belgium has had to adapt to the fast-moving crisis at a time when little information or directives were available. Using a complex adaptive system lens allows a deep analysis of the way self-organising at the local level in a highly decentralised system took place and contributes to our understanding of health system resilience and pandemic management as a whole and at the local level in Wallonia, Belgium.