BACKGROUND: The COVID-19 pandemic has had an important impact on healthcare services globally and in Mozambique. In June 2021, a cohort study (“COVid19-hIV”) was initiated in three provinces in Mozambique, evaluating the COVID-19 pandemic’s impact on people living with HIV, healthcare workers and on the healthcare system. It included assessments of health facility (HF) fidelity to the national infection prevention and control (IPC) program and preparedness for future COVID-19 outbreaks.
METHODS: Between August 2021-November 2022, trained study staff performed serial assessments (with intervals of 2 to 8 months) of the preparedness and fidelity to IPC/COVID-19 guidelines at three selected urban HF in three provinces (Maputo City, Inhambane, Zambézia). The assessment tool, adapted from a Ministry of Health-approved checklist, included 12 sections from 4 key areas (general aspects, aspects per service, COVID prevention measures, material/waste management). Items of each area were graded according to the proportion of standards met (minimum recommended 80%). Descriptive analysis was done using Microsoft Excel.
RESULTS: Eleven assessment rounds were completed. Adherence to IPC/COVID-19 standards ranged between 62.0% to 86.4%, with the highest score in the HF in Inhambane and the lowest in the Zambézia HF. All sites, except Zambezia, showed improvement over time (see Table). Improvement between the first and last rounds was primarily seen in the following assessment components: compliance with prevention measures among healthcare staff and management measures such as making available protective personal equipment, hygiene material and consumables, sterilization of used materials, infectious waste management and preparedness to manage persons with COVID-19.

Table: IPC assessment results per site.

	Maputo City		Zambezia		Inhambane
General aspects Human Resources (24 items) Management (16 items) Administrative aspects (18 items) Environmental measures (9 items)	Baseline (R1) 83.3% 63.6% 33.3% 33.3%	Endline (R4) 100.0% 84.6% 33.3% 100.0%	Baseline (R1) 95.8% 68.8% 50.0% 33.3%	Endline (R3) 16.7% 75.0% 33.3% 33.3%	Baseline (R1) 87.5% 75.0% 88.9% 88.9%	Endline (R4) 95.8% 93.8% 100.0% 100.0%
COVID-19 prevention measures COVID19 outbreak preparedness (5 items)	100.0%	100.0%	40.0%	100.0%	40.0%	100.0%
Aspects per service area Outpatient clinic (5 items) Inpatient ward (5 items) Laboratory (10 items)	80.0% 60.0% 100.0%	80.0% 80.0% 90.0%	60.0% 60.0% 90.0%	60.0% 60.0% 80.0%	100.0% 0.0% 90.0%	100.0% 0.0% 90.0%
Material and waste management Removing personal protective equipment (3 items) Management of hospital linen (7 items) Material processing and sterilization (7 items) Waste management (7 items)	100.0% 100.0% 28.6% 85.7%	66.7% 71.4% 85.7% 71.4%	0.0% 100.0% 71.4% 71.4%	0.0% 100.0% 100.0% 85.7%	66.7% 57.1% 28.6% 57.1%	100.0% 100.0% 71.4% 85.7%
Average	72.3%	80.3%	61.7%	62.0%	65.0%	86.4%

CONCLUSIONS: The improvement in adherence to national IPC/COVID-19 guidelines observed in two of the three facilities participating in the COVIV study, reaching the minimal recommended standard over the evaluation period, suggesting an effort by the healthcare system to more successfully implement IPC guidelines including pandemic-related preparedness. However, the varying levels of improvement observed indicates a need for site-specific monitoring and support for IPC implementing guidelines.

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