Expanding and Improving Healthcare Capacity in San Pedro Sula, Honduras
Lessons from the COVID-19 Pandemic
Introduction & Context
Early in the pandemic, the Honduran Ministry of Health (MOH) recognized the urgent need to expand its healthcare capacity by opening additional care facilities or triage centers to serve as temporary hubs for testing and intermediate care and treatment for COVID-19 patients. San Pedro Sula, one of the country’s largest metropolitan regions, opened three such centers, collectively capable of handling 22,400 potential COVID-19 cases monthly.
These triages provided a vital short-term boost to the region’s healthcare capacity and patient management, but funding constraints resulted in the closure of two centers by the end of 2021. So, in early 2022 there was only one center left with the capacity to care for 7,600 COVID-19 cases.
Adding to the problem, San Pedro Sula health officials lacked timely and accurate data on their COVID epidemic, as none of the cases data was reported in national systems. This was due to a lack of integration between regional alert systems and private laboratories and the official Health Surveillance System (SVS), leading to an incomplete picture of the regional COVID-19 situation for local health officials and disrupting the monitoring and response to outbreaks in a targeted manner.
Identifying Obstacles & Strategies
Knowing that the last remaining triage system would close in November 2022, metropolitan health authorities began to funnel COVID-19 patients to four health facilities in its network, increasing response capacity by 42% (5,600). This helped alleviate pressure on the system, allowing Data.FI and a consortium of local partners and government teams in San Pedro Sula to help build the region’s healthcare capacity and improve its surveillance data integration.
In July 2022, a major step was taken in identifying the Miguel Paz Barahona Health Center (MPB) as an ideal facility for expanded COVID-19 care and sample collection. The potential was clear—MPB was the region's busiest healthcare facility and served as the primary center of reference.
However, only 8% of MPB’s healthcare staff were trained in essential aspects of COVID-19 response, such as infection control, case notification, and epidemiological record keeping. The center also experienced space constraints, labor union opposition to treating COVID-19 patients, and a shortage of on-site microbiologists to collect COVID-19 samples.
At the same time, Data.FI, working with the MOH and local stakeholders, conducted a root cause analysis to identify the factors contributing to a lack of data integration between San Pedro Sula and national surveillance systems.
The analysis found five core problems:
Lack of System Analysis: The health information system's underlying structure was not thoroughly assessed.
Inadequate Monitoring: The alert response system was not closely monitored for discrepancies.
Limited Coordination: Opportunities for improvement were missed due to insufficient coordination among stakeholders.
Training Gaps: Many users lacked proper training in the utilization of the SVS.
Exclusion of Private Laboratories: The SVS did not incorporate notifications from private laboratories.
The Intervention
Simply by bringing together the relevant stakeholders and pouring over the problems in a data-driven manner, San Pedro Sula officials were well placed to pursue targeted solutions. Their efforts focused across four key areas:
Training:
Twenty doctors received training in case notification and proper COVID-19 patient care.
Infection control measures were emphasized, and a patient flow system based on case severity was established.
Laboratory Setup:
A suitable physical space was identified and transformed into a COVID-19 patient care and sample collection area.
Two microbiologists were assigned to extend sample collection hours, from 7:00 am to 5:00 pm.
Labor Union Engagement:
Ongoing dialogue and cooperation with labor unions resulted in agreements to enable COVID-19 care at MPB.
Enhancing Personnel Competencies:
Healthcare staff at MPB underwent training in COVID-19 patient care, accurate case notification, and proper epidemiological record-keeping.
In parallel to these efforts, several strategies were devised to foster a more robust and well-integrated health surveillance system:
System Analysis: A meticulous examination of the COVID-19 information system was conducted, contrasting it with the alert response subsystem. This revealed disparities in reporting between healthcare establishments within the network.
Enhanced Coordination: Stakeholders made it a mission to collaborate, conducting courtesy visits to healthcare establishments and private laboratories. This fostered better coordination for continuous system improvement, and it became a shared responsibility among the stakeholders.
Training and Adaptation: Healthcare workers received training in navigating the COVID-19 information system, accompanied by technical support for improved reporting. Focal points from both sides were designated to provide ongoing assistance.
Impact & Conclusions
Improving healthcare capacity is always complicated and often frustratingly slow. But the collective efforts in San Pedro Sula paid off. By Oct. 21, 2022, COVID-19 care at MPB was officially launched, boosting the region’s COVID-19 response capacity
by 42%.
And the region also saw a remarkable transformation in COVID-19 data integration, as the testing results of the private laboratories and regional alert systems now fed into the national SVS system, integrating distinct systems so they could operate as a unified diagnostic test result registry. This enhancement now allows decision makers to leverage more complete data for a more accurate and nuanced analysis of the epidemiological situation in the regions.
In turn, this had led to a marked improvement in the health authorities’ capacity to make informed decisions and implement targeted interventions to effectively combat rapidly evolving epidemics.
The success story of San Pedro Sula highlights the power of adaptability and collaboration in healthcare. It shows that with determination, training, and teamwork, healthcare facilities can rise to meet unprecedented challenges, ultimately benefiting the health and well-being of their communities.
Moreover, the improvements in the region go beyond COVID—by taking pressure off other areas of the health system, resources, personnel, and attention can be better allocated throughout regional and national networks. This, in turn, can create positive feedback loops which leave countries better prepared to deal with crises when they arise.
The example of San Pedro Sula suggests that data-driven teams with locally responsive technical support can enact rapid health system strengthening and capacity building— even in low-resource contexts.