Visualising the impacts of COVID-19 on health service delivery during the height of the pandemic in Papua New Guinea; a photovoice study

In Papua New Guinea (PNG), like other countries, health service access, engagement and the provision of primary health and public health infectious disease care changed dramatically during the height of the COVID-19 pandemic. To understand this disruption a photovoice study was conducted with community members (n = 12), clients of health services (n = 10) and healthcare workers (n = 5) and in six provinces in PNG during the third and largest wave of COVID-19 in country. The key findings from this study highlight how COVID-19 fear, and absence and avoidance of health facilities during COVID-19 directly influenced how healthcare was accessed and provided during COVID-19 in PNG. Spatiality, specifically the distance to service, to each other, and to treatment and care were directly influenced by health facility changes, service provision reconfigurations, and fear of COVID-19. This fear and these changes were presented through stark, but symbolic, images of health facilities empty and devoid of clients and healthcare workers. People struggled to get to health facilities due to a lack of transport, and when they could entry was restricted by locked gates and doors, and movement across health facility spaces was controlled by security. This article follows the varying, but mostly similar, experience of healthcare works and clients with respect to health setting spatiality and its important influence in providing or accessing care during COVID-19 – providing important lessons for the management of health facilities for future health emergencies and pandemics. • Health service access, engagement and delivery changed dramatically during COVID-19. • Avoidance, absence and absenteeism featured prominently due to a fear of COVID-19. • Changing nature of health facility space created separation and distance to care. • Visual experience symbolically narrated through empty spaces, closed gates and doors. • Important lessons for existing and future global health emergencies.