Building Resilient Health Systems Through Community Voices: Insights from Delhi During COVID-19

The COVID-19 pandemic exerted unique challenges to our health systems, particularly in urban settings with diverse and densely populated communities. This study explores how primary healthcare services in Delhi's South and West districts responded to these challenges. Objective: This study aimed to examine the resilience of health systems in ensuring the availability with a focus on community-level experiences and perceptions. Methods: A cross-sectional community-based survey was conducted among 402 adult household residents using a structured questionnaire. Results: While initiatives such as Mohalla Clinics played a crucial role in sustaining healthcare access, over 50% of respondents experienced challenges in accessing services, primarily due to the repurposing of healthcare facilities for COVID-19 response. Despite these barriers, 63.4% of respondents reported receiving necessary care, suggesting a degree of systemic resilience. However, communication emerged as a major concern, with 43.3% of participants not receiving timely information about service changes. Satisfaction with communication from healthcare authorities and providers was mixed. Significant disparities in information access were observed across socio-demographic groups, particularly among the differently abled, less educated, and marginalized populations. Although community support was perceived as important, actual collaboration between communities and healthcare providers remained limited. Conclusions: The findings underscore the urgent need to develop community-centric and resilient health systems. Key policy recommendations include strengthening primary healthcare infrastructure, institutionalizing emergency preparedness, adopting inclusive and multi-channel communication strategies, promoting meaningful community engagement, and targeting support for vulnerable groups.