Healthcare workers beliefs, practices and experiences regarding the COVID-19 pandemic and resulting governance from preparedness and response plans in Faranah, Guinea.

There is a growing interest in the implementation of people-centered components within outbreak preparedness and response plans and their resulting governance. Information on this topic still remains scarce, in particular in settings like Guinea, West Africa. We draw from 21 qualitative interviews with healthcare workers in the context of COVID-19 from the Faranah Regional Hospital in Guinea to explore pandemic preparedness and response adherence as well as its corresponding senses of vulnerability and risk, information sources, perceived information reliability, associated rumors and previous outbreak experiences. To achieve a broader analysis, we make use of the "therapeutic landscape" concept which conceives health provision as a process constructed through practices, beliefs and experiences. A theme articulated across interviews was an overabundance of information, which caused confusion mainly due to rumors and a lack of trust in the countrys health system. Initial fear gradually diminished due to the diseases low mortality rate in the country. HCWs described preparedness enforcement in the city of Faranah that started strong but lightened overtime. This waning of enforcement marked a difference between the city and the hospital. HCWs appraised the first positive case declaration in the city as the most significant moment, followed by a strong community reaction hindering the pandemic governance. We conclude that preparedness and response plans need to better socially situate their interventions and devote more structural efforts into incorporating the social landscapes of a disease and an outbreak. Incorporation of these social landscapes facilitates understanding of operational barriers to their people-centered approaches. Responses should therefore comprehend 1) hospitals as applying different pandemic understandings transcending biomedical and scientific orders and 2) HCWs as portraying shifting pre-existing identities leading to marked in-/out-group distinctions directly influencing healthcare, risk perception as well as information and rumors management.