Factors Influencing COVID-19 Testing: A Qualitative Study in Bhutan

Abstract Background: The COVID-19 pandemic has reaffirmed an all-knowing truth – that health is central in the 2030 Sustainable Development Agenda. To fully meet its associated challenges, global campaigns edge countries to implement strategies addressing COVID-19, including measures to scale-up testing. This study explored factors that influenced COVID-19 testing in Bhutan. It is envisioned findings could serve as a roadmap to effectively respond to COVID-19 and future outbreaks, particularly in low- and middle-income countries.Methods: The study employed an exploratory qualitative design. Data collection methods included interviews with key informants with a purposively selected sample of 20 participants and documentary review. A hybrid approach of inductive and deductive coding and theme development was conducted to analyze findings. A tailored version of the WHO Health System Framework incorporating the Essential Public Health Function was used to guide data interpretation.Results: Improved political will through the influence and leadership of the Royal King of Bhutan played a crucial role in raising attention to the problem, and provision of adequate financial and technical relief to ensure that all people irrespective of their socioeconomic status do not pay to get tested of COVID-19. Further, a combination of multifaceted factors such as: the whole of society approach to health; Bhutan’s pragmatic tactic in delivering on the promise of universal health coverage through primary health care strategy; the use of information technology for awareness creation and improving surveillance system; all fast-tracked COVID-19 testing service delivery. Conclusion: Bhutan’s success relied greatly on multi-sectoral and systems approach during policy design, implementation and monitoring, and active collaborative efforts involving consultation and engagements with a broad range of local (community members), national and global actors accelerated COVID-19 testing. These efforts were made possible through improved health governance and leadership at the highest level in the country.