To Explore the Positive Adaptive and Transformative Changes in the Health System and Community During the COVID-19 Pandemic in Puducherry

Mahalakshmy Thulasingam; Zunatha Banu; K. C. Premarajan; Mahadevan Duraiswamy; Robert Rajasekar A; Nanda Kishore

doi:10.5530/ijcep.2025.12.4.29

Mahalakshmy Thulasingam Department of Preventive and Social Medicine, JIPMER, Puducherry
Zunatha Banu Department of Preventive and Social Medicine, JIPMER, Puducherry
K. C. Premarajan Department of Preventive and Social Medicine, JIPMER, Puducherry
Mahadevan Duraiswamy Department of Preventive and Social Medicine, JIPMER, Puducherry
Robert Rajasekar A Department of Preventive and Social Medicine, JIPMER, Puducherry
Nanda Kishore Department of Surgery, JIPMER, Puducherry

DOI: https://doi.org/10.5530/ijcep.2025.12.4.29

Keywords: COVID-19, Health system strengthening, Leadership, Positive adaptations, Puducherry, Qualitative research

Abstract

Background and Aim: The COVID-19 pandemic placed substantial pressure on health systems, but it also created opportunities for positive organisational change. While most studies from India have focused on challenges, limited evidence describes the beneficial adaptations that strengthened routine systems during the pandemic. This study aimed to explore the positive adaptive and transformative changes in the health system and community during COVID-19 in Puducherry. Methods: A qualitative study was conducted using a phenomenological approach. Eight key informant interviews and three focus group discussions were carried out across primary, secondary and tertiary care facilities in Puducherry in 2021. Participants were purposively selected using maximum variation sampling. Data were collected using semi-structured guides mapped to health system building blocks, audio-recorded, transcribed verbatim and analysed using a hybrid inductive–deductive approach guided by the Health Systems Dynamics Framework. Themes were validated through investigator triangulation and participant confirmation. Results: Ten major thematic areas emerged: leadership and governance, human resources, infrastructure and supplies, financing, knowledge and information, service delivery, population behaviour, context, values and principles, and outcomes. Participants described stronger leadership presence, improved teamwork, rapid decision-making and effective intersectoral collaboration. Infrastructure and digital platforms expanded quickly, including oxygen plants, diagnostics, telemedicine and digital documentation. Service delivery became flexible through home-based care, teleconsultation and vaccination outreach. Community trust in government services improved, and adherence to preventive behaviours increased. Conclusion: The COVID-19 pandemic impelled positive changes in Puducherry’s health system, including stronger leadership, better coordination, improved infrastructure, digitalisation, and increased community engagement. Sustaining these improvements can strengthen routine services and emergency preparedness.