Аннотация
Relevance. The COVID-19 pandemic placed unprecedented pressure on hospital systems, exposing structural vulnerabilities in resources, governance, and workforce capacity. In Kazakhstan, particularly in Almaty, major system reorganizations, including modular COVID-19 hospitals, were implemented; however, qualitative data on healthcare managers’ views on their effectiveness and preparedness for future challenges remain limited. Objective: This study aims to explore healthcare managers’ experiences of hospital functioning during the COVID-19 pandemic in Almaty, assess the perceived effectiveness of implemented measures, and identify key factors influencing preparedness and resilience for future pandemics. Materials and Methods. A qualitative study design was employed using semi-structured in-depth interviews. Sixteen healthcare managers (5 senior-level and 11 mid-level) from multidisciplinary hospitals in Almaty were recruited through purposive sampling via professional WhatsApp groups. Data were collected in the first quarter of 2026 through online interviews lasting 15-20 minutes. Interviews were audio-recorded, transcribed verbatim, and analyzed using inductive thematic analysis. Results. Seven interrelated topics were identified: (1) hospital overload as a manifestation of systemic unpreparedness; (2) resource constraints, with oxygen infrastructure as a critical bottleneck; (3) modular COVID-19 hospitals as a key adaptive strategy; (4) the importance of timely and coordinated organizational responses; (5) workforce well-being as a core determinant of system performance; (6) partial preparedness for future pandemics; and (7) the need for an integrated and adaptive preparedness system. Modular hospitals were perceived as a turning point in the pandemic response, improving capacity and system coordination. Despite improvements, persistent challenges related to workforce shortages, governance, and digital infrastructure remain. Conclusion. Hospital system performance during the COVID-19 pandemic was shaped by the interaction of resources, governance, and workforce resilience. The findings highlight the need for integrated and adaptive health system approaches, including scalable infrastructure, strengthened workforce policies, improved governance, and enhanced digital systems, to ensure preparedness for future public health emergencies.