Strengthening the primary health care response to COVID-19: an operational tool for policymakers

Abstract

Aims: The aim of this paper is to introduce an operational checklist to serve as a tool for policymakers in the WHO European Region to strengthen primary health care (PHC) services and address the COVID-19 pandemic more effectively and to present the results from piloting the tool in Armenia. Backgrounds: PHC has the potential to play a fundamental role in countries’ responses to COVID-19. However, this potential remains unrealized in many countries. To assist countries, the WHO Regional Office for Europe developed a guidance document – Strengthening the Health Systems Response to COVID-19: Adapting Primary Health Care Services to more Effectively Address COVID-19 – that identifies strategic actions countries can take to strengthen their PHC response to the pandemic. Based on this guidance document, an operational checklist was developed to serve as a tool for policymakers to operationalize the recommended actions. Methods: The operational checklist was developed by transforming key points in the guidance document into questions in order to identify potentially modifiable factors to strengthen PHC in response to COVID-19. The operational checklist was then piloted in Armenia in June 2020 as part of a WHO mission to provide technical advice on strengthening Armenia’s PHC response to COVID-19. Two WHO experts performed semi-structured, face-to-face interviews with nine key informants (both facility managers and clinical staff) in three PHC facilities (two in a rural and one in an urban area). The data collected were analyzed to identify underlying challenges limiting PHC providers’ ability to effectively and efficiently respond to COVID-19 and maintain essential health services. Findings: The paper finds that making adjustments only to health services delivery will be insufficient to address most of the challenges identified by PHC providers in the context of COVID-19 in Armenia. In particular, strategic responses to the pandemic were missed, due, in part, to the absence of COVID-19 management teams at the facility level. Furthermore, the absence of PHC experts in Armenia’s national pandemic response team meant that health system issues identified at the facility level could not easily be communicated to or addressed by policymakers. The checklist therefore helps policymakers identify critical challenges – at both the facility and health system level – that need to be addressed to strengthen the PHC response to the COVID-19 pandemic.

Integrated use of laboratory services for multiple infectious diseases in the WHO European Region during the COVID-19 pandemic and beyond

“…The crisis caused by the COVID-19 pandemic has documented the importance of and the need to strengthen the institutional capacity and governance mechanisms of the ministries of health in many countries [ 40 ]. While this may be politically difficult and time-consuming, it should not be a barrier to carrying out needed reforms.…”

Impact of COVID-19 on selected essential public health services – lessons learned from a retrospective record review in the Free State, South Africa

“…In Poland, measures taken to ensure the stability of PHC functioning during the COVID-19 pandemic highlighted a signi cant need to introduce organisational and nancial changes in PHC to improve the uidity and effectiveness of the actions taken by PHC staff [36]. In Armenia, researchers found that adjusting only health services delivery was insu cient in addressing the challenges identi ed by PHC providers in the context of COVID-19 [37]. Furthermore, the absence of PHC experts in Armenia's national pandemic response team meant that health system issues identi ed at the facility level could not easily be communicated to or be addressed by policymakers.…”

Primary care and COVID-19

“…Hence, they suggest strengthening the surveillance function of primary care. Another interesting paper under this category is a development paper by Johansen et al (2021). They explored an operational tool for policymakers developed by WHO, and its pilot results are very promising for identifying the critical challenges that need to be addressed for an efficient response to COVID-19.…”