Primary health care in the context of the COVID-19 pandemic in 10 South-East Asian countries: a cross-case synthesis with lessons for future health systems strengthening.

INTRODUCTION: Strengthening primary health care (PHC) in the WHO South-East Asia Region is key to addressing evolving health needs, including the high burden of non-communicable diseases and emerging public health threats within rapidly changing demographic, climatic and geopolitical contexts. Between 2021 and 2023, 10 case studies were conducted to examine PHC in the context of the COVID-19 pandemic. A cross-case regional synthesis aimed to identify key lessons for PHC strengthening from the pandemic experience.

METHODS: The synthesis involved comparative analysis using an analytic framework comprising three PHC components framed by the Astana PHC vision: integrated primary care and essential public health functions; multisectoral policy and action; and community empowerment. The case studies used document review and consultations with national PHC experts and policymakers.

RESULTS: Integrated primary care: The pandemic crisis prompted health workforce mapping to meet demand, well-coordinated task sharing and shifting between facilities and organisations, and new technology-enabled platforms and models of care to improve healthcare access and continuity. Multisectoral collaboration: Multisectoral PHC reforms included expanding the role of multiple sectors to implement public health measures, including testing, contact tracing, border controls and quarantine. New or expanded multiagency and multilevel collaborations involved different government departments coordinating responses across health and other sectors. Community empowerment: Active and engaged communities, and community trust in government services and the health system, contributed to positive responses to government-issued messaging and effective mobilisation of community resources. Community engagement platforms created space for community participation in health care decision-making.

CONCLUSION: Findings demonstrate how PHC principles remain relevant not only for responding to public health emergencies, but also for improving and promoting health system resilience. Findings highlight opportunities to further examine and implement health workforce, community engagement, digital technology and governance strategies to meet evolving epidemiological and climate-related health challenges facing the Region.