Primary healthcare in the time of COVID-19: breaking the silos of healthcare provision

Health services have not prevented the loss of 4 million lives3 and the loss of livelihoods of million more people.4 5 This situation also highlights the necessity of addressing health improvements in the context of the social determinants of health and governance.6 7 On the 40th anniversary of the Alma Ata Declaration in 2018, member countries of WHO signed the Astana Declaration.8 The declaration focuses on promoting PHC through (a) providing primary care services throughout the life course, (b) ensuring equity for healthcare, (c) addressing the social determinants of health, and (d) empowering citizens and communities.9 To pursue these objectives in the post-COVID-19 era, the way forward is to integrate public health systems and health services to include: clinical care, surveillance and rapid response to prevalent infectious and emerging diseases, a population health approach and a recognition of improved health as both a result of the social determinants of health and a social goal that requires multisectoral action. PHC emphasised the need for: an integrated approach of preventive, curative and promotive services for both the community and the individual; for interventions to be undertaken at the most peripheral and accessible level of the health services by the workers most simply trained for this activity; for other echelons of services to be designed in support of the needs of the peripheral level; and for PHC services to be fully integrated with the services of the other non-health sectors involved in community development.11 Despite this vision, PHC has focused on health service delivery within static health units often with a sole provider and the ‘command and control’ approach to disease control.12 It fossilised the ability of most governments to provide an adequate response to the COVID-19 pandemic. First is the cost of curative care for which the most part is provided in hospitals and health centres and the cost of medicines for cure.13 WHO found that based on a study of 300 cases, hospitals could achieve the same outcomes for 15% less spending. [...]allocation of health service provision does not maximise the possibility of critical health improvements for the population.