Lancet Commission on Primary Health Care -
“Transformation of Primary Health Care in the post-COVID era”
(English version only)
Primary health care (PHC) was established as a global priority in the 1978 Alma-Ata Declaration. Forty years late, the 2018 Astana Declaration on PHC reiterated the call for universal health care coverage for all people across the life cycle, advocating for essential public health functions, community engagement, and a multisectoral approach to health. Since 2018, global influences, compounded by the COVID-19 pandemic, have reshaped the boundaries of PHC, with pressures including ageing populations[1], rising burdens of non-communicable diseases[2] (NCDs), rapid advancements in digital technologies[3], health workforce burnout, shortages and maldistribution[4], increasing numbers of migrants and refugees with diverse health needs[5], rising health concerns related to the environmental impacts of climate change[6], and the continuing emergence of global health emergencies[7]. These challenges compound pre-existing pressures, placing an increasing strain on PHC systems, exacerbating health workforce shortages and poor morale, and increasing community expectations about medical and social care. At the same time, particularly in many low- and middle-income countries (LMICs), a significant portion of people still lack access to essential health services[8]. These challenges have been amplified by the impact of deep-rooted social determinants of health, such as poverty, discrimination, and gender inequality[9].
The COVID-19 pandemic has both highlighted and exacerbated many of these inequities underscoring the urgent need for well-planned global action[10]. COVID-19 has also presented a new opportunity to redefine PHC, based on the contributions of PHC to public health measures and adaptability that was required of health services during the initial years of the pandemic. The significant impacts seen on service access, health-seeking behaviours, and social engagement, coupled with the ongoing economic recovery of global markets, have emphasised the importance of addressing health issues at a population level, and the need to re-evaluate health systems, and particularly the role of PHC as the primary point of contact for the provision of comprehensive and coordinated community-based health services for all people. More work is needed on rethinking the balance and scope of services provided in hospitals and those provided in the community, the greater focus on prevention and health promotion, and ensuring the PHC health workforce in each country is well supported and capable of delivering the health care that communities require and deserve.
Building upon the work of a previous Lancet Commission on financing PHC[11], which emphasised the critical necessity to "invest more and invest better" in PHC through appropriate financial mechanisms, this new Lancet Commission will delve into how the challenges encountered by PHC systems during the COVID-19 pandemic, and the post-pandemic reforms now underway in many countries, will support transformation of PHC to better meet community needs. This Commission will offer recommendations on the reallocation of resources needed to ensure that health service delivery becomes both more equitable and affordable and will highlight how PHC can be harnessed to deliver more person-centred, equitable, and accessible PHC for all. This was repeated in the last two paragraphs.
Since the COVID-19 pandemic began, many medical consultations have shifted to virtual platforms, with telehealth and remote health monitoring being introduced and funded in many countries[12]. The role of family medicine, pharmacies and community health care services has transitioned to support greater home-based care to increase access for those who are frail and homebound[13]. Digital technologies are altering the role of healthcare providers, including the impact of the steady introduction of a growing number of predictive algorithms utilising artificial intelligence (AI)[14] to assist with the automation of aspects of health monitoring, disease screening, and care management. Advances in data integration and communications are creating new opportunities for greater and more effective community engagement and PHC policy development.
This Lancet Commission will synthesise the evidence behind many of these reforms and develop recommendations for changes to make PHC systems more equitable, accessible, and person-centred, aligning with the goals of the 2018 Astana Declaration. The Commission will examine existing and emerging PHC structures and policies, present critical components identified to support successful PHC reforms, and include stakeholder perspectives on current and future PHC developments. Major areas of focus will include:
(1) Improving equity of access to health services;
(2) The reform of person-centred care in the post-COVID era;
(3) Safe and responsible adoption of digital health innovations;
(4) Integration of community-based medical and social care;
(5) PHC workforce reforms; and
(6) PHC preparedness for future health emergencies. The Commission will synthesise evidence from scoping and literature reviews, analyse secondary datasets, and study country-specific case studies to inform its recommendations. The Commission will devise actionable recommendations within each of these focus areas, paired with key metrics to support each country in measuring their successful implementation.
The Commission brings together leading researchers and international experts in PHC, health systems research, health economics, health policy, and healthcare delivery from across the world. The Commission aims to deliver its recommendations by mid-2026. Would it be helpful for you to add how these researchers work together to deliver the commission such as commission meetings? I think it is not just about recommendations only, but also about the analysis. Are there any specific date for the launch to coincide with?
Co-Chairpersons:
Professor William CW Wong,
Clinical Professor & Chairperson of the Department of Family Medicine & Primary Care, LKS Faculty of Medicine,
The University of Hong Kong;
Professor Michael Kidd,
Professor of Global Primary Care and Future Health Systems,
Nuffield Department of Primary Care Health Sciences at the University of Oxford, and
Director of the International Centre for Future Health Systems,
University of New South Wales;
Professor Vivian Lin,
Honorary Professor with the School of Public Health,
LKS Faculty of Medicine, The University of Hong Kong, and
Former Director of Health Systems with the Western Pacific Regional Office of the World Health Organization.
References:
-
Jones, C. H., & Dolsten, M. (2024). Healthcare on the brink: navigating the challenges of an aging society in the United States. Npj Aging, 10(1). https://doi.org/10.1038/s41514-024-00148-2
-
Kruk, M. E., Nigenda, G., & Knaul, F. M. (2015). Redesigning primary care to tackle the global epidemic of noncommunicable disease. American Journal of Public Health, 105(3), 431–437. https://doi.org/10.2105/ajph.2014.302392
-
Neves, A. L., & Burgers, J. (2022). Digital technologies in primary care: Implications for patient care and future research. European Journal of General Practice, 28(1), 203–208. https://doi.org/10.1080/13814788.2022.2052041
-
Džakula, A., Relić, D., & Michelutti, P. (2022). Health workforce shortage – doing the right things or doing things right? Croatian Medical Journal, 63(2), 107–109. https://doi.org/10.3325/cmj.2022.63.107
-
Partyka, O., Pajewska, M., Czerw, A., Sygit, K., Lyubinets, O., Banaś, T., Małecki, K., Grochans, E., Grochans, S., Cybulska, A., Schneider-Matyka, D., Cipora, E., Kaczmarski, M., Sośnicki, K., Dykowska, G., Sienkiewicz, Z., Strzępek, Ł., Bandurska, E., Ciećko, W., . . . Kozlowski, R. (2024). Migration Challenges and their impact on the Primary Healthcare System—A Qualitative research. Healthcare, 12(16), 1607. https://doi.org/10.3390/healthcare12161607
-
Kadandale, S., Marten, R., Dalglish, S. L., Rajan, D., & Hipgrave, D. B. (2020). Primary health care and the climate crisis. Bulletin of the World Health Organization, 98(11), 818–820. https://doi.org/10.2471/blt.20.252882
-
Frieden, T. R., Lee, C. T., Lamorde, M., Nielsen, M., McClelland, A., & Tangcharoensathien, V. (2023b). The road to achieving epidemic-ready primary health care. The Lancet Public Health, 8(5), e383–e390. https://doi.org/10.1016/s2468-2667(23)00060-9
-
World Health Organization: WHO. (2017, December 13). World Bank and WHO: Half the world lacks access to essential health services, 100 million still pushed into extreme poverty because of health expenses. News Release. https://www.who.int/news/item/13-12-2017-world-bank-and-who-half-the-world-lacks-access-to-essential-health-services-100-million-still-pushed-into-extreme-poverty-because-of-health-expenses
-
Alegre, J. C., Sharma, S., Cleghorn, F., & Avila, C. (2024). Strengthening primary health care in low- and middle-income countries: furthering structural changes in the post-pandemic era. Frontiers in Public Health, 11. https://doi.org/10.3389/fpubh.2023.1270510
-
Mheidly, N., Fares, N. Y., Fares, M. Y., & Fares, J. (2022). Emerging Health Disparities during the COVID-19 Pandemic. Avicenna Journal of Medicine, 13(01), 060–064. https://doi.org/10.1055/s-0042-1759842
-
Hanson, K., Brikci, N., Erlangga, D., Alebachew, A., De Allegri, M., Balabanova, D., Blecher, M., Cashin, C., Esperato, A., Hipgrave, D., Kalisa, I., Kurowski, C., Meng, Q., Morgan, D., Mtei, G., Nolte, E., Onoka, C., Powell-Jackson, T., Roland, M., . . . Wurie, H. (2022). The Lancet Global Health Commission on financing primary health care: putting people at the centre. The Lancet Global Health, 10(5), e715–e772. https://doi.org/10.1016/s2214-109x(22)00005-5
-
Tu, K., Kristiansson, R. S., Gronsbell, J., De Lusignan, S., Flottorp, S., Goh, L. H., Hallinan, C. M., Hoang, U., Kang, S. Y., Kim, Y. S., Li, Z., Ling, Z. J., Manski-Nankervis, J., Ng, A. P. P., Pace, W. D., Wensaas, K., Wong, W. C., & Stephenson, E. (2022). Changes in primary care visits arising from the COVID-19 pandemic: an international comparative study by the International Consortium of Primary Care Big Data Researchers (INTRePID). BMJ Open, 12(5), e059130. https://doi.org/10.1136/bmjopen-2021-059130
-
Whitty, J. A., Kendall, E., Sav, A., Kelly, F., McMillan, S. S., King, M. A., & Wheeler, A. J. (2014). Preferences for the delivery of community pharmacy services to help manage chronic conditions. Research in Social and Administrative Pharmacy, 11(2), 197–215. https://doi.org/10.1016/j.sapharm.2014.06.007
-
Rajpurkar, P., Chen, E., Banerjee, O., & Topol, E. J. (2022). AI in health and medicine. Nature Medicine, 28(1), 31–38. https://doi.org/10.1038/s41591-021-01614-0