Edelman Alexandra, Marten Robert, Dhillon Ibadat, Suresh Adithyan Geetha, Thamarangsi Thaksaphon, Grundy John, Jhalani Manoj, Rasanathan Kumanan
Menzies School of Health Research, Charles Darwin University, Alice Springs/ Darwin, Northern Territory, Australia
College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.
BMJ Glob Health. 2025 Jun 30;10(Suppl 2):e018076. doi: 10.1136/bmjgh-2024-018076.
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.
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.
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 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. 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.
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.
加强世界卫生组织东南亚区域的初级卫生保健（PHC）是应对不断变化的卫生需求的关键，这些需求包括在快速变化的人口、气候和地缘政治背景下，非传染性疾病的高负担以及新出现的公共卫生威胁。2021年至2023年期间，开展了10个案例研究，以审视新冠疫情背景下的初级卫生保健。一项跨案例区域综合分析旨在从疫情经历中确定加强初级卫生保健的关键经验教训。
该综合分析采用了一个分析框架进行比较分析，该框架由阿斯塔纳初级卫生保健愿景构建的三个初级卫生保健组成部分构成：综合初级保健和基本公共卫生职能；多部门政策与行动；以及社区赋权。案例研究采用了文件审查以及与国家初级卫生保健专家和政策制定者的磋商。
疫情危机促使进行卫生人力规划以满足需求，实现设施和组织之间协调良好的任务分担与转移，并采用新技术支持的平台和护理模式以改善医疗服务的可及性和连续性。多部门初级卫生保健改革包括扩大多个部门在实施公共卫生措施方面的作用，这些措施包括检测、接触者追踪、边境管制和隔离。新的或扩大的多机构和多层次合作涉及不同政府部门协调卫生及其他部门的应对措施。积极参与的社区以及社区对政府服务和卫生系统的信任，有助于对政府发布的信息做出积极回应，并有效调动社区资源。社区参与平台为社区参与医疗保健决策创造了空间。
研究结果表明，初级卫生保健原则不仅在应对突发公共卫生事件方面仍然具有相关性，而且在改善和提升卫生系统韧性方面也具有相关性。研究结果突出了进一步审视和实施卫生人力、社区参与、数字技术和治理战略的机会，以应对该区域面临的不断变化的流行病学和与气候相关的卫生挑战。
