Integrating public health and primary care: the response of six Asia–Pacific countries to the COVID-19 pandemic

Abstract

INTRODUCTIONStrong primary health care (PHC) is the cornerstone for universal health coverage (UHC), reinforced by the Astana Declaration of 2018 1 as the best means to achieve an inclusive, effective, and efficient approach to enhance people's physical and mental health and social wellbeing.PHC includes both public health (PH) and primary care (PC). A highly performing PC system provides access to first-contact, patient-centred care that is comprehensive, and continuous over time while coordinating services. 2 The World Health Organization (WHO) resolution on the primary health care draft operational framework, approved by the WHO Executive Board in January 2020, notes that a key lever is 'Models of care that promote high-quality, people-centred primary care and essential public health functions as the core of integrated health services throughout the course of life.' 3 Effective PHC therefore requires a coherent integration of PH and PC services, which involves a number of actions that include comprehensive PC services to a defined population, improved communication between PH and PC providers, knowledge sharing between individual-and population-focused health services, and strengthened and coordinated PC and PH surveillance functions. 4 The year 2020 saw the advent of the COVID-19 pandemic, and now more than ever PH and PC measures are needed to form the foundation of the crisis response and provide continued health care to all those suffering the ongoing direct and indirect effects of this health crisis. There is a need for adaptation, flexibility, and innovation, with task shifting in the workforce to mount the response, and a move to telehealth where possible for provision of non-COVID-19 care. 5 We report on the PHC approaches of six different countries in the Asia-Pacific region (Fiji, Japan, Macao (a Special Administrative Region of China), New Zealand (NZ), Philippines, and Thailand) and describe the degree to which their PH and PC systems have mounted an integrated response to the spread of COVID-19 in their country. Our analysis is based on the data provided by expert academic family doctors, using PHC framework developed by the World Organization of Family Doctors (WONCA) Working Party on Research. Our aim is to identify the relative strength of PHC and integration of PH and PC in each country, and relate this to their response to COVID-19. CHARACTERISTICS OF PRIMARY CARE IN THE SIX COUNTRIES BEFORE COVID-19Key characteristics of PHC in the six countries are outlined in Table 1. Gatekeeping was well established in NZ, Macao, Thailand, and Fiji. In Thailand and Macao, this was largely through the public sector, whereas private GP clinics generally provided this role in NZ and Fiji. In all countries, governments funded PH, but there were different funding arrangements for PC services that range from out-of-pocket through blended to government-funded models. PC services were largely delivered by interdisciplinary teams in coordination with other community-based providers in Thailand, Macao, NZ, Philippi...

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