Resilience of primary healthcare system across low- and middle-income countries during COVID-19 pandemic: a scoping review

Abstract

Introduction Globally, the coronavirus disease 2019 (COVID-19) pandemic tested the resilience of the health system and its shock-absorbing capacity to continue offering healthcare services. The available evidences does not provide comprehensive insight into primary health care (PHC) system functioning across low- and middle- income countries (LMICs) during the pandemic. Therefore, the objective of this scoping review was to generate evidence on the resilience of PHC systems in LMICs during the COVID-19 pandemic. Methods A scoping review was carried out utilizing an iterative search strategy using the National Library of Medicine (NLM) and the WHO COVID-19 electronic databases. Data from the identified studies in LMICs were charted in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist in the first step. The analysis framework was adapted and modified using COVID-19 and health systems resilience framework developed by Sagan et al., Blanchet et al., and the WHO position paper on ‘Building health systems resilience for universal health coverage and health security during the COVID-19 pandemic and beyond’. A total of 26 documents were included on the basis of predefined eligibility criteria for our analysis. Results Our review explored data from 44 LMICs that implemented strategies at the PHC level during the COVID-19 pandemic. Most of the LMICs developed national guidelines on sexual, reproductive, maternal, newborn, child, and adolescent health (SRMNCAH). Most of the countries also transformed and reoriented PHC service delivery by introducing digital healthcare services to continue essential services. Task shifting, task sharing, and redeployment of retired staff were some frequently adopted health workforce strategies adopted by most of the countries. Only a few of the countries demonstrated the availability of necessary monetary resources to respond to the pandemic. Conclusions The functionality of the PHC system during the COVID-19 pandemic was demonstrated by a variety of resilience strategies across the six building blocks of the health system. To strengthen PHC resilience, we recommend strengthening community-based PHC, cross-sectoral collaboration, establishing surveillance systems, capacity building in financial risk planning, and investing in strengthening the digital healthcare system.

Interventions to maintain essential services for maternal, newborn, child, and adolescent health during the COVID-19 pandemic: A scoping review of evidence from low- and middle-income countries

“…Summing up, our findings add to the body of existing evidence and joint initiatives on actions to maintain MNCAH essential services in response to COVID-19 in LMICs [ 8 , 49 - 51 ]. We extend the literature by incorporating a synthesis of 32 interventions that shed light on problem identification, solution implementation, and evaluation during the COVID-19 pandemic in LMICs, hence these findings can contribute to the preparedness for future pandemics or health crises.…”

Evidence of health system resilience in primary health care for preventing under-five mortality in Rwanda and Bangladesh: Lessons from an implementation study during the Millennium Development Goal period and the early period of COVID-19

“…For example, innovation and adaptation to unique barriers during COVID-19, including lockdown and movement restrictions, likely led both countries (and many other places) to more rapidly expand their use of telemedicine and digital health than likely would have happened otherwise. Adoption of digital health and telehealth was already under way, albeit more slowly, in many parts of the world before the COVID-19 pandemic [ 27 ], and accelerated because of it [ 28 , 29 ].…”

Concurrent emergencies: overlapping Salmonella and COVID-19 concerns in public health strategies and preparedness

“…The healthcare system had significant difficulty in properly treating numerous health concerns due to the new coronavirus, resulting in a temporary halt of regular healthcare services. In Pakistan, several crucial primary health care services were discontinued during the COVID-19 epidemic, resulting in millions of children being deprived of polio vaccination ( 32 ). Uganda and Sierra Leone had similar reductions in vaccination rates, with decreases ranging from 21 to 66% and 18 to 29%, respectively.…”

“…The COVID-19 pandemic has had a substantial impact on healthcare systems, not just in low- and middle-income nations but also in higher-income regions like as Europe and the United States ( 30 , 32 ). European countries showed considerable diversity in their approaches to healthcare practices during the COVID-19 pandemic, but overall, they successfully implemented appropriate measures to tackle this problem ( 34 , 35 ).…”