The impact of the Covid-19 pandemic on primary health care utilization: an experience from Iran

Rezapour, Ramin; Dorosti, Abbas Ali; Farahbakhsh, Mostafa; Azami-Aghdash, Saber; Iranzad, Ilnaz

doi:10.1186/s12913-022-07753-5

Cited by 32 publications

(32 citation statements)

References 33 publications

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“…The COVID - 19 pandemic and the restrictions placed as part of controlling the pandemic affected the PHC service delivery globally [ 53 , 54 ] as in Kerala’s newly introduced FHC program. However, insofar as the FHC program itself was built on a strong edifice of reforms, backed by community participation and political will, the state had some early success in managing the pandemic [ 55 ].…”

Section: Discussionmentioning

confidence: 99%

Of primary health care reforms and pandemic responses: understanding perspectives of health system actors in Kerala before and during COVID-19

et al. 2023

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Background In 2016, the Government of the southern Indian state of Kerala launched the Aardram mission, a set of reforms in the state’s health sector with the support of Local Self Governments (LSG). Primary Health Centres (PHCs) were slated for transformation into Family Health Centres (FHCs), with extended hours of operation as well as improved quality and range of services. With the COVID-19 pandemic emerging soon after their introduction, we studied the outcomes of the transformation from PHC to FHC and how they related to primary healthcare service delivery during COVID-19. Methods A qualitative study was conducted using In-depth interviews with 80 health system actors (male n = 32, female n = 48) aged between 30–63 years in eight primary care facilities of four districts in Kerala from July to October 2021. Participants included LSG members, medical and public health staff, as well as community leaders. Questions about the need for primary healthcare reforms, their implementation, challenges, achievements, and the impact of COVID-19 on service delivery were asked. Written informed consent was obtained and interview transcripts – transliterated into English—were thematically analysed by a team of four researchers using ATLAS.ti 9 software. Results LSG members and health staff felt that the PHC was an institution that guarantees preventive, promotive, and curative care to the poorest section of society and can help in reducing the high cost of care. Post-transformation to FHCs, improved timings, additional human resources, new services, fully functioning laboratories, and well stocked pharmacies were observed and linked to improved service utilization and reduced cost of care. Challenges of geographical access remained, along with concerns about the lack of attention to public health functions, and sustainability in low-revenue LSGs. COVID-19 pandemic restrictions disrupted promotive services, awareness sessions and outreach activities; newly introduced services were stopped, and outpatient numbers were reduced drastically. Essential health delivery and COVID-19 management increased the workload of health workers and LSG members, as the emphasis was placed on managing the COVID-19 pandemic and delivering essential health services. Conclusion Most of the health system actors expressed their belief in and commitment to primary health care reforms and noted positive impacts on the clinical side with remaining challenges of access, outreach, and sustainability. COVID-19 reduced service coverage and utilisation, but motivated greater efforts on the part of both health workers and community representatives. Primary health care is a shared priority now, with a need for greater focus on systems strengthening, collaboration, and primary prevention.

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Section: Discussionmentioning

confidence: 99%

Of primary health care reforms and pandemic responses: understanding perspectives of health system actors in Kerala before and during COVID-19

et al. 2023

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“…Studies have established a clear relationship between burnout and the bureaucratic burden, which reduces the time left for clinical activity [ 15 , 16 ]. The prioritization of COVID-19 care, both clinically and administratively, caused a displacement of care with respect to chronic diseases and the diagnosis of new health problems, the usual tasks of PHC in Spain and in other countries [ 17 , 18 , 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

Primary and Community Care Transformation in Post-COVID Era: Nationwide General Practitioner Survey

Solanes-Cabús

Paredes

Límón

et al. 2023

IJERPH

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Introduction: The health emergency caused by COVID-19 has led to substantial changes in the usual working system of primary healthcare centers and in relations with users. The Catalan Society of Family and Community Medicine designed a survey that aimed to collect the opinions and facilitate the participation of its partners on what the future work model of general practitioners (GPs) should look like post-COVID-19. Methodology: Online survey of Family and Community Medicine members consisting of filiation data, 22 Likert-type multiple-choice questions grouped in five thematic axes, and a free text question. Results: The number of respondents to the questionnaire was 1051 (22.6% of all members): 83.2% said they spent excessive time on bureaucratic tasks; 91.8% were against call center systems; 66% believed that home care is the responsibility of every family doctor; 77.5% supported continuity of care as a fundamental value of patient-centered care; and >90% defended the contracting of complementary tests and first hospital visits from primary healthcare (PHC). Conclusions: The survey responses describe a strong consensus on the identity and competencies of the GP and on the needs of and the threats to the PHC system. The demand for an increase in health resources, greater professional leadership, elimination of bureaucracy, an increase in the number of health professionals, and greater management autonomy, are the axes towards which a new era in PHC should be directed.

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“…This may be due, to the community phobia that limited patients’ consultations, the absenteeism of healthcare workers, and the closure of some healthcare facilities [ 14 ]. The literature has also demonstrated that there have been changes in the demand and offer of PHC services characterized by a decrease in in-person visits, a drop-in vaccination rate, and a rise in non-communicable diseases’ complications [ 15 , 16 , 17 ]. Second, PHC in Tunisia, as highlighted by the participants of the study, did not play an effective role in the management of the COVID-19 pandemic.…”

Section: Discussionmentioning

confidence: 99%

Perception of Tunisian Public Health Practitioners on the Role of Primary Health Care during the COVID-19 Pandemic

Melki

Hassine

Chebil

et al. 2022

IJERPH

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Context: Primary Health Care is the first level of healthcare delivery services. Its role in the management of epidemics has been documented especially during the SARS and Ebola epidemics, and more recently during the COVID-19 pandemic. Objective: To describe public health experts’ perceptions of the implication of Primary Health Care on managing the COVID-19 pandemic in Tunisia. Methods: This qualitative study was based on a structured interview covering five domains: 1. Preparedness, 2. Implication, 3. Health delivery, 4. Response and 5. Fight against COVID-19 in Primary Health Care in Tunisia. Convenient sampling was done to include public health practitioners and experts. Results: A total of 25 experts were included with a sex ratio that was equal to 0.92, including two international experts, and four that were working in the Ministry of Health. The majority of respondents affirmed that the Tunisian PHC was not prepared to fight against the COVID-19 pandemic. Concerning the response role of PHC against COVID-19, some experts stated that PHC played an important role in the early stages of the pandemic. Almost all included participants claimed that PHC was marginalized from the national strategy against COVID-19. In addition, all respondents affirmed that there had been a weakening effect of the delivery of the minimum healthcare package that was dispended by the PHC after the pandemic. However, they all expressed the ability of PHC to manage future epidemics. Conclusion: The Tunisian PHC system did not play an efficient role in the current COVID-19 pandemic. However future lessons should be deduced for further implications in potential upcoming epidemics.

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The impact of the Covid-19 pandemic on primary health care utilization: an experience from Iran

Cited by 32 publications

References 33 publications

Of primary health care reforms and pandemic responses: understanding perspectives of health system actors in Kerala before and during COVID-19

Of primary health care reforms and pandemic responses: understanding perspectives of health system actors in Kerala before and during COVID-19

Primary and Community Care Transformation in Post-COVID Era: Nationwide General Practitioner Survey

Perception of Tunisian Public Health Practitioners on the Role of Primary Health Care during the COVID-19 Pandemic

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