Role of a primary healthcare approach in COVID-19 pandemic response in the eastern Mediterranean region: multicountry case study synthesis

INTRODUCTION: Primary healthcare (PHC) can play a critical role in disease preparedness and response. The PHC approach was not always considered in the COVID-19 response in the eastern Mediterranean region (EMR). This article assesses the extent to which a PHC approach was deployed in the pandemic response and identifies barriers, enablers and lessons learnt for strengthening PHC for disease preparedness and response in EMR. METHODS: A multicountry synthesis of 17 case studies from EMR was conducted, using an analytical framework building on the three components of PHC framed by the 2018 Astana Declaration and adapted to enable the analysis of pandemic responses, namely the following. (1) How primary care (PC) and essential public health functions were employed to respond to COVID-19? (2) How multisectoral policy and actions were involved in responding to COVID-19? (3) To what extent was engaging and communicating with communities to leverage community resources effective? Countries were classified into three groups based on the level of socioeconomic development, representing the EMR diversity. Deductive content analysis was conducted. RESULTS: Findings revealed variations across countries in the application of a PHC approach in pandemic response, with Group 1 countries (higher socioeconomic development) swiftly scaling up PC responses, while Groups 2 and 3 countries prioritised secondary and tertiary care responses. Multisectoral coordination, digital health innovations, cross referrals and expanded disease surveillance commonly emerged as new practices in most EMR countries. Uneven regulatory capacity, inadequately equipped PC workforces and insufficient community engagement were key areas requiring further support. CONCLUSION: Priority areas for a comprehensive action agenda for PHC-oriented disease preparedness and response in EMR would benefit from establishing comprehensive PHC-oriented models of care; better resourcing PC; activating an emergency funding pool and strengthening community engagement. Advancing this agenda would contribute to ensuring the health security goal while progressing towards universal health coverage in EMR.