1.1.1 Countries enabled to provide high-quality, people-centred health services, based on primary health care strategies and comprehensive essential service packages

COVID-19 has affected delivery of workplans for output 1.1.1 at all levels. WHO has adapted to the situation and provided support to countries flexibly in a timely manner, not only in the response, in particular maintaining essential health services during the pandemic, but also in progression towards primary health care (PHC) for universal health coverage (UHC) and working better with communities and the private sector.

 

Scorecard

COVID-19 has affected delivery of workplans for output 1.1.1 at all levels. WHO has adapted to the situation and provided support to countries flexibly in a timely manner, not only in the response, in particular maintaining essential health services during the pandemic, but also in progression towards primary health care (PHC) for universal health coverage (UHC) and working better with communities and the private sector. Nevertheless, the numerous requests for country support and guidance on the pandemic delayed parts of the workplan, in particular the delivery of global goods, some of which were replaced in 2020 by COVID-19-specific guidance such as pillar 9 of the Strategic Preparedness and Response Plan. The output delivery team also discussed how to improve integration of gender, equity and human rights, including clarity and accountability, among managers to ensure a consistent approach. This should be addressed in the longer term. 

Achievements and challenges

PHC is the most cost-effective means for achieving UHC and health security with the objectives of equity, social justice, solidarity and the right to highest level of health, including during a pandemic. The aim of this output is to build integrated, people-centred health systems based on PHC with the engagement of communities. 

COVID-19 placed a severe strain on health systems in 2020, hampering plans to progress towards UHC. Yet, the pandemic provided a clear demonstration of the importance of UHC and the value of strong community engagement for acceptance of public health measures in the COVID-19 response. 

WHO worked with Member States to support the urgent response to COVID-19, fast-tracking actions to meet needs, while working to maintain essential services and continuing core work to strengthen the safety and quality of services. WHO provided strong leadership, technical expertise and advocacy in this regard, using the opportunity to promote UHC. In particular, WHO has been monitoring disruptions to health systems. A WHO  survey on the impact of COVID-19 on health systems in 105 countries showed that health services were disrupted in almost every country. 

To strengthen its support to Member States, WHO set up a special programme on PHC in 2020. In addition, the WHO UHC Partnership, which provides technical assistance on PHC to 115 countries, was merged with the special PHC programme to boost the post-Astana PHC agenda. In response to COVID-19, the UHC Partnership reprogrammed its workplans in all countries to support their response plans, maintain essential health services or develop national COVID-19 vaccine deployment plans. 

Headquarters not only issued the Strategic Preparedness and Response Plan guidance to maintain essential health services during the pandemic but also developed a  UHC compendium of health interventions to be used by countries in building their packages of essential services and created the dynamic web-based COVID-19 Health Services Learning Hub.

In the African Region, policy advisers in the UHC Partnership focused on maintaining the availability of and access to essential health services during the COVID-19 response in data-driven decisions. In Zimbabwe, for example, WHO worked with the Ministry of Health and Child Care on a tool to monitor and support continuation of essential health services. It also supported countries in preparing their health workforce for the COVID-19 response (e.g. in Ethiopia) and accelerated the development and finalization of national infection prevention and control strategic frameworks (e.g. in South Africa).

In the Region of the Americas, direct support was provided to all 56 countries and territories for reorganization of health services and expansion of capacities. Technical cooperation was reoriented to support the comprehensive response of health services to the pandemic, including capacity-building for intensive care. Many innovations were introduced, such as extension of the use of telemedicine and telecommunications. The provision of essential service and the control and prevention of neglected diseases, such as vector control in countries with endemic Chagas disease, was, however, hindered, which could result in re-infestation in geographical areas in which the disease had been eliminated.

In the Eastern Mediterranean Region, the COVID-19 response is focused on hospitals, but a strong primary health care sector – with community-level surveillance and education – is crucial to address most cases at the local level. Most countries lack a family physician, while 93% of primary health care facilities are managed by general practitioners who have neither training nor experience in family practice. WHO is supporting the American University of Beirut’s online family medicine programme. With WHO support, Jordan is one of the first countries to implement the programme.

In the European Region, technical assistance was provided to nearly 20 countries for a dual-track response – to strengthen the role of PHC in the pandemic response while maintaining essential health services. Technical guidance was provided, with a checklist for adapting PHC services to address COVID-19. In addition, the Primary Health Care Operational Framework was developed with WHO headquarters. A strong leadership agenda and partnerships for political impact were established.

Guidance on maintaining essential services was provided in the South-East Asian Region, and work to improve PHC to achieving UHC continued on various fronts. In Sri Lanka, WHO provided technical support for development of the essential services package. PHC is being reorganized in 600 institutions throughout the country.

In the Western Pacific Region, service delivery capacity was strengthened to address the rising numbers of cases of COVID-19 and also to maintain essential health services. Countries were supported in adapting WHO guidance to both enhance the response and ensure continuity of services. The pandemic provided many lessons. It highlighted the importance of infection prevention and control and of safe, affordable, high-quality services. It strengthened the capacity of health-care workers and the resilience of health systems, and it revealed loopholes in PHC for the continuity of essential services. These gaps will be addressed.