William Chi-Wai Wong, Vivian Lin, Xiaoxuan Fang, Michael Kidd on behalf of the Lancet Commission on Transforming Primary Health Care in the Post-COVID-19 Era. From The Lancet 15 Feb 2025 https://doi.org/10.1016/S0140-6736(25)00198-9
Primary health care (PHC) was established as a global priority in the 1978 Alma-Ata Declaration. Four decades later, the 2018 Astana Declaration reaffirmed the call for universal health coverage for all individuals across the life course, emphasising essential public health functions, community engagement, and a multisectoral approach to health.
The COVID-19 pandemic exacerbated existing pressure on PHC systems that were already struggling to adapt to the challenges of ageing populations, social inequalities, geopolitical conflicts, and the impacts of climate change. On an individual level, the pandemic exposed and worsened existing health inequities, such as poverty, discrimination, and gender inequality, affecting service access, health-seeking behaviours, and social engagement. The impacts of the COVID-19 pandemic have challenged the resilience of PHC systems, especially in low-income and middle-income countries (LMICs), underscoring the need for tailored approaches to address the unique contexts of each country’s health system.
These manifold challenges call for a re-evaluation of health systems, particularly the role of PHC as the main point of contact for comprehensive and coordinated community-based health services. There is a pressing need to reassess the balance and scope of services provided in hospitals compared with those delivered in the community, with a stronger emphasis on prevention and health promotion. Only by addressing these challenges can more effective and equitable health systems be achieved.
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