Health systems continue to adapt to cope with the COVID-19 pandemic. Much focus has been placed on the scaling-up of hospital capacities. However, the pandemic is also deeply affecting the health of many people who are not infected by the virus.

In his last report, Organization for Economic Co-operation and Development- OECD, «Strengthening the frontline: How primary health care helps health systems adapt during the COVID-19 pandemic», highlights different examples on how to strengthen the frontline so as for the healthcare systems to adapt to the new reality.

The COVID-19 pandemic has physically, mentally, economically and socially damaged the lives of many people and put immense pressure on health systems. People with chronic conditions are facing a ‘double threat’: they are more vulnerable to complications and death from COVID-19, and they experience indirect health effects from disruptions in essential care. Cancer diagnoses, chemotherapy appointments, and the number of visits to ambulatory practices have all decreased. To effectively tackle these challenges, policy cannot just focus on ‘virus and hospital’.

For health systems to be resilient against health crises of this magnitude, strong primary and community health care – the frontline of all health systems – is essential. Primary health care delivers the first line of care in communities during the acute phase of a health crisis, and helps maintaining continuity of care for people with chronic conditions. Primary health care also reduces pressure on the entire health systems by providing comprehensive and preventive care during and after the crisis.

Faced with the pandemic, many OECD countries have strengthened the frontline by:

Reorganizing the delivery of primary health care services by establishing team practices and a strong link with community services (e.g. France, Iceland, Ireland, Slovenia, United Kingdom). Expanding home-based programs has also improved access to care for all patients during the crisis, alleviating pressure on hospitals in (e.g. Canada, Spain United States).

Rearranging tasks and responsibilities in primary health care, notably to allow community pharmacists to extend prescriptions and prescribe chronic disease medications (e.g. France, Ireland, Portugal, United States). However, community health workers have not been mobilized as much as they could have during the pandemic.

Leveraging digital tools and systems such as e-Health and telemedicine, for example by new legislation (e.g. Estonia, Poland), new telemedicine services (e.g. Canada, the Slovak Republic), or new guidelines and regulations (e.g. Belgium, France, Japan).

Add-on payments for primary health care providers who are facing high workload and risks due to the pandemic, including for teleconsultation services or home visits (e.g. Netherlands, Germany, Italy) or for hygiene and safety measures, in response to the pandemic (e.g. Germany, the United Kingdom).

Stronger involvement of patients in care can help address the needs of people whose lives are impacted most. In the heat of a crisis, the voice of the patient needs to be heard.

Promising and innovative developments in primary health care have been accelerated during the pandemic. These efforts need to be further expanded to ensure that health systems are more resilient to future public health emergencies but also to meet the challenges of ageing societies and growing burden of chronic conditions.

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