Pandemics and Primary Health Care Resilience: Why This Matters Now and in the Future
Pandemics and the Future of Primary Health Care
The COVID-19 pandemic has upended the delivery of routine and emergency medical care around the world. Primary care systems that often serve as a first point of medical contact are stretched and stressed, making the delivery of comprehensive and coordinated care a challenge. This week, Northwestern Feinberg School of Medicine professors Dr. Lisa Hirschhorn and Dr. Mark Huffman and the University of Abuja Teaching Hospital’s Dr. Anthony Orji joined the Northwestern Buffett Institute for Global Affairs for a discussion on what COVID-19 is revealing about how primary care systems worldwide can grow more resilient and better equipped to handle the next inevitable pandemic. Here are three key takeaways:
Primary health care systems need a “redesign.” Many primary care clinics have taken measures to ensure physical distancing like putting fewer chairs in waiting rooms, Huffman said, “but there needs to be greater investment in redesigning primary health centers to protect patients.” We also need a fundamental rethinking of how primary care is delivered amid lockdowns and travel bans, Huffman added. People can miss their clinic visits and medicines because they can’t get to clinics, which can be especially problematic in low- and middle-income countries where prescribing a short-term, 30-day supply of medicine is the norm, he said. “Amid the waxing and waning of the [COVID-19] pandemic, how do we prevent people from missing out on medicines and missing out on care?” We’re already seeing the broader health impacts of COVID-19, Hirschhorn added, pointing to spikes in measles, cholera and diphtheria cases in many countries. “We really need a broad platform for thinking about strengthening primary health care,” she said.
Telemedicine has taken off in many areas, but could exacerbate inequities. Excitement about telemedicine among patients and providers is growing, especially as insurance companies have embraced it, but isn’t a panacea, Huffman said, pointing to disparities in access to the technology necessary to make telemedicine work well everywhere and for everyone. “Telemedicine is in its formative stage in Nigeria and is likely to widen inequities,” Orji said. “Not all telehealth is the same.”
Hirschhorn concurred, noting telemedicine has its place, especially at this time, “but we need to make sure it’s equitable and adaptive—that it reflects the needs and context of the communities where it is practiced.”
We also have to remember that a lack of access to technology doesn’t necessarily mean a lack of access to care right now, Hirschhorn said. “Televisits aren’t possible in rural areas, but many rural areas have very strong community health programs.” Dr. Orji and his team know how to do things like contact tracing and we’re much less accustomed to that in the U.S., Huffman added. “We’re bringing back ideas from Nigeria.”
The coronavirus crisis has brought us to a crossroads. How do we create an economy in which nobody is left behind? How do we reshape the relationship between people and nature? What is the role of science in resolving global problems? These are among the many questions the COVID-19 crisis is raising, Huffman said. “In the context of this pandemic, we have an opportunity to create the future—to create plans for achieving global goals,” he said, pointing to the United Nations Sustainable Development Goals (UN SDGs). Huffman pointed to UN SDG number three, specifically, which calls for “achieving universal health coverage...and access to safe, effective, quality and affordable essential medicines and vaccines for all.”
“As soon as we put a price tag on things, we think about what is most efficient versus most effective and equitable,” Hirschhorn said. “Until we treat health as a human right and not as a commodity, it will be a business enterprise,” Huffman added. “It’s exciting to think things could change.”