"Health systems research needs to build the research capacities of the primary-level care settings and the communities that they serve to effectively respond to public health emergencies like COVID-19. Why? To maintaining essential health services for populations, especially vulnerable groups."
Lo Veasnakiry, Director of Planning and Health Information, Ministry of Health, Cambodia
What are the priority challenges being faced by policy- and decision-makers as they work to maintain primary health care (PHC) services while responding to the COVID-19 crisis? Uncovering the answer to that question for policy-makers across Asia and the Pacific is at the heart of an initiative that the Alliance has launched with several partner organizations.
This new initiative – Embedded primary health care research to engage communities and build learning health systems – is being spearheaded by the WHO Science Division and the Alliance, in partnership with the WHO Special Programme on Primary Health Care, the South-East Asia Regional Office of WHO, the Western Pacific Regional Office of WHO, UNICEF and the United Nations University International Institute for Global Health. Two regional consultations with policy-makers representing more than 20 countries were held in early July, followed by a synthesis consultation bringing together participants from the regional consultations with other high-level participants to agree an action plan and to reconfirm commitments to embedded research on primary health care.
Why embedded research?
"The beauty of this [embedded research] model is that it is a relatively low cost. Research is conducted in a relatively short period of time, there are very, very clear recommendations and we respond to those recommendations. We need to build on this kind of a model because this is not theoretical, but it really speaks to everyday challenges that countries might face.”
Anuradha Gupta, Deputy CEO, GAVI, the Vaccine Alliance
Embedded research begins with close collaboration between policy-makers and researchers to define research priorities. The approach challenges traditional global health research, where priorities are too often defined by funders and researchers in high income countries, ignore the contextually determined needs and challenges of primary health care systems and undervalue local knowledge and innovations.
Embedded research, through continuous dialogue between stakeholders, promotes the institutionalization of learning, strengthens institutional memory and can prevent the erosion of important tacit knowledge. Embedded research can also support engaging communities and frontline health staff in a learning system, which is essential if health systems are to be responsive to people's needs.
The importance of PHC research, especially in the context of COVID-19
“We are seventeen years on from SARS, and yet the health system is the same. So, while talking about research questions related to COVID, this is a time also to talk about overall health systems – responsive health systems – systems that can respond to issues that may arise from any medical emergency in the future.”
Dr Padam Chand, Former Chief Specialist, Ministry of Health and Population, Nepal
Strengthening health systems in general, and supporting primary health care (PHC) in particular, is essential for realizing renewed efforts to accelerate progress towards universal health coverage. Critical to this effort is connecting different parts and levels of health systems to forge meaningful relationships between stakeholders for healthy communities. Indeed, the ongoing COVID-19 pandemic exemplifies how critical the needs are for health systems to build and develop the ability to learn in their responses, address the broader determinants of health, as well as engage communities in efforts to mitigate and contain the outbreak.
The current COVID-19 pandemic presents a series of critical questions that should be addressed in the context of PHC. Our consultations organized the priority-setting exercise around five key thematic areas:
- Scaling up and managing critical emergency services
- Continuing essential primary health care services
- Managing referral systems to ensure appropriate distribution of service load
- Engaging and communicating with communities effectively and leveraging community resources
- Addressing broader health determinants and working multisectorally to improve health
A number of additional emerging priorities focused on human resources for health and also on maintaining essential PHC services in the face of COVID-19. The importance of ensuring access to care for vulnerable and marginalized communities was also underscored in both regions. Results of the consultations will be published shortly.
What's next?
“The important thing from this meeting is moving from identifying research priorities into really embedding those big questions at the primary level.”
Marijke Wijnroks, Chief of Staff, the Global Fund
The consultations have provided impetus for countries to advance the agenda of embedded PHC research. Following from these consultations, a programme of embedded research is planned in the low- and middle-income countries of the two regions represented during the consultations. Although broad research priorities have been identified at a regional level, these will be refined and further contextualized in each country.