The Covid-19 pandemic has caused an unprecedented health and socioeconomic crisis, and is a calamity at every level. The virus has affected people all over the world and millions have died. The pandemic has exposed deep inequalities. Division and inequality between and within countries have been heightened and the impact has been severe on people who were already marginalised and disadvantaged.
The World Health Organisation did admirable work during the pandemic. Many committees and panels of the WHO worked hard and produced highly commendable reports and documents. Besides this, the global body closely worked with all its member countries, extended support and made attempts to strengthen their health services.
In May 2020, the WHO constituted an independent panel to initiate an impartial, independent and comprehensive review of the international health response to Covid-19 and make recommendations for the future.
The panel’s report titled “Covid-19: Make it the Last Pandemic”, has recommended strategic action to end this pandemic and to ensure that any future infectious disease outbreak does not become as catastrophic. The panel called on political decision-makers at every level to champion a major change and to make resources available to increase effectiveness. Two important recommendations of this panel are to strengthen public health institutions and to increase the investments to build resilient health systems grounded in high quality primary and community health services.
The World Organisation of Family Doctors (WONCA), representing over half-a-million doctors, reiterated the above WHO recommendations. It noted that those countries with stronger primary care offered a better response to the pandemic and recommended increasing investments in primary healthcare (PHC) to face new global health challenges. It has clearly stated that the family doctor-led primary healthcare team is a cost-effective practice that governments should put in place to face future global health risks.
Learning from the Covid experiences and responding to the WHO and WONCA concerns, we need to prioritise high-quality primary and community health services to build a fairer and healthier world for everyone.
For this purpose, we need to learn from our critical experiences, WHO recommendations, and emerging family medicine and primary-care practices across the world.
A comprehensive and integrated understanding is needed about the parameters of a new radical approach to primary healthcare, widely propagated by the WHO during the last two decades. According to this novel approach, primary care and essential public health functions are the core of integrated health services. Besides this, multi-sectoral policy and action, along with empowerment of people and communities, are equally important.
Comprehensive generalist physicians, commonly called family doctors, play a central role in PHC-oriented health systems with quality primary care. Family doctors are at the heart of delivering effective primary healthcare, responding to the needs and preference of the people at both the individual and population level.
Primary care teams work productively at the community level with a range of skills and address many healthcare issues. Primary care teams are multidisciplinary, and will include family doctors, community health workers, rehabilitation workers, care managers, pharmacists, nurses, physician assistants, traditional healers, nutritionists, social workers, dentists and supportive staff. The primary care rendered by these teams has shown clear benefits in a wide range of settings.
Family medicine has been recognised and integrated into the primary healthcare system in varied contexts around the world. Canada, Australia, Norway, Brazil, Latin America, Nigeria, Ghana, Ethiopia, South Africa, China, Russia, Nepal and several other countries have prioritised family medicine throughout the health system.
Family doctors stood at the frontline of Covid services all over the world.
They are the leaders of primary care teams. They are the trusted leaders in their communities and are committed to encouraging patients and families as partners in safer care. They managed social and professional risks to guarantee the safer and best quality healthcare possible. They actively participated in the vaccination process. They provided quality healthcare in person, in the clinic, at home and via telehealth, to patients with Covid and those with other health needs. Their role as community health reference has been reinforced in the pandemic.
Indian policymakers should see that the state invests significantly in family-doctor centric primary healthcare, preventive public health, social development programmes, opening of new healthcare facilities, safe universal health coverage, investment in public health and primary care research and infrastructure development, including large scale reforms in public health. They should put in serious effort to create a pandemic-free world for our future generations.
Dr V Sreenivas
Director, Academics, Academy of Family Physicians of India