Impact of the COVID-19 pandemic on primary health care reform in Pakistan.

Abstract

Background: Primary health care reform in low- and middle-income countries involves complex processes of prioritisation and agenda-setting. Evidence remains limited on how the COVID-19 pandemic influenced these processes at the subnational level.

Aim: To examine how COVID-19 affected primary health care reform in Khyber Pakhtunkhwa, Pakistan.

Methods: We conducted semi-structured interviews with 14 key informants, including provincial health leaders, provincial political leaders and their advisers, and representatives of national and international organisations, and reviewed relevant supporting documents. We analysed the data inductively through thematic coding and process tracing across data sources.

Results: Most of the respondents agreed that the pandemic facilitated the implementation of reforms at the primary health care level, by strengthening advocacy and political influence. The reforms began around August 2020 and included improved financial management and allocation of resources, establishment of primary health care management committees, increased budget for essential medicines, recruitment of additional frontline clinical staff, and outsourcing of selected support services. Investments in public health increased through an almost 40% increase in the health budget between the 2019/2020 and 2022/2023 financial years.

Conclusion: COVID-19 created an opportunity to advance primary health care reform at the provincial level in Khyber Pakhtunkhwa, Pakistan. There is a need to sustain and improve on these reforms to strengthen primary health care services and advance towards the longer-term health goals and Universal Health Coverage.