From disease- to people-centred pandemic management: organized communities, community-oriented primary care and health information systems

International Journal for Equity in Health

Research

Ricardo Fabrega¹  Punam Mangtani²  Salman Rawaf³  Richard A. Powell³  Austen El-Osta³  Sara Willems⁴  Jan De Maeseneer⁴  Vivian Camacho⁵  Christine Leyns⁶ 

[1] Dean, Faculty of Health Sciences, Universidad Santo Tomás de Chile, Santiago, Chile;Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK;Department of Primary Care and Public Health, Faculty of Medicine, Imperial College London, London, UK;Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium;High Level Commissioner at “Alma Ata 40 years High Level Commission for PAHO”, National Director inside Health Ministry in Bolivia, La Paz, Bolivia;Research Institute of Social Sciences (INCISO), Faculty of Social Sciences, Universidad Mayor de San Simon, Cochabamba, Bolivia;Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium;

关键词: Community participation;    Health information systems;    Primary health care;    Public health;    COVID-19;    Health equity;   

DOI  :  10.1186/s12939-023-02032-z

 received in 2023-07-24, accepted in 2023-10-05,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThe COVID-19 pandemic exposed the health equity gap between and within countries. Western countries were the first to receive vaccines and mortality was higher among socially deprived, minority and indigenous populations. Surprisingly, many sub-Saharan countries reported low excess mortalities. These countries share experiences with community organization and participation in health. The aim of this article was to analyse if and how this central role of people can promote a successful pandemic response.MethodsThis analysis was partly based on local and national experiences shared during an international and Latin American conference on person-and people-centred care in 2021. Additionally, excess mortality data and pandemic control-relevant data, as well as literature on the pandemic response of countries with an unexpected low excess mortality were consulted.ResultsTogo, Mongolia, Thailand and Kenya had a seven times lower mean excess mortality for 2020 and 2021 than the United States of America. More successful pandemic responses were observed in settings with experience in managing epidemics like Ebola and HIV, well-established community networks, a national philosophy of mutual aid, financial government assistance, more human resources for primary care and paid community health workers.DiscussionSince trust in authorities and health needs vary greatly, local strategies are needed to complement national and international pandemic responses. Three key levers were identified to promote locally-tailored pandemic management: well-organized communities,community-oriented primary care, and health information systems. An organized community structure stems from a shared ethical understanding of humanity as being interconnected with each other and the environment. This structure facilitates mutual aid and participation in decision making. Community-oriented primary care includes attention for collective community health and ways to improve health from its roots. A health information system supports collective health and health equity analysis by presenting health needs stratified for social deprivation, ethnicity, and community circumstances.ConclusionsThe difference in excess mortality between countries during the COVID-19 pandemic and various country experiences demonstrate the potential of the levers in promoting a more just and effective health emergency response. These same levers and strategies can promote more inclusive and socially just health systems.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

【 图 表 】

Fig. 7