Qom University of Medical Sciences Journal

Introduction
Different pandemics and epidemics have happened in history, which had a great negative impact on health, economy, politics, and cultures. Examples are SARS (2003), mumps (2006), H1N1 (2009), pertussis (2012), MERS (2012), Ebola (2014), Zika (2016), and finally COVID-19. The health systems are on the frontline of the battle against these events. Therefore, their empowerment is more important. One of the most important aspects of empowering the health system is the shift in focus from treatment-oriented health care to prevention. Primary health care (PHC) emphasizes community-oriented health care. The PHC refers to providing accessible and affordable care to everyone in the community. Its goal is to preserve health, prevent disease, and improve society.
According to the World Bank, health systems are resistant to crises if they can protect human life and produce good health outcomes in society, and at the same time, the quality of care does not undergo many changes. According to the studies, the healthcare system depends greatly on managing limited resources, distributing human resources, using health and treatment spaces to respond to emergencies, and the number of needy patients. This indicates the importance of the macro-policies of the health system. In this study, we aim to investigate the strategies of different countries for strengthening their PHC systems in emergency situations to find a policy model appropriate for Iran’s PHC system.
Methods
A search for studies published from 1990 to 2021 was conducted using related keywords in PubMed, Scopus, Web of Science, and EMBASE databases. Documents and reports published by international organizations or different health systems were also reviewed. The quality of the articles was examined using the STROBE checklist.
Results
Out of 109 studies whose full texts were reviewed, 9 met the inclusion criteria, indicating insufficient evidence on how to strengthen the PHC system for dealing with emergencies. The included studies had been published from 2006 to 2020. The recommendations in most of the studies (n=4, 44%) were based on the experiences gained from managing the influenza epidemic, followed by the Ebola epidemic (n=2, 22%), SARS (n=2, 22%) and COVID-19 (n=1, 11 %). Also, in the present study, all articles had moderate or good quality.
Conclusion
According to the studies, four strategies were identified:
1. Strengthening the capacity: During a crisis, it is difficult to prepare all centers quickly for increased demand with acceptable standards; therefore, we need a comprehensive plan that pays attention to the anticipation of the required resources, limitations, and the efficiency of alternatives. Hence, by strengthening the PHC services, the process of referring patients to higher levels of service provision should be managed. On the other hand, prioritizing the safety of healthcare workers should be done by developing protocols for disease management and providing personal protective equipment. Furthermore, the combination of information obtained from different information systems can allow healthcare systems to accurately perceive the situation and identify the people at risk, leading to an active approach to managing the situation.
2. Increasing public participation and public trust: Before a crisis, we should have a comprehensive plan for the coordination and participation of various organizations and institutions as well as the society. In this regard, a) Creating mechanisms of communication with people and informing them and b) Encouraging public participation by non-material incentives are important. Establishing communication mechanisms is important for increasing public awareness and following the instructions to deal with the situation.
3. Ensuring access to health services: Healthcare centers depend on public infrastructure (e.g. electricity, water, and roads) to provide services. Providing this infrastructure has a great role in adequate and fair access to health services and the proper functioning of the service delivery chain. Therefore, we should: a) Strengthen public and health infrastructure and b) Continue service delivery for all patients with a focus on people with acute illnesses and chronic diseases using the capacities of civil society and health volunteers
4. Increasing the capabilities of healthcare workers in facing crises: Healthcare workers are mostly trained to provide health services in normal conditions; however, during a crisis, due to not having enough skills, they are not able to provide health services. To improve their preparation to deal with crisis situations, crisis management courses for active healthcare workers at different levels should be one of the priorities of health systems.
Ethical Considerations
Compliance with ethical guidelines
This study observed the publication ethics.
Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Authors contributions
All authors contributed equally to preparing this article.
Conflicts of interest
The authors declared no conflict of interest.