The Lancet Commission on Transforming Primary Health Care in the Post-COVID-19 Era

Abstract

<p>Primary health care (PHC) was established as a global priority in the 1978 Alma-Ata Declaration.<a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00198-9/fulltext#">¹</a> Four decades later, the 2018 Astana Declaration<a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00198-9/fulltext#">²</a> reaffirmed the call for universal health coverage for all individuals across the life course, emphasising essential public health functions, community engagement, and a multisectoral approach to health.</p><p>The COVID-19 pandemic exacerbated existing pressure on PHC systems that were already struggling to adapt to the challenges of ageing populations, social inequalities, geopolitical conflicts, and the impacts of climate change.<a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00198-9/fulltext#">³</a> On an individual level, the pandemic exposed and worsened existing health inequities,<a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00198-9/fulltext#">⁴</a> such as poverty, discrimination, and gender inequality, affecting service access, health-seeking behaviours, and social engagement. The impacts of the COVID-19 pandemic have challenged the resilience of PHC systems, especially in low-income and middle-income countries (LMICs),<a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00198-9/fulltext#">⁵</a> underscoring the need for tailored approaches to address the unique contexts of each country's health system.</p><p>These manifold challenges call for a re-evaluation of health systems, particularly the role of PHC as the main point of contact for comprehensive and coordinated community-based health services. There is a pressing need to reassess the balance and scope of services provided in hospitals compared with those delivered in the community, with a stronger emphasis on prevention and health promotion. Only by addressing these challenges can more effective and equitable health systems be achieved.</p><p>Simultaneously, the COVID-19 pandemic created new opportunities for reforming PHC systems. Many medical consultations shifted to virtual platforms, with telehealth and remote monitoring systems being introduced and funded in many countries.<a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00198-9/fulltext#">⁶</a> This transition has transformed the roles of family medicine, pharmacies, and community health services,<a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00198-9/fulltext#">⁷</a> and has enhanced home-based care for frail and homebound individuals in some settings. Digital technologies are reshaping health-care provider responsibilities, particularly through the increasing use of predictive algorithms powered by artificial intelligence (AI)<a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00198-9/fulltext#">⁸</a> that can assist in automating health monitoring, disease screening, and care management. Advances in data integration and communication are creating new opportunities for community engagement and the development of responsive evidence-based PHC policies. These innovations not only address immediate medical needs, but also potentially pave the way for more resilient future health systems.<a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00198-9/fulltext#">⁹</a></p><p>To devise effective strategies for addressing these issues and challenges in PHC systems the <em>Lancet</em> Commission on Transforming Primary Health Care in the Post-COVID-19 Era has been established, comprising leading researchers and international experts in PHC sciences, health policy and systems, family medicine, nursing, pharmacy, and public health from across Africa, the Asia–Pacific region, Europe, the Middle East, North America, South America, and South Asia. This diverse group includes people from high-income countries (HICs) and LMICs, with equal gender representation. The objectives of this Commission are to explore the challenges faced by PHC systems throughout the COVID-19 pandemic and the ongoing post-pandemic reforms needed to support the transformation of PHC to better meet future community needs.</p><p>To achieve this goal, the Commission will synthesise evidence regarding these transformations and develop recommendations to make PHC systems more equitable, accessible, and person-centred, aligning with the goals of the 2018 Astana Declaration.<a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00198-9/fulltext#">²</a> The Commission will examine existing and emerging PHC structures and policies, identify key components necessary for successful transformations, and incorporate stakeholder perspectives on PHC developments. A cohesive strategy will address six areas of focus: improving equity in access to health services; maintaining person-centred care in the post-COVID-19 era; promoting the safe and responsible adoption of digital health innovations and AI; integrating community-based medical and social care; building the future PHC workforce; and enhancing PHC preparedness for future health emergencies. The Commission will access extensive datasets from the INTernational ConsoRtium of Primary Care BIg Data Researchers (INTRePID) currently from 14 countries (Argentina, Australia, Brazil, Canada, Chile, China, Japan, Norway, Peru, Singapore, Sweden, Togo, the UK, and the USA), facilitating international comparisons of health-care delivery methods and factors influencing variations in practice during and after the COVID-19 pandemic. In addition, the Commission will synthesise evidence from scoping and literature reviews, analyse secondary datasets, and study country-specific case studies to inform its recommendations. Furthermore, the Commission will build on the work of other relevant Lancet Group Commissions<a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00198-9/fulltext#">¹⁰</a> and consider the ongoing efforts of international organisations in both HICs and LMICs.<a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00198-9/fulltext#">^11,12</a> Actionable recommendations will be developed within each area of focus, accompanied by key metrics to assist countries in measuring the success of their implementation.</p>