Lessons on integrated chronic care organisation of primary care during the COVID-19 pandemic: case study analyses in Cambodia, Slovenia, and Belgium

Abstract

Abstract Background During the COVID-19 pandemic, people living with Noncommunicable diseases (NCDs) were at double risk: developing severe COVID-19 and developing complications from not having their chronic condition(s) well controlled. Primary Health Care (PHC) is paramount for integrated care of chronic diseases, but was severely restrained during the pandemic. Our aim was to examine how the organisation of PHC for chronic diseases was affected by the pandemic, and as such, shine a light on strengths, weaknesses, and opportunities in different types of health systems. Methods Semi-structured interviews with 69 participants were carried out in three countries with different primary health care systems: a developing health system in a lower middle-income country (Cambodia); a centrally steered health system in a high-income country (Slovenia); and a publicly funded highly privatised health-care health system in a high-income country (Belgium). Both PHC providers and macro-level stakeholders were interviewed by the international team. An inductive thematic analysis was performed. Results In all three countries the workload of the staff was high and shifted towards pandemic related tasks, affecting availability for chronic care. It also created space for innovations such as telemedicine. In general, recognition of the importance of PHC increased. But also considerable differences between the three countries’ health care systems have been uncovered. In Cambodia medicines are lacking but a strong civil servant ethos is present. In Slovenia strong leadership appeared to be an important strength, but flexibility of PHC workers was limited. This flexibility and entrepreneurship turned out to be valuable in Belgium, but there fragmentation of PHC was a barrier. Conclusions Moments of crisis and disruption lay bare the structural agility and gaps more clearly, as a magnifying glass. In Cambodia, there is a need to sustainable supply of medicines. In Slovenia, the shortage of general practitioners (GPs) needs attention. In Belgium, rethinking of the PHC practice organisation is needed. Our analyses provide the opportunity to analyze and build back stronger health care systems.