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Study Overview


This multinational survey aimed to understand characteristics and strategies employed by different countries to deal with COVID-19 from a PHC perspective to determine:

  • Factors most associated with national mortality rates during the pandemic period to date
  • Lessons to better address both current and future pandemics

Peer-reviewed Publications from the Study

Multinational primary health care experiences from the initial wave of the COVID-19 pandemic: A qualitative analysis

Melina K.Taylor, Karen Kinder, Joe George, Andrew Bazemore, Cristina Mannie, Robert Phillips, Stefan Strydom and Felicity Goodyear-Smith

COVID-19 has impacted the entire world on a global, national, and local level (Dong et al., 2020). Millions of primary care workers worldwide have faced significant challenges in attempts to contain and treat the virus. National pandemic plans, quarantining and testing protocols, the closing of borders and lockdown procedures, and strategies to flatten the curve or boost herd immunity have all been implemented in various ways. The pandemic has shown the gaps in primary health care (PHC) worldwide, and the climb it will take to fulfill the public health goals of the Declaration of Astana (Declaration of Astana: Global Conference on Primary Health Care, 2018) and the Sustainable Development Goals 2030 (United Nations Foundation (2021) Sustainable Development Goals).

Integrating primary care and public health to enhance response to a pandemic

Karen Kinder, Andrew Bazemore, Melina Taylor, Cristina Mannie, Stefan Strydom, Joe George and Felicity Goodyear-Smith

Primary health care (PHC) includes both primary care (PC) and essential public health (PH) functions. While much is written about the need to coordinate these two aspects, successful integration remains elusive in many countries. Furthermore, the current global pandemic has highlighted many gaps in a well-integrated PHC approach. Four key actions have been recognized as important for effective integration.

Relationship between the perceived strength of countries’ primary care system and COVID-19 mortality: an international survey study

Felicity Goodyear-Smith, Karen Kinder, Cristina Mannie, Stefan Strydom, Andrew Bazemore and Robert L Phillips BJGP Open 2020; 4 (4):bjgpopen20X101129.

Strong primary health care (PHC) is the cornerstone for universal health coverage and a country’s health emergency response. PHC includes public health and first-contact primary care (PC). Internationally, the spread of COVID-19 and mortality rates vary widely. The authors hypothesised that countries perceived to have strong PHC have lower COVID-19 mortality rates.

Primary care perspectives on pandemic politics

Felicity Goodyear-Smith, Karen Kinder, Aimee R. Eden, Stefan Strydom, Andrew Bazemore, Robert Phillips, Melina Taylor, Joe George & Cristina Mannie (2021) Primary care perspectives on pandemic politics, Global Public Health, DOI: 10.1080/17441692.2021.1876751

While the COVID-19 pandemic now affects the entire world, countries have had diverse responses. Some responded faster than others, with considerable variations in strategy. After securing border control, primary health care approaches (public health and primary care) attempt to mitigate spread through public education to reduce person-to-person contact (hygiene and physical distancing measures, lockdown procedures), triaging of cases by severity, COVID-19 testing, and contact-tracing. An international survey of primary care experts’ perspectives about their country’s national responses was conducted April to early May 2020.

Strong PHC System and Death Rates:

Existing strong PHC systems were not correlated with death rates. This may be attributed to:

  • Uncoordinated responses between public health and PC personnel
  • Lack of PPE and testing for community-based workers
  • Reduced reliance on PHC if potential carriers were stopped at the border (most relevant to small island nations)
  • PC not being engaged


1035 surveys were collected from PHC clinicians (73.0%), researchers (16.9%), and policymakers (10.0%) across the world. The survey was distributed in both English and Spanish via PHC networks and snowballing. Participants were asked a series of questions that addressed the nature of their PHC system, how it responded to the pandemic, the use of health information technology in their country, if their country had a pandemic plan, and various strategies utilized to respond to the virus. Countries that had 10 or more surveys are referred to as the “top 21 countries

Data for Each Country:

For each country, the maximum death rate on a 7-day moving average served as the response variable in the survey.


Univariate and bivariate analyses were employed to arrive at the preliminary results.

Current Public Health and Primary Care Responses:

  • Implementing hygiene measures: hand washing and wearing PPE
  • Limiting person-to-person contact: physical distancing, banning mass gatherings, providing primary care remotely, self-isolating, and shutting down
  • Identifying Cases: testing, contact tracing, counsel & care for high risk groups, and surveillance

Current Approaches to Address the Pandemic:

Most countries utilized a combination of the following strategies:

  • Blocking entry to country: border control, testing and or quarantining new arrivals
  • Reducing the spread within the country: employing a variety of public health and primary care measures
  • Managing severe cases to reduce deaths: hospitalization, oxygenation, ventilation, and intensive care

Distribution and relative number of responses by country.

COVID-19 MAP: Distribution and relative number of responses by country.

Preliminary Results (1035 responses, 111 nations):

What factors correlated most with lower death rates?

  • Testing: Lower death rates were observed in countries where participants indicated that the following testing practices were employed:
    • Having readily available testing at the time of first COVID death
    • Testing all incoming travelers
    • Testing symptomatic persons
    • Testing those exposed to COVID positive individuals
  • Movement Restrictions: Lower death rates were observed where participants indicated that the following movement restrictions were employed:
    • Physical distancing
    • Event closures, and border closures at time of first death
    • Closure of all but essential services
    • Isolation based on contact tracing
    • Self-Isolation in households
    • Quarantine for suspected cases

Presentations from the Study at Recent Conferences

For further information, please contact Andrew Bazemore