An unfinished agenda: insights from seven country case studies on strengthening primary health care in the Western Pacific Region
Edelman, Alexandra, Vinyals Torres, Lluis, Kazi, Anis, Rasanathan, Kumanan, and Marten, Robert (2025) An unfinished agenda: insights from seven country case studies on strengthening primary health care in the Western Pacific Region. BMJ Global Health, 10 (Suppl 2). e017442.
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Abstract
In the WHO Western Pacific Region, primary health care (PHC) is considered 'the future of health' and the key to achieving universal health coverage. However, political, economic and social forces underlying curative, hospital-centric models have eroded public, local-level health service capacity - contributing to fragmented systems and persisting health inequities. Drawing insights from seven published country case studies from East Asia examining PHC in the context of the COVID-19 pandemic, this paper discusses key factors influencing the implementation of PHC. Countries are improving service delivery through a PHC approach, but persisting governance and structural barriers to PHC reform include vertical approaches to health care planning and programme delivery, health workforce shortages and maldistribution, and market forces that have shaped health care and workforce models towards curative care. Three domains for future policy and research to strengthen PHC are proposed. First, managing the political economy of PHC reform requires mapping relationships and systematically unravelling political, social and economic factors shaping accountability, receptiveness and capacity for change. Second, strengthening participatory governance involves shifting power to communities through platforms for shared policy creation and implementation, decentralised governance and empowering community-oriented health workers. Third, improving conceptual clarity and policy guidance on PHC can use the Sustainable Development Goals to orient systems towards preventing illness and valuing good health. The case studies offer a practice model of applied health policy and systems research coproduced with policy stakeholders.
| Item ID: | 88144 |
|---|---|
| Item Type: | Article (Research - C1) |
| ISSN: | 2059-7908 |
| Keywords: | COVID-19, Global Health, Health policy, Health systems |
| Copyright Information: | Copyright © 2026 BMJ Publishing Group Ltd. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial Intergovernmental Organization (CC BY-NC 3.0 IGO) license. |
| Date Deposited: | 26 Mar 2026 00:22 |
| FoR Codes: | 42 HEALTH SCIENCES > 4206 Public health > 420602 Health equity @ 100% |
| SEO Codes: | 20 HEALTH > 2003 Provision of health and support services > 200310 Primary care @ 100% |
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