Kumanan Rasanathan’s research while affiliated with UNICEF and other places

Introduction Primary healthcare (PHC) can play a critical role in disease preparedness and response. The PHC approach was not always considered in the COVID-19 response in the eastern Mediterranean region (EMR). This article assesses the extent to which a PHC approach was deployed in the pandemic response and identifies barriers, enablers and lessons learnt for strengthening PHC for disease preparedness and response in EMR. Methods A multicountry synthesis of 17 case studies from EMR was conducted, using an analytical framework building on the three components of PHC framed by the 2018 Astana Declaration and adapted to enable the analysis of pandemic responses, namely the following. (1) How primary care (PC) and essential public health functions were employed to respond to COVID-19? (2) How multisectoral policy and actions were involved in responding to COVID-19? (3) To what extent was engaging and communicating with communities to leverage community resources effective? Countries were classified into three groups based on the level of socioeconomic development, representing the EMR diversity. Deductive content analysis was conducted. Results Findings revealed variations across countries in the application of a PHC approach in pandemic response, with Group 1 countries (higher socioeconomic development) swiftly scaling up PC responses, while Groups 2 and 3 countries prioritised secondary and tertiary care responses. Multisectoral coordination, digital health innovations, cross referrals and expanded disease surveillance commonly emerged as new practices in most EMR countries. Uneven regulatory capacity, inadequately equipped PC workforces and insufficient community engagement were key areas requiring further support. Conclusion Priority areas for a comprehensive action agenda for PHC-oriented disease preparedness and response in EMR would benefit from establishing comprehensive PHC-oriented models of care; better resourcing PC; activating an emergency funding pool and strengthening community engagement. Advancing this agenda would contribute to ensuring the health security goal while progressing towards universal health coverage in EMR.

An era in global health, inaugurated in 2000 by the UN Millennium Declaration,1 has passed. This era saw large increases in domestic spending on health and official development assistance for health,2 the creation of new global health institutions, such as the Global Fund and Gavi, and impressive progress in child mortality and infectious disease epidemic control.3 The sudden passing of this era, triggered in early 2025 by rapid reductions in development assistance for health (by US, European, and other large external funders), has exacerbated existing pressures on domestic health spending (which decreased between 2021 and 2022 per capita across all countries for the first time since 20002) and led to dramatic health financing cliffs. DOI: 10.1016/S0140-6736(25)00720-2 Full commentary in thelancet search financing cliffs

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.

Despite recognized need and reasonable demand, health systems and rehabilitation communities keep working in silos, independently with minimal recognition to the issues of those who require rehabilitation services. Consolidated effort by health systems and rehabilitation parties, recognizing the value, power and promise of each other, is a need of the hour to address this growing issue of public health importance. In this paper, the importance and the need for integration of rehabilitation into health system is emphasized. The efforts being made to integrate rehabilitation into health systems and the potential challenges in integration of these efforts were discussed. Finally, the strategies and benefits of integrating rehabilitation in health systems worldwide is proposed. Health policy and systems research (HPSR) brings a number of assets that may assist in addressing the obstacles discussed above to universal coverage of rehabilitation. It seeks to understand and improve how societies organize themselves to achieve collective health goals; considers links between health systems and social determinants of health; and how different actors interact in policy and implementation processes. This multidisciplinary lens is essential for evidence and learning that might overcome the obstacles to the provision of rehabilitation services, including integration into health systems. Health systems around the world can no longer afford to ignore rehabilitation needs of their populations and the World Health Assembly (WHA) resolution marked a global call to this effect. Therefore, national governments and global health community must invest in setting a priority research agenda and promote the integration of rehabilitation into health systems. The context-specific, need-based and policy-relevant knowledge about this must be made available globally, especially in low- and middle-income countries. This could help integrate and implement rehabilitation in health systems of countries worldwide and also help achieve the targets of Rehabilitation 2030, universal health coverage and Sustainable Development Goals.