Primary Health Care and COVID-19 Pandemic in the Islamic Republic of Iran

The Islamic Republic of Iran's health system is divided into three levels: the first level is the Primary Health Care (PHC) system, the second level includes specialized polyclinics/clinics, general and specialized hospitals, and the third level is the sub-specialized hospitals. Based on the available evidence, Iran's HS has evolved and progressed since 1984, becoming a comprehensive, public-centered, responsive, and cost-effective system, (Figure 1).1, 2

During the COVID-19 pandemic, countries reacted differently based on their HS infrastructure and structure, available primary resources (financial and human resources), and the severity of the disease spread.
Evidence reveals that most countries relied on their hospitals and health systems to combat the COVID-19 epidemic. However, the health system’s response was slightly different in the Islamic Republic of Iran. Since the early days of identifying cases and preparing hospitals for admission and treatment of COVID-19 patients, the PHC system initiated a comprehensive reaction to combat the COVID-19 pandemic as the first line and the first point of the HS's contact with the community. In this regard, the PHC system determined the principal policies for combating COVID-19 as follows: 3

- General vaccination based on the priorities in the national document

- Provision of active and essential healthcare and services (in-person/remotely)

- Early identification of COVID-19 cases and tracing their close contacts (family/workplace)

- Protection and isolation of vulnerable populations (reverse quarantine)

- Ensuring compliance with isolation and quarantine rules (hotel quarantine and house quarantine)

- Development and improvement of outpatient COVID-19 treatment

Different solutions and strategies have been devised to implement and fulfill the determined policies, which can be divided into three general categories:

a) Modifying the structure of service delivery

b) Modifying the programs and procedures

c) Improving the methods of service provision

Strategy 1: The first strategy is to make structural changes in the PHC system (Figure 2), which occurred in the first week of the outbreak in the Iran’s PHC system. Through alterations in structure, human resources, duties, and function, 1200 comprehensive urban (1099) and rural (111) health centers were designated as COVID -19 centers for suspected COVID-19 outpatients from rural health houses, urban health posts, rural/urban comprehensive health service centers, and other private centers.