Developing a framework for primary health care resilience in pandemic conditions for Iran

Primary Health Care (PHC) services are people's first point of contact with the health system. PHC helps to ensure health system resilience and health community, playing a vital role in preventing and detecting diseases early, especially during pandemics. By doing so, PHC helps reduce mortality rates significantly. This study aimed to explore the challenges affecting the resilience of PHC during pandemics and to develop a Framework for strengthening that resilience.

This qualitative research was conducted in three phases in 2024. In the first phase, semi-structured interviews were held with 14 experts in PHC that originated from IRAN to identify key challenges in PHC service delivery during pandemics. In the second phase, an initial resilience Framework was designed through an expert panel involving five specialists. In the final phase, the Framework was validated using a one-round Delphi process with 21 experts. Data were analyzed using MAXQDA 2020.

The analysis revealed six main themes: processes, human resource management, financial resource management, infrastructure and equipment, sociocultural factors, and policy and planning. From the data, 20 sub-themes and 102 initial codes were extracted. Based on expert feedback, a proposed PHC resilience Framework was developed and validated through the Delphi method, achieving a consensus score of 0.90.

Health system managers and policymakers can apply the identified components of the proposed Framework to improve PHC resilience. Key strategies include optimizing financial resource allocation, expanding human resource capacity, enhancing workforce preparedness for pandemic response, promoting public awareness, strengthening social support systems, and advancing digital health and telemedicine infrastructure. These measures can help ensure the continuity of PHC services and enhance preparedness for future pandemics.