International Primary Health Care and COVID-19 Study

June, 2020

Prof Felicity Goodyear-Smith reports on the recent research that has been done through WONCA networks. The research team is Felicity Goodyear-Smith, Karen Kinder, Robert Phillips, Andrew Bazemore, Cristina Mannie, and Stefan Strydom


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

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:
     o Having readily available testing at the time of first COVID death
     o Testing all incoming travelers
     o Testing symptomatic persons
     o Testing those exposed to COVID positive individuals

• Movement Restrictions: Lower death rates were observed in where participants indicated that the following testing practices were employed:
     o Physical distancing
     o Event closures
     o Closure of all but essential services
     o Isolation based on contact tracing
     o Self-Isolation in households
     o Quarantine for suspected cases

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
• Irrelevance of PHC if potential carriers were stopped at the border (most relevant to small island nations)
• PC not being engaged


1131 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. Map shows the distribution of respondents.


Univariate, bivariate, regression model analyses, and thematic analysis were employed to arrive at the preliminary results.

Current Public Health and Primary Care Responses:

• Hygiene Measures: hand washing and wearing PPE
• Limit person-to-person contact: physical distancing, ban mass gatherings, primary care provided remotely, self-isolation, and shutdown
• Identify Cases: testing, contact tracing, 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

“Primary health care perceptions of COVID-19 responses on rate of death: an international study”, Felicity Goodyear-Smith, Karen Kinder, Andrew Bazemore Robert Phillips, Stefan Strydom, Cristina Mannie, under
consideration for publication, 2020. For further information, please contact Andrew Bazemore at