Innovative shortcuts and initiatives in primary health care for rural/remote localities: a scoping review on how to overcome the COVID-19 pandemic

Introduction: The COVID-19 pandemic has emerged as one of the greatest challenges to societies, world health systems and science in the last century, making it imperative to restructure care networks. Therefore, it is essential to discuss the role and initiatives of Primary Health Care (PHC) to deal with it. However, regarding the response to the pandemic, including the current global effort against COVID-19, the nuance of the rural/remote PHC context in the pandemic is barely visible. Rural remote communities have differentiated health risks, such as socioeconomic disadvantages, difficulties in mobility and access to health services, in addition to linguistic and cultural barriers. This scoping review aims to analyze the set of individual and collective initiatives and innovations developed to face the COVID-19 pandemic, within the PHC scope, in rural/remote areas.
Methods: A scoping review methodology was applied to peer-reviewed articles. Eight databases were searched to identify scientific articles published in English, Spanish and Portuguese initially from January 2020 to July 2021, complemented by a rapid review, from January 2022 to April 2023. The main focus sought in the literature was the set of initiatives and innovations carried out within the PHC scope in rural/remote locations during the pandemic, as well as the comparison with pre-pandemic situations and between different countries. The bibliographic information of each search result was imported into Rayyan (Intelligent Systematic Review), followed by the screening and eligibility stages, performed independently by two reviewers, with a third reviewer being assessed in case of conflicts.
Results: This review included 54 studies, with publications mostly from Australia, Canada, USA and India. The main PHC initiatives were related to access; to the role of Community Health Workers and Health Surveillance; and to the importance of placing, retaining and valuing human resources in health. Cultural, equity and vulnerability issues occupy a major place among the initiatives. Regarding the innovations, telehealth and customized communication are highlighted. From an organizational point of view, rural remote locations showed enormous flexibility to deal with the pandemic and to improve intersectoral activities at the local level. The description of rurality and remoteness is practically coincident with that of their specific populations, present in geographic areas of difficult socio-spatial and cultural access. Rarely, there is an index to measure rurality, or its description deals with the need to overcome distances and obstacles.
Conclusions: The findings highlight and summarize knowledge about initiatives and innovations developed to face the COVID-19 pandemic, within the PHC scope in rural and remote areas in the world. This review has identified collective, clinical, intersectoral and, mainly, organizational health initiatives. An articulation between different government levels would be paramount in evaluating the implementation of policies and protocols in remote rural locations for future sanitary crises. Innovations and lessons learned are equally relevant in strengthening health services and systems. This issue calls for considerable further exploration by new reviews and empirical research that seek evidence to assess the sustainability and effectiveness of the implemented measures to face post-pandemic difficulties and other adversities.
Keywords: Primary Health Care, Rural Health Services, COVID-19 Pandemic, Organizational Innovation, Telehealth, Health Services Accessibility