Perception of Tunisian Public Health Practitioners on the Role of Primary Health Care during the COVID-19 Pandemic

Context: Primary Health Care is the first level of healthcare delivery services. Its role in the management of epidemics has been documented especially during the SARS and Ebola epidemics, and more recently during the COVID-19 pandemic. Objective: To describe public health experts' perceptions of the implication of Primary Health Care on managing the COVID-19 pandemic in Tunisia. Methods: This qualitative study was based on a structured interview covering five domains: 1. Preparedness, 2. Implication, 3. Health delivery, 4. Response and 5. Fight against COVID-19 in Primary Health Care in Tunisia. Convenient sampling was done to include public health practitioners and experts. Results: A total of 25 experts were included with a sex ratio that was equal to 0.92, including two international experts, and four that were working in the Ministry of Health. The majority of respondents affirmed that the Tunisian PHC was not prepared to fight against the COVID-19 pandemic. Concerning the response role of PHC against COVID-19, some experts stated that PHC played an important role in the early stages of the pandemic. Almost all included participants claimed that PHC was marginalized from the national strategy against COVID-19. In addition, all respondents affirmed that there had been a weakening effect of the delivery of the minimum healthcare package that was dispended by the PHC after the pandemic. However, they all expressed the ability of PHC to manage future epidemics. Conclusion: The Tunisian PHC system did not play an efficient role in the current COVID-19 pandemic. However future lessons should be deduced for further implications in potential upcoming epidemics.