Pan American Health Organization · 2020
PAHO technical note on reorganising primary care services to respond to COVID-19 whilst maintaining essential health services during community transmission.
- Issuer
- Pan American Health Organization
- Edition
- 2020
- Audience
- Health services managers, administrators, and coordinators at the first level of care
- Evidence
- Expert consensus with references to WHO interim guidance documents
- Reviewed
- 21 Oct 2026 · GMJ
What this guideline says
GMJ summary
This PAHO technical note provides a comprehensive framework for reorganising first-level-of-care services during sustained community transmission of COVID-19. It defines three core functions for primary care: services focused on COVID-19 response (identify, report, contain, manage, and refer cases); maintaining continuity of essential services; and reducing demand on hospitals to increase hospital capacity for COVID-19 response.
The document provides detailed matrices of interventions, activities, modalities, and settings across these three functions. COVID-19-specific activities include case tracing, pre-triage and triage of respiratory patients, diagnosis following national protocols, support for isolation and quarantine, domiciliary care or care in isolation centres for mild cases, and referral mechanisms for severe cases. Alternative care modalities emphasised include telemedicine, telephone calls, tele-messaging, activation of community networks, and mobile broadcasting.
For maintaining essential services during the pandemic, the note recommends continuing care for persons with disabilities and chronic conditions (including STIs, diabetes, COPD), communicable diseases (tuberculosis, malaria, HIV), prenatal and newborn care, immunisations, sexual and reproductive health, care for older adults (particularly those aged 60 years or living alone), mental health services, palliative and end-of-life care, and surveillance of environmental health risks. The note emphasises domiciliary monitoring, longer medication dispensing periods, self-care programmes, and use of remote consultation methods.
Key points
For clinicians — doses and thresholds as stated in the guideline
- First-level care has three functions during community transmission: COVID-19 response (identify, report, contain, manage, refer); maintaining essential services; and reducing hospital demand
- Establish separated physical areas for management of patients with respiratory symptoms, with pre-triage and triage protocols
- Implement domiciliary care or isolation centre care for mild COVID-19 cases, with monitoring via telemedicine and telephone calls
- Support isolation of cases and contacts, quarantine measures, and social distancing through community network activation
- Maintain continuity of essential services including immunisations, care for chronic conditions (diabetes, COPD, STIs), tuberculosis, malaria, HIV, and prenatal/newborn care using telemedicine and home visits
- Prescribe and dispense medications for longer periods to reduce facility attendance for persons with chronic and communicable diseases
- Provide health monitoring and follow-up for older adults (focus on people aged 60 years or living alone or care-dependent), emphasising functional and mental capacity
- Strengthen first-level capacity for 24-hour emergency services, day care centres, ambulatory surgery, delivery care, medication dispensing, and blood collection
Services focused on the response to COVID-19: identify, report, contain, manage, and refer
Table extracted from the guideline
| Intervention | Activities | Modalities | Setting |
|---|---|---|---|
| Identify and report cases and contacts | Support for case tracing and early detection; Identification and monitoring of older adults; Pre-triage and triage of respiratory patients; Diagnosis following national protocols | Activation of community networks; Individual care at first level-of-care centres; Domiciliary care or in isolation centres; Telemedicine; Telephone calls; Tele-messaging | Individual, Family, Community |
| Containing the expansion | Support for isolation of cases and contacts, quarantine, and social distancing; Communication of public health measures (cough hygiene, hand hygiene, social distancing, early isolation) | Activation of community networks; Tele-messaging; Mobile broadcasting; Intersectoral support | Individual, Family, Community |
| Manage treatment, care, and monitoring of individuals with mild COVID-19 symptoms in isolation | Ensure domiciliary care or in isolation centres; Care of convalescent patients; Provision of drugs and devices for symptom management and isolation; Special measures for older adults in nursing homes | Care at home or in isolation centres; Telemedicine; Telephone calls; Intersectoral support | Individual, Family, Community |
| Refer | Mechanisms for referral of patients with severe signs and symptoms or risk factors to hospital level | In-person care at first level-of-care centres; Domiciliary care or care at isolation centres; Telemedicine; Telephone call | Individual |
Source: Pan American Health Organization, Adapting the First Level of Care in the Context of the COVID-19 Pandemic: Interventions, Modalities, and Scope. Reproduced in summary form.
From the guideline
Verbatim
“During the period of sustained community transmission, the first level of care has three functions: Services focused on the response to COVID-19: identify, report, contain, manage, and refer. Maintaining continuity of essential services during community transmission of COVID-19. Reducing the demand on hospitals to increase the capacity of hospital-based services in response to COVID-19.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
This PAHO technical note provides an essential operational framework for Georgia's primary health care system during COVID-19 community transmission. Having worked on health system strengthening in the region, I recognise that the challenge for Georgia will be rapidly scaling telemedicine and telephone consultation modalities whilst maintaining infection prevention and control standards across diverse rural and urban primary care settings. The recommendation to prescribe medications for longer periods for chronic conditions is particularly important for maintaining continuity of care for Georgia's noncommunicable disease burden and existing tuberculosis and HIV programmes. Implementation will require careful attention to rational use of personal protective equipment given global supply constraints, and coordination between the primary care network and the universal health coverage programme to ensure equitable access to both COVID-19 response and essential services. The emphasis on special measures for older adults aged 60 years or living alone is timely given Georgia's ageing population demographics.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 21 Oct 2026
Applicability
Georgia and the South Caucasus
This technical note is directly applicable to Georgia and the South Caucasus region for reorganising primary health care during COVID-19 community transmission whilst maintaining essential programmes. Georgia’s universal health coverage programme and primary care infrastructure would need to adapt the telemedicine and telephone consultation modalities within existing regulatory frameworks. National programmes should consider how to maintain continuity of care for high-burden conditions regionally relevant to the Caucasus (tuberculosis, HIV, noncommunicable diseases) whilst redeploying resources to COVID-19 response. The emphasis on care for older adults is particularly pertinent given ageing demographics in Georgia, Armenia, and Azerbaijan. Implementation would require coordination between primary care, specialised services, and community networks, with attention to infection prevention and control standards and rational use of personal protective equipment as specified in referenced WHO guidance documents.
Questions this guideline answers
Quick answers
What are the three core functions of first-level care during COVID-19 community transmission?
The three functions are: (1) services focused on COVID-19 response (identify, report, contain, manage, and refer cases); (2) maintaining continuity of essential services during community transmission; and (3) reducing demand on hospitals to increase hospital capacity for COVID-19 response.
How should mild COVID-19 cases be managed at the primary care level?
Mild cases should receive domiciliary care or care in isolation centres for COVID-19 patients in isolation, with monitoring via telemedicine and telephone calls. Provide drugs and devices for symptom management and isolation when necessary, with special attention to preventing transmission in the home and addressing social stigma.
Which essential services must continue during the pandemic and how?
Continue care for persons with disabilities and chronic conditions (STIs, diabetes, COPD), communicable diseases (tuberculosis, malaria, HIV), prenatal/newborn care, immunisations, sexual and reproductive health, care for older adults (especially those aged 60 years or living alone), mental health, and palliative care. Use domiciliary monitoring, telemedicine, telephone calls, prescribe and dispense medications for longer periods, and implement self-care programmes.
What modalities should be used to reduce in-person attendance at primary care facilities?
Use telemedicine, telephone calls, tele-messaging, activation of community networks, domiciliary care, mobile broadcasting for public health messaging, and intersectoral support. Prescribe medications for longer periods and promote self-care programmes to reduce frequency of facility visits.
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Quality & accreditation
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Other guidelines on this topic
- Recommendations for Preparing Disinfecting Solution in Health Establishments, 9 April 2020
- Requirements and technical specifications of personal protective equipment (PPE) for the novel coronavirus (2019-nCoV) in healthcare settings
- The Immunization Program in the Context of the COVID-19 Pandemic
- Rapid Assessment of service delivery for NCDs during the COVID-19 pandemic in the Americas
- Checklist for the Management of Human Resources for Health in Response to COVID-19
- Issuer
- Pan American Health Organization
- Type
- Procedures, manuals, guidelines
- Status
- Current
- Published
- 2020-01-01
- Scope
- First-level-of-care (primary care) reorganisation
- Audience
- Health services managers, administrators, and coordinators at the first level of care
- Licence
- CC BY-NC-SA 3.0 IGO
- Evidence
- Expert consensus with references to WHO interim guidance documents
- Record history
- Created 21 Oct 2026 · updated 21 Oct 2026 · next check Apr 2027
Pan American Health Organization. Technical Note. Adapting the First Level of Care in the Context of the COVID-19 Pandemic: Interventions, Modalities, and Scope, 23 April 2020. Washington, D.C.: PAHO; 2020. (PAHO/HSS/HS/COVID-19/20-0017).GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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