Enhancing European governance for health crisis management: A proposal for the effective integration of primary healthcare systems into emergency preparedness and response plans.

BACKGROUND: Primary healthcare (PHC) facilities are fundamental components of health systems across Europe, serving as the first point of contact and ensuring continuity of care. However, the COVID-19 pandemic exposed significant gaps in their preparedness for large-scale health crises. Although emergency preparedness frameworks developed by the World Health Organization (WHO) and the European Union existed, they often lacked adequate integration of PHC into comprehensive public health (PH) emergency preparedness and response plans (EPRPs). OBJECTIVES: To identify regulatory and operational gaps in the integration of PHC into existing European health EPRPs; to evaluate challenges related to governance and health information system (HIS) interoperability between PHC and PH authorities; and to develop a multilevel governance model to harmonize the role of PHC across the continuum of health crisis management in future PH emergencies. MATERIAL AND METHODS: The EURODATA research group conducted a comprehensive analysis of the role of primary care during the COVID-19 pandemic. The study included a review of international and European health policies and emergency preparedness frameworks. The analysis followed the health EPRP framework and focused on regulations, governance structures, HIS interoperability, and the role of PHC. Based on these findings, recommendations were developed to strengthen EPRPs for European PHC systems. RESULTS: The analysis identified limited regulatory guidance on coordination between PHC and PH authorities, insufficient interoperability of HIS, and gaps in local coordination. The proposed EPRP framework addresses these shortcomings by promoting improved governance, integration of information systems, and harmonization of the role of PHC within coordinated health crisis management. CONCLUSIONS: Strengthening the role of PHC in health emergency preparedness is essential for building resilient health systems. The proposed EPRP provides actionable strategies to address the identified gaps and improve the integration of PHC into health crisis management. Implementation of these recommendations may enhance the capacity of European PHC systems to respond effectively to both acute and chronic health needs during future crises.