Questioning global health in the times of COVID-19: Re-imagining primary health care through the lens of politics of knowledge

Abstract

The advent of the COVID-19 pandemic and the inequitable response to it has created a space for rethinking the knowledge translation that informs current health policy formulation and planning. Wide recognition of the failure of global health governance and national health systems has led to calls for reviving the Primary Health Care (PHC) agenda for post-COVID health systems development. Despite the joint international declaration on PHC made four decades ago, it has had limited application. This paper argues that the recent attempts to rethink PHC will prove inadequate without analysing and learning from the politics of knowledge (PoK) underlying global health policy and planning. Even with the growing relevance of the spirit of the Alma-Ata Declaration (1978) and its operationalisation as detailed in the report of conference proceedings, reassessment of reasons for its limited implementation continues to be located largely in the political economy of the medical establishment, the international economic order or in national governance flaws. Failure to address the dominant knowledge paradigm in the Alma Ata articulation of PHC has contributed to its limited application. This calls for expansion in the analysis from knowledge translation to generation and hierarchisation of knowledge. The paper discusses how the application of PoK as an analytical lens helps understand the power equations underlying the process of knowledge generation and its translation into policy and practice. Beneath the techno-centric and commodified health system is the dominant ‘knowledge’ system whose foundations and assumptions ought to be interrogated. By following a PoK approach, a reorientation of thinking about the relationship between various forms of knowledge and knowledge holders is anticipated. A new health service system design is outlined—translating the spirit of PHC of 1978 into a ‘PHC Version 2.0’—that addresses the PoK gap in operational terms, with an approach to guide all levels of healthcare. It suggests how the world can be empowered to respond better by engaging with diverse ontologies and epistemologies to conceptualise knowledge and frame policies. Further, in the contexts of Asia, Africa and Latin America, it can contribute to the development of self-reliance to democratise general health policy and planning in the post-pandemic period.