## 5 Discussion  
PHC is an alternative approach to providing the health services that have been disrupted due to the COVID-19 pandemic. PHC provides community-based services where health care workers and community health workers use portable medical devices and mobile applications to provide health services in the outreach areas or through home visits. The PHC improved access to health services in the community level when there are restrictions on visits at the health facilities such as during the COVID-19 pandemic. PHC can reduce the risk of being exposed to the COVID-19 virus on the way to health care facilities, in the waiting rooms, and when meeting with health workers [27,30]. It can determine whether a patient requires further medical appointments to avoid unnecessary visits. Real-time data collection of certain parameters in the PHC enables health care providers to observe patient conditions directly [31], and indirectly save costs, time and travel for the patients [32]. At the same time, the PHC has empowered and increased community participation in NCD prevention and treatment programs [33,34]. Compared to conventional telemedicine, which only facilitates consultation with health workers, the PHC is equipped with clinical decision support systems. It provides alerts and recommendations through a combination of physical examinations, simple laboratory tests related to NCDs, cognitive, mental health and behavior assessments. The algorithms are embedded into the mobile applications where users are assisted to measure the health risks of a patient and determine options for further actions. However, incorporating the PHC into routine community-based activities requires further validation and continuous refinement of the algorithms, with organizational formation, while strengthening the human resources capacity and legality aspects [35]. Improving the capacity of community health workers to use mobile apps was also a solution for supporting community members or patients who have low smartphone experience and can benefit from the emerging information and communication technology [36]. The continuity of patient health records; real time monitoring of patient health status; clinical-decision-support systems through automatic triage from the patient observations; targeted teleconsultation and recommendation of patient referral, health promotion, and education are enhancements to the current community-based services in primary health centers. Moreover, the study showed there was a good user acceptance of the developed mobile technology to facilitate PHC implementation that can further improve the adoption of PHC at the community level [37]. The implementation of PHC or telemedicine requires interconnected technology such as electronic medical records, high-speed Internet access [38], standard applications and mobile devices. It is still challenging in some areas that have limited infrastructure and expertise, lack of Internet coverage, non-interoperable electronic medical records and fragmented information systems at the health facility level. High-speed Internet access is required to have synchronous teleconsultation while electronic data capture serves as the tool to collect patient data as their medical records achieve optimal service [39]. In Bangladesh, for example, clinics are still using paper-based medical records which do not make it possible to continuously monitor patients' health status effectively. The Samigaluh 2 Primary Health Center in Kulon Progo District which is located in a mountainous area faced the Internet problem to operate the PHC mobile apps. Many health care facilities located in rural areas tend to have limited resources to use this type of technology [39]. This is exacerbated by the issue of security, privacy, confidentiality, and data protection. The PHC is still being implemented while the mobile application is continuously improved to collect health data at the community level, including interoperability with electronic health records at the primary health centers.