Even as India is gearing up to minimise the spread and impact of COVID-19, the months ahead are likely to pose additional challenges for our health system, including those caused by weather events and natural calamities.
Temperatures have started to increase in many parts of the country and are expected to go up to 45 degrees Celsius by mid-May in states like Delhi, Punjab and Haryana. Heat waves also affect large parts of Rajasthan, Madhya Pradesh, Maharashtra and Uttar Pradesh, which together account for around 50% of total COVID cases in India. This period of heat waves will be followed by the monsoon.
Heavier rainfall patterns, coupled with unplanned urban growth in many cities, can make large numbers of people vulnerable to the dual risk of COVID and non-COVID related health issues. In fact, across the world, COVID is affecting urban areas disproportionately and a similar pattern has been observed in India as well thus far. Let us take the example of Dharavi in Mumbai, one of the most densely populated areas in the world. It is challenging enough controlling the spread of COVID in such an area let alone also having to deal with diseases caused by potential flooding that Mumbai often has to contend with every year.
So, what can States do to minimise disruption to non-COVID health services during the pandemic?
Firstly, a data-driven and hyper-localised approach is of the essence. The spread of COVID is not uniform and there are considerable disparities between and within States. For instance, nearly 50% of India’s COVID cases are concentrated in just 10 districts across the country. While the Centre has outlined a broad approach for classifying districts as red, orange and green zones, States need to undertake a more detailed classification and mapping of hotspots to determine how strongly they need to focus on COVID containment and management vis-à-vis the delivery of other health services. A blanket focus on COVID across the State, at the cost of other health issues, might not be warranted or appropriate. For instance, it is quite possible that many districts are faced with a higher burden of jaundice, typhoid, malaria or dengue during the summer and monsoon months, compared to COVID. Moreover, micro-level mapping of the COVID outbreak at the sub-State level can also help to identify non-hotspot areas where routine and elective services may be relocated at this time.
Designate Focal Points
Second, States should designate a focal point in every district with the overall responsibility of identifying which essential health services need to be prioritised and ensuring that their delivery is not disrupted. Some critical health services include vaccinations; basic diagnostic, imaging and lab services as well as interventions related to pregnancy, childbirth, tuberculosis and malaria. With respect to management of non-communicable diseases, the focus must be on ensuring a regular and uninterrupted supply of medicines, in addition to adequate provisions for emergency and acute care.
Map Healthcare Providers
Third, a mapping of providers in the public and private sectors should be carried out followed by the preparation of a joint action plan for health service delivery. The need of the hour is for the public and private sectors to work synergistically. The nod given by the Centre to the opening of outpatient departments in hospitals and medical clinics in all zones as part of lockdown 3.0 guidelines is an important step in this direction. Of course, it is imperative that physical distancing norms, protective gear for healthcare providers and sanitisation of medical equipment is prioritised in health facilities offering non-COVID services as well.
Protect Your District Hospitals from Disruptions
Fourth, all possible efforts should be made to minimise disruptions to the working of district hospitals so that they can continue to provide acute care services like treatment of fevers, headaches, chest pain and pregnancy-related issues. Many States have designated COVID hospitals, however, in areas where this is not possible, a separate wing of the district hospital can handle COVID patients while other departments continue to deliver services as usual.
Lay Down Protocols for Managing Patients
Fifth, clear protocols need to be put in place for management of patients after they present to the health system. After all, patients with or without COVID initially access health services in the same manner. Mechanisms for screening and referral of patients to ensure rational use of scarce resources, becomes all the more important at a time when health system capacity is already stretched. Utilisation of telemedicine at Health and Wellness Centres and hospitals in urban areas should also be explored as a means for providing good quality medical advice to patients, especially in rural and remote places.
Telemedicine can also help to reduce the influx of patients at hospitals who perhaps have a simple cold or cough but are concerned that it could be COVID. It is quite natural in times like these to witness an increase in the numbers of people who fall in the category of the “worried well”. Unnecessary crowding at hospitals ends up wasting precious time and resources, diverts attention from those who actually need critical care and puts people at risk of contracting diseases by visiting a high-risk setting like a healthcare facility when they do not in fact need to.
Insentivise Healthcare Workers
Finally, to reinforce the health workforce, those who are currently on part-time contracts could be asked to work full-time with due compensation or adequate incentives. Volunteers also need to be engaged for contact tracing and screening patients, apart from augmenting health services in facilities. A few weeks ago, the Central Government had put out a request for engaging volunteer doctors who are fit and willing to provide their services in public health facilities and training hospitals. Some States have also been utilising final-year medical students to good effect. Government workers in non-health sectors could additionally be repurposed for performing support roles like administration.
It is imperative that we find a balance between managing COVID and non-COVID related health conditions. Else we run the risk of reversing the gains made in the control of diseases like tuberculosis and malaria; falling behind in the timely management of non-communicable conditions like cancer and mental health as well as losing more people to vaccine-preventable illnesses like measles.
(Urvashi Prasad is a Public Policy Specialist with NITI Aayog. She can be reached at @urvashi01. The views expressed in the article are the author’s own. FIT neither endorses nor is responsible for the same.)
(Disclaimer: The views expressed in the article are personal)
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