Ironing out wrinkles in India’s pandemic response-THE HINDU-25-03-2020


State-to-State coordination:

To what extent India’s ongoing efforts to control COVID-19 using physical distancing and isolation will be successful is yet unknown. The higher number of confirmed COVID-19 cases in States such as Kerala and Maharashtra suggest this . This highlights the importance of approaching India’s COVID-19 response from the perspective of State health system capacity. Second, it is unlikely that States which experience a COVID-19 hotspot will have the resources to manage the outbreak independently.

Ramping up hospital capacity:

Addressing the scarcity of hospital and intensive care unit beds in India is critical for providing clinical support to severe COVID-19 cases. Without flattening India’s COVID-19 epidemic curve, our current hospital capacity is so low that it will be quickly overwhelmed if infections surge. India has around 70 hospital beds and 2.3 ICU beds per 100,000 people. India’s health system is highly privatised and most of the country’s health-care capacity in terms of human resources, hospital beds, laboratories, and diagnostic centres is in the private sector.

Health workers are crucial:

This requires a substantial number of health workers, and India faces an acute shortage of them. These characteristics of India’s health workforce will affect its COVID-19 response, particularly in rural India and in States with fewer health workers. While increasing the health workforce in the short term is difficult, it is important to consider task shifting and multi-skilling strategies where a variety of health-care workers are engaged. Because it is highly likely that certain regions in India will become COVID-19 hotspots, to contain these outbreaks it is important that human and other resources can be flexibly shifted to these areas from other parts of the country.

Primary-care providers, whether they are formally trained , or lay workers or informal workers rural will likely be the first contact health workers for COVID-19 patients. For example, more than 70% of the outpatient visits in India are to private providers, the majority of whom are RMPs. Engaging these primary-care providers in the COVID-19 response is important. While this may not be easy to accomplish, COVID-19 response strategies should involve engaging these primary-care providers and providing them information on preventing the spread of COVID-19, danger signs or where to refer in case of serious illness.

Health worker safety:

One of the enduring images from Italy is of an exhausted nurse lying face down on her desk. Such actions will be particularly important if there is a prolonged response to COVID-19. India like other countries faces important health system challenges in mounting a credible response to COVID-19. Addressing these health system issues will require much effort, financing, and, in some cases, not even entirely possible to remedy in the near future.

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