Prof. Sanjay Zodpey, President, PHFI stresses on the major lessons learnt from the pandemic
The COVID-19 pandemic has stretched the health systems globally. The rise and fall of cases, emergence of new variants, and designing a coherent and science-based response that nimbly respond to these challenges have been the hallmark of the past three years. India has performed commendably to these challenges and our country has been at the forefront of evolving a holistic response with strong community participation and effective vaccination at a large scale. While the occurrence of a pandemic cannot be foretold with accuracy, we are certain that man lives in the midst of diseases. Large scale changes in planetary ecology, emergence of antibiotic resistance in bacteria, and a propensity of easy global transmission through air travel will continue to pose new epidemic challenges in the not-so-distant future.
The response to a globally devastating pandemic will prompt some immediate changes at the global level in declaring a pandemic, but we must realise that the real response will be driven at the ground level within the countries. Health systems will have to be ready to detect the earliest signals of a new challenge and design an appropriate response within a short time-span.
There are three important lessons that we must remember for the coming few years. These lessons are related to an enhanced preparedness & response system, creating quality health care infrastructure, and broadening the community engagement in health.
The emergence of a disease and the concomitant rise in disease numbers at the initial stage are often hidden beneath the big numbers of clients observed by the health system. The analogy is that the early cases of the new disease are not just a needle in the haystack, which must not only be eventually detected, but as soon as they emerge. Detecting such a tiny but important signal necessitates a highly sensitive surveillance system which is capable of identifying such events. A majority of the cases of illness in India reach out to private sector, and at times to informal care providers within the community, for their problems. Consequently, our surveillance system must have a sizeable presence in the private sector that collaborates with the wide network of care providers to routinely capture this information. This forms the first step of obtaining the data. We will have to evolve an even greater capacity to sift through this data and make quick inferences. The advances in big data analytics and artificial intelligence will have to be leveraged through a systematic approach at the district and state level to provide immediate indications of any suspicious occurrence. I anticipate that in the coming times, we will witness a closer collaboration between health and Artificial Intelligence driven algorithms.
We will have to re-examine our current capacities for service provision from two dimensions: adequacy and distribution. While two-thirds of India lives in the rural and semi-urban areas, our health care services, especially in the private sector, are located in urban areas. This creates a situation wherein there is a greater stress on the health infrastructure, both public & private, in the rural areas of the country during a pandemic. This is a structural problem which does not have a short-term solution. The government has significantly increased the capabilities of district hospitals in the past five years and is committed towards implementing the updated Indian Public Health Standards for health care institutions. This is a welcome step and will certainly yield positive results in the medium-term.
The community is the focal point for all the public health action. It has the capacity to amplify the government’s response through its meaningful participation. Community participation is dependent on a clear and sound call to action. The state and district health systems will have to travel the extra mile through the formal and informal networks that exist within the community. The presence of the health and Wellness Centres across the country will provide the last mile connect, but we will need a continuous engagement with the community on all health matters round the year for it to partner with us at short notice. We will have to think of newer paradigms of community engagement in health in the times to come. We will have to maintain emphasis on supporting government efforts through a broad-based partnership with voluntary organisations, civil society, and non-governmental organisations.
Disease cannot be perpetually treated by the service providers. We will have to embrace the idea of prevention, wherein we create a health promoting environment that encourages citizens to stay healthy. Healthy citizens are the foundations of a progressive country. We must continue with the strong momentum in health into the future through a science and society driven approach.