Poonam Muttreja, public health expert and Executive Director, Population Foundation of India, urges that it is essential to put in place key infrastructure before arbitrarily announcing decisions imposing lockdowns. In her view, we must recognise that without a focus on health equity, India will fail to achieve its health and development goals
The COVID-19 pandemic has had far-reaching effects on health care in India and around the world. The nation-wide lockdown that started on March 24, 2020, took its toll not only on the country’s economy but the state of its health system as well. Given the restrictions on movement during the lockdown, people’s ability to access health care services was severely impacted. Disruptions in supply also meant that health care products could not reach those who needed it the most.
Maternal and child health have been among the most severely impacted, with the lack of access to ante-natal care leading to a rise in preventable deaths. Other essential, life-saving services, such as for family planning, were disrupted due to the country-wide lockdown in India. An estimated twenty-six million couples were unable to access contraceptives in 2020. Close to 2 million Indian women were unable to access abortion services due to COVID-19. The lifting of the lockdown and a slow easing of restrictions have lowered barriers for access, but the situation is still far from the pre-COVID-19 scenario.
Given the severe impact of the lockdown, it must be only viewed as a last resort. However, today, with a relaxation of the adoption of Covid Appropriate Behaviours (CAB) and a more virulent strain of the virus causing another wave of infections country-wide, curfews and lockdown seem inescapable.
Delhi and many other cities in the country are currently under lockdown again to try and curb the unprecedented rate of infection. There is almost a sense of déjà vu as we witness the scramble for COVID-19 tests, hospital beds, oxygen cylinders and other emergency services. Patients struggling to get blood plasma or other support have been reaching out via social media, after all else has failed. Elected surgeries have once again been put on hold and across the country regular OPD services disbanded. Our health systems are overburdened and what might have been an opportunity last year to significantly strengthen our capacities seems to have been missed.
Experts in the public health domain have said that a lockdown may be inconvenient but as the situation worsens it seems inevitable. Professor K Srinath Reddy, President, Public Health Foundation of India (PHFI), has said that the solution to rising numbers will not be easy or quick. While some say that a lockdown could protect lives, there are, however, others who believe that it will have a devastating impact on livelihoods. We are already witnessing the exodus of migrant labourers from Delhi, Mumbai and other cities back to their homes. Last year, millions of people walked home or risked their lives in crowded trains and buses, contributing significantly to the rise in cases, especially in rural areas. This threat to migrant workers can be avoided by planning and taking timely action. Measures such as long-term work from home, staggered public transportation, micro-lockdowns and micro-containment zones in identified hotspots, restrictions on public gatherings and strict enforcement of CAB will all be key to saving lives.
In 2021, as we witness an exponential rise in the numbers of cases, on a graph much steeper than experienced anywhere else in the world, we must weigh the decision to lockdown carefully. It is essential to put in place key infrastructure before arbitrarily announcing a decision. Emergency situations, such as the COVID-19 pandemic, need the health system to restructure itself and prioritise the differential needs of vulnerable groups. In order to respond to the long-term consequences of COVID-19 as well as prepare ourselves for similar situations in the future, there is an urgent need to enhance budgetary allocations for public health systems, to strengthen existing infrastructure and expand capacities to ensure health care for all. Last year’s experiences taught us that there is a burgeoning need to equip health facilities at all levels, country-wide with the tools to deal with rising cases as well as continue providing essential non-COVID services for those with existing health care needs.
We must also educate and empower people to prevent the unnecessary spread of the virus. Improved social behaviour change communication programmes, for example, can be implemented to ensure that people are aware of the urgent need for self-care, such as to wear masks, wash their hands and seek medical care promptly when needed.
Greater investments in public health and prioritising universal health coverage will make India’s response to health emergencies more robust by strengthening free or subsidised testing, treatment and vaccination along with provision of uninterrupted essential health services for the most vulnerable and marginalised groups. As the government realigns health policies, programmes and infrastructure in the wake of COVID-19 and prepares for future pandemics, we must recognise that without a focus on health equity, India will fail to achieve its health and development goals.
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