Anil Parmar, Vice President-Community Investment, United Way Mumbai highlights that investing in pandemic prevention and preparedness is as critical as the response involved. A reinvented health care delivery model is required that is focused on decentralised community services and resources which are oriented toward patients
Public healthcare system is defined as the organised efforts in a country that prevents disease, prolong life, and promote health and efficiency of its people. The already overburdened Indian public healthcare system was overwhelmed when faced with a raging COVID-19 pandemic. That we will need to live with COVID-19 for the foreseeable future is a foregone conclusion. It has brought much-needed focus toward COVID and regular healthcare infrastructure and services. Limited or non-availability of beds and medical services during the crisis meant several difficulties for non-COVID patients. The pandemic has unquestionably resulted in more deaths and illnesses in the country, especially for the most vulnerable sections of the community –women, children, people with disability, and senior citizens.
COVID-19 disrupted the routine services and delivery of essential health and nutrition services. Women and children faced challenges in accessing facilities. The immunisation cycle and critical services related to nutrition for children were severely impacted. Most of the health staff was reassigned towards COVID-19 support during different waves of the pandemic. World Health Organization (WHO), in its report in 2020 on the impact of COVID-19 on Non-Communicable Diseases (NCDs), highlighted that nearly half of the countries report that patients experienced partial or complete disruption of services for diabetes, hypertension and related complications during the pandemic. One-third reported disrupted services for cardiovascular emergencies. Multiple reports mention worsened mental health challenges.
Reduced access to care also meant that conditions related to various diseases were severely impacted. Interventions related to Hepatitis B and C, HIV AIDS, were disrupted, especially for those from vulnerable communities. Community groups such as commercial sex workers and transgender community members were disproportionately affected. Such community groups had unequal access to quality health care to begin with, which was exacerbated even more.
The pandemic is also reversing the development gains made over the years and has highlighted the need to reimagine public health care beyond COVID-19. The reimagination needs to start with the ground level, i.e., primary health services. A WHO report published in March 2022 stated that household out-of-pocket (OOP) expenses on health services continue to push over 5.5 crore people in India into poverty annually. A strong primary health services support for the underserved communities can help reduce these costs. This also reduces the burden on tertiary health infrastructure and government hospitals. Needless to mention, the benefits of timely screening, diagnosis, and prevention of many diseases. India recently achieved the mark of 200 crores COVID-19 vaccine doses, which was heavily driven through primary health centres, especially in rural India. This truly speaks of the reach of public health care into the country’s hinterlands, which needs to be strengthened to provide decentralised quality health care.
Timely recruitment and capacity building of the healthcare workers, especially those at the primary level such as Accredited Social Health Activists (ASHA), Auxiliary nurse midwife (ANM), and Aanganwadi workers, need to be prioritised. They proved to be unsung champions in the fight against COVID-19. Compensation commensurate to their challenging work profile is a must. A demand that they have raised time and again. Performance-linked incentives can also be evaluated to increase their outreach and make their services more efficient.
Investing in pandemic prevention and preparedness is as critical as the response involved. A reinvented health care delivery model is required that is focused on decentralised community services and resources which are oriented toward patients. Along with this psychosocial support system needs to be integrated into mainstream public health care. There has been increased awareness of mental health issues in recent times. However, services related to these challenges need to be initiated at the ground level, especially in underserved communities where hunger, safety, and livelihood are prevalent and mental health issues are treated secondary and not accorded the importance they need.
Public healthcare is one of the most affected sectors and remains the most pivotal sector to affect the fight against COVID-19 and future pandemics. The COVID-19 pandemic has forced us to reimagine how public health needs to function to make quality health care a reality for all. Health for anyone, anywhere is truly health for everyone, everywhere.
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