November 19, 2020

Health | Insights from Charcha 2020

Re-imagining the health sector in times of COVID-19

deliberated on the response measures of the government, reflecting upon the challenges policy-makers grapple with as they switch gears and direct their energies toCOVID-19 containment. As strategies and programmes get realigned due toCOVID-19, current approaches of the government to continue the delivery of regular health services, such that the gains made in the last few decades are not lost entirely. A pandemic of this scale calls for cooperative federalism where the Centre works closely with the State Governments to plan response measures. As each state responds to the pandemic in different ways, there is a lesson to be learnt from each of them, discussed in this session. Lastly, with the spread of the disease to different parts of the country, health financing has emerged as a critical component to the COVID-19. Policy-makers should direct protection measures to reduce out-of-pocket expenditures of the public for effective containment. 


Pivoting to a community-centric healthcare model

Experts on the panel stressed the importance of people-partnered primary health care, in times like this, that is what will impact the spread of this virus, and our strength in retaliating, the most. Many western countries have focused on patient-centred care, even during this pandemic, butIndia’s population, and size, and number of people with co-morbid conditions, means that preventive, community-based measures will reign supreme in its fight against the virus. It is time to use the great resource of civil society organizations, to spread the word, and educate people who may be at risk of contracting this virus, such as the elderly, pregnant women, and immunocompromised, to practice self-discipline, and safety measures, even more so in rural areas. 


Need for a novel financing model for health

While public spending on healthcare has been low in India, Ayushman Bharat is here to change things, especially for the 66 crore poor citizens of the country. Especially during this pandemic, Ayushman Bharat has fast-tracked empanelment of 1000 private hospitals in one month, with the total number standing at nearly 10,000 hospitals, ready to serve the COVID-19 burden at immediate notice. They have also negotiated new terms with insurance agencies for COVID-19 and flu-like symptoms, adding testing and treatment to the basket of services covered under PM-Jan Arogya Yojana, as well as resolving the issue of increased cost of hospitalization to be borne by private hospitals. The migrant labourers, in a mass exodus across the country, still have access to Ayushman Bharat services in all states, regardless of home location, due to portable nature of the programme.


Attention to MentalHealth 

India’sNational Mental Health Survey 2015-16 indicated that about 100 million, almost10% of the total population, were diagnosed with some form of mental health issues. And about 85% of these people received no support or treatment necessary. Mortality caused by mental health issues was also high at the time of the survey. This suggests that India already had a mental health crisis even before the COVID-19 pandemic.

The Govt. spend on mental health is not enough and the current spent primarily focuses on doctors, hospitals and drugs. There is need to increase investment in community-centric solutions that yield more impact as witnessed in the nation’s fight with other major health issues such as the spread of Polio, AIDS etc. in past.

The emergence of the pandemic has brought additional absolute anxiety to the existing burden of mental health issues. It is highly likely to grow in coming years due to the associated economic recession. The world has witnessed increase in mental health related mortality in the western nations, especially US, in the decade following the 2008 recession which was much lesser in intensity compared to the ongoing socio-economic crisis of 2020.The recently released UN suggestions emphasizes on the need of mental health action being an integral & essential part of overall COVID-19 combat strategy. It needs to be includedin any national response policy and plan across relevant sectors. The national leadership framed National Mental Health Policy and initiated other necessary steps towards providing better care in recent past. This enables India to fight the mental health crisis in times of the pandemic. 


Continuity of regular healthcare services

The Indian health system has responded to the pandemic with a combination of screening, testing, quarantine and isolation mechanisms. Strategies have been re-aligned, resources re-distributed and responsibilities of the frontline workers repurposed to contain the spread of the disease. The focus of the health system has been directed towards COVID-19 containment in the face of this public health emergency, and rightly so. 

However, this repurposing has led to a massive disruption in the delivery of regular health services; consequently, risking the lives of those who are vulnerable as well as those who have co-morbidities associated with COVID-19. Regular health services have taken a hit, with reports suggesting a fall in institutional delivery rates, disruption of immunization services and decrease in both in-patient and out-patient treatment for infectious and non-communicable diseases. Such a grim scenario requires all stakeholders to come together to complement the efforts of an already stretched health system. 

Experts discussed the potential impact of this pandemic on different vulnerable groups and deliberate upon possible measures to secure their health and highlighted ways in which international organizations, research institutes, for-profit as well as non-profit organizations can join forces with the government to protect the vulnerable groups and minimize the direct and indirect impact of COVID-19 on them. 


The growing role of technology

Technology plays an important role, now more than ever. Teleconsultations are taking place, and are an important mode for improving access to specialist care, for several life-threatening conditions. Tele-oxygen, tele-ICU, as future technologies that are needed NOW. However, the Indian health care system is centred around primary healthcare, in small clinics everywhere. Their strength needs to be leveraged, so that after this crisis, we come out with a stronger primary health system than ever before. Our referral systems need to be stronger, so that apps like Arogya Setu can be of much better use. All these are recommendations to make our health system more resilient when faced with pandemics like COVID-19 in the future. This is a historic opportunity to introduce a paradigm shift in the way health is perceived in the country.


Challenges, and the way forward

The novel COVID- 19 virus has sent nations on a desperate chase for a solution out of it.Doctors, scientists and experts across nations have huddled together, co-ordinating and working together to find a drug or a vaccine that is efficacious against the disease. A review of clinical trial registries, as ofMarch 2020, identified 536 relevant registered clinical trials. These clinical trials that would usually span over years are being compressed into weeks with almost instant transfer and sharing of knowledge and medical advances. Five months into the pandemic, while there are a number of trials going on, with some showing positive signs, we still have no effective treatment. Our exit strategy is unclear therefore, the four public health measures - testing, isolating, tracing and lockdown still remain most important.

Organizations in healthcare, both in the for-profit private sector, and the not-for-profits, can combat the threat they face as they fight for survival. Organizations may report negative impacts related to the virus, such as dwindling revenues from reduced footfall, or an inability to access traditional modes of fundraising.Staffing and operations disruptions, travel restrictions limiting contact with stakeholders, increased costs, and disturbed supply chains have affected nearly all players. With the need to factor organisational survival into decision-making, organizations, global and domestic, are acting fast to adapt to the changing landscape. Non-profit leaders, as well as industry executives need to come together to navigate the on-going crisis, pro-actively plan for future and re-align with evolving priorities.

Pressure points

  • Escalation of the health crisis before discovery of cure, or vaccine
  • Resource and capacity crunch in healthcare systems at all levels
  • Financing for pandemic, and regular healthcare needs
  • Mental health challenges amidst economic distress
  • Survival and effectiveness of nonprofits, healthcare businesses at the grassroots

Download the full Insight report on Charcha 2020, covering 16 events and 150+ hours of discussion.

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