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Wednesday, January 27, 2021

For India, pandemic is an opportunity to move towards universal health coverage

Health has been and is at the front and centre now and will be so for a year or more. This is the time to highlight the need for increasing investment on health services, to strengthen them and make them fit for future challenges.

Written by Chandrakant Lahariya , Gagandeep Kang , Randeep Guleria | Updated: December 9, 2020 8:57:38 am
Tackling the pandemic required experts to draw on experience from dealing with other diseases even as epidemiologists, clinicians and biologists tried to learn as much possible, and as quickly as possible. (Illustration by C R Sasikumar)

It has been only nine months since COVID-19 was declared a pandemic on March 11, but the world has changed in previously unimaginable ways. International travel was halted, countries were locked down, and schools closed (in some countries, they remain closed). The health systems in many of the wealthy countries struggled; some were overwhelmed due to inadequate beds, supplies and healthcare workers who struggled with infection, fatigue and stress, recognising their inability to care for everyone who needed it. Outside the healthcare system, the information epidemic (termed an “infodemic”) in society led to fear, stigma and discrimination that added to the damage caused by the virus. The pandemic has touched every citizen and has had a substantial effect on all walks of life.

As cases increased and the immediate response to the pandemic was ramped up, the challenges faced by migrants and the poor became some of the defining images of the pandemic. The closure of schools affected the learning of children, with those from disadvantaged backgrounds struggling to cope and frequently giving up. Access to non-COVID-19 essential health services was affected, the impact of which will be fully understood in the time ahead. Reduction in business activities caused massive losses of both formal and informal employment and a fall in economic growth. All these highlighted how much population health matters for society and the economy.

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Tackling the pandemic required experts to draw on the experiences of dealing with other diseases even as epidemiologists, clinicians and biologists tried to learn as much and as quickly as possible. Public health interventions of “test, trace, isolate and treatment” were introduced and scaled up. Molecular testing and laboratories were expanded. Non-pharmacological interventions of face masks, hand washing, and physical distancing rapidly became the norm. COVID-19 related health services including hospital beds, intensive care unit (ICU) and ventilator beds were increased even as research on drugs and vaccines kicked off at an unprecedented rate.

About a year after the first cases were reported, we are in a different position than at the start. Even in countries now experiencing second and third waves, doctors, public health specialists and policymakers have a better sense of the interventions that are required. Many treatments initially proposed, based on expert experience, have been tested and removed from management strategies even as modified protocols have improved survival rates.

Vaccines have moved even faster than drugs with over 300 vaccine candidates being developed, nearly 40 of them undergoing clinical trials, a dozen of which are at the phase three stage, and at least one has been licensed post-phase three trials under conditional emergency use authorisation (EUA). This highlights the importance of science, technology, multilateral partnerships such as the Coalition for Epidemic Preparedness Innovations and the WHO.

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The COVID-19 pandemic has affected everyone, but we have stories of grit and valour of healthcare workers, particularly those at the frontline, such as the accredited social health activists (ASHA) who visited hundreds of households repeatedly during the pandemic to ensure that every possible case is identified as early as possible. Health has been and is at the front and centre now and will be so for a year or more. This is the time to highlight the need for increasing investment on health services, to strengthen them and make them fit for future challenges.

The countries which handled the pandemic best (Thailand and Vietnam) have well-functioning health systems designed to deliver primary healthcare services. These countries also have strong preventive and promotive health services as well as a dedicated public health workforce. Their governments had made sustained investments in health over decades. In contrast, countries which focused mainly on hospital centric medical systems struggled.

Second, the role of community health workers in recognising, referring and motivating individuals for therapy was remarkable. These unsung heroes work informally and for a pittance. If we are to build back better, we need to give them better recognition, salaries and career progression. Third, community trust and participation is essential for implementation of non-pharmacological interventions. Dharavi in Mumbai is an example of the difference community participation can make. Finally, the response to the pandemic was multi-sectoral — health staff, policy makers and technical experts in multiple domains worked together to identify and implement solutions.

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Outside of the immediate response, the need for timely and quality data in a health information system was recognised again during the pandemic. Without real time data on testing, disease surveillance and other outcomes, tailored responses are near impossible. The solutions that have brought us hope have come from long-term private or public investments in scientific research and developments. It is self-evident that we need to emphasise what is feasible when resources are available.

Will we have another pandemic? Yes. Will we be better prepared? Yes, but systems for surveillance and preparedness do not build themselves. Future readiness needs to start now, and we have the resources and knowledge to do this — all we need is commitment and that is outlined in the recent National Health Policy 2017 and reiterated in the report of the Fifteenth Finance Commission, which for the first time has a dedicated chapter on health.

We and others have an opportunity and should use the challenge posed by the pandemic to accelerate long pending initiatives for health system reforms, accelerating towards universal health coverage — the central goal of the National Health Policy 2017. We owe it to our society and ourselves.

This article first appeared in the print edition on December 9, 2020 under the title ‘Needed: More wealth in health’. Lahariya is a public policy and health systems specialist, Kang is a virologist and vaccine researcher and Guleria is Director of All Indian Institute of Medical Sciences, New Delhi. Their book Till We Win: India’s Fight Against The COVID-19 Pandemic will be published by Penguin Random House India this week. Views are personal

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