Sandeep Sharma & Deepanwita De
Founder/Manager Communications
If there is one thing that we have all learned in the last one and a half year, is that health is of utmost importance. COVID-19 will go down in the annals of history for the irrevocable damage that it has caused to society, but also for the transformation that it has brought about in our thinking and attitude towards life, technology, environment, education, health etc. The fad of the new normal is a sour pill, but the more we conform to it, the easier our lives would be. India is still reeling under the weather of the second wave, which was extremely fatal for vast communities in rural and urban areas. Although metropolitan cities had a better resource system to mobilise, the struggle to breathe in rural areas was mostly unrecorded.
We will probably never know the girth of the problem that rural India faced during the second wave, but we can draw numerous inferences from projected death ratio in urban to rural India, (recorded & unrecorded), distressing testimonies from rural doctors, nurses and vulnerable communities, estimated population pushed towards poverty, so on and so forth. And all these parameters project a grim reality.
Like the second wave, the penetration of the virus in the rural populace was unanticipated and widely miscalculated. The rural healthcare system which is in general burdened by the lack of infrastructure nearly crumbled to support the epidemiological crisis. However, access to healthcare is not just about infrastructure but also low-cost health insurance, widespread awareness, and even acceptability of services.
We are likely to face these problems in perpetuity if there is not a complete overhaul in our healthcare structures and address the larger problems of adequacy, equality, scalability, admissibility. While working on the COVID-19 response at INDIAdonates with rural hospitals, some poignant issues came to light and we are going to pen them here, for the benefit of the community.
Telehealth – With the first COVID lockdown almost all private healthcare providers moved to telehealth services, but this fascinating transformation couldn’t seamlessly make in-roads to the villages in India. Telehealth is not a new concept, in fact, Telemedicine - an offshoot of telehealth has been in India for many years. ISRO made a modest beginning of bringing telemedicine in rural India in 2001[i]. In the past few years, many private players have entered the telemedicine market like Narayana Hrudalaya, Asia Heart Foundation, Apollo, etc, however, it has not been enough to integrate every village and town so far, which proved a major bottleneck during the ongoing COVID-crisis.
During our intervention with one of the hospitals in Lamtaput, Odisha, telehealth proved an effective ammunition to fight symptomatic cases of COVID. The hospital’s community outreach arm distributed oximeters, thermometers, masks, IEC materials along with phone numbers in the tribal belts of Southern Odisha. In case of mild symptoms, the community members were given a helpline number as opposed to travelling 60-100kms to the hospital. '
Telehealth, in this existing scenario, cannot be treated as a contingency plan, instead, it needs to be wired to increase accessibility and reduce the burden on the physical health care system, as India moves towards digital transformation. While private players have a huge role to play in scaling such an operation across the remotest corners, the community workers at the grassroot level can ensure acceptability within communities, as previously mentioned.
Allocation and creation of resources - In the coming days' health needs to be prioritized across the spectrum, because unless we ensure healthy living, everything else will take a back seat. And to our mind, the creation and allocation of resources can be divided into long term and short term objectives. Long term objective of the creation of resources can be addressed by looking at the doctor population ratio in India, which is currently at 1:1436 against the WHO recommended 1:1000, according to the Economic Survey 2019-20. This distribution is further skewed with urban to rural doctor density being at 3.8:1. It might take a decade to fill this lacuna but what can be done on an interim basis is to incentivize paramedical education in both urban and rural areas. Educational institutes and NGOs can create synergies to prepare a cadre to address emergencies and long term care.
As a short term objective, we need to revise and re-engage communities on existing schemes and benefits available at our disposal. The Pradhan Mantri Jan Arogya Yojana is an insurance scheme available for secondary and tertiary health services for poor and vulnerable communities. Since the launch of the scheme, more than 150 million beneficiary cards have been issued and offers coverage of 5,00,000. However, due to its decentralized approach, and lack of awareness, many are still missing out on this opportunity to get affordable & quality health care. NGOs are in a unique position to solve this issue, as they are closer to the community and share a bond, which is otherwise impenetrable to authorities. Even as vaccination drives pick up steam, while NGOs directly cannot implement vaccine drives, they are better placed to mobilise communities than any other private player and move the country closer from Availability, Access to Acceptability.
As we begin our recovery to rebuild lives around the world, we need to recognize the power of communities, individuals and agencies in redesigning our approach towards health. 364 million Indians continue to experience acute deprivations in health, nutrition, schooling and sanitation.[ii] This number might magnify as COVID-19 pushes thousands towards destitution. Hopefully these interventions at a large scale could help us to mitigate the future challenges, but it will also give a much needed breather to the doctors who not only saved millions of lives but continues to hold the fort with determination and courage. On the occasion of Doctor’s Day, (1/07/2021) it is important to remember and commemorate the contribution of the Doctors who are fighting effectively against the virus, despite the adversities.
References:
[i] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6618173/
[ii] https://www.in.undp.org/content/india/en/home/sustainable-development/successstories/MultiDimesnionalPovertyIndex.html
