By Debapriya Sen Vaite

New Delhi, May 19, 2020: Governments around the world are reorienting their outlook towards public health amid the Covid-19 pandemic.

While influenza pandemics have occurred in the past and have a potential to reoccur, the current situation must be viewed in the larger context of overall public health emergency preparedness.

The pandemic may be treated as an opportunity to ensure the country’s health system is well equipped to respond better and faster to any health crisis. Achieving this requires a sustained partnership between the healthcare system and the community within which they are operating.

The role of primary health care becomes most significant in such situations as it is the first point of contact for the community connecting it with the national health system and is imperative to optimally address the preventive, curative and rehabilitative services at the community level.

There has been a visible impact on the primary health system exposing its vulnerabilities associated in responding to severe disease outbreaks. An analysis of the recently released National Health Mission (NHM) data for the months of January to March this year, when compared with the 2019 data, shows a severe disruption of critical health care services.

A sharp decline in vital immunization for children, maternal health care and potential lifesaving medical treatment, TB treatment and screening for HIV/AIDS has also registered a decline. Treatment for non-communicable diseases and emergencies has fallen as well. Coverage of vaccinations against early childhood diseases – including BCG, Typhoid, Rotavirus1, MMR – has gone down.

The data indicates that many services for pregnant women, for instance providing iron and calcium supplements as well as tetanus injections continued in March, indicating that accredited social health activists (ASHA), and auxiliary nurse and midwives (ANMs) were largely able to continue their work.

However, the number of institutional delivery registered a sharp fall. Expecting mothers are either enable to reach the hospitals and health care centers or are afraid to visit fearing infection. NHM data shows slip in medical treatment (inpatients and outpatients) for all diseases including malaria, dengue, respiratory infections, diabetes, and hypertension. This downward trend in immunization coverage, tests, screenings and critical medical interventions can leave children and vulnerable adults at risk of infections, diseases and malnutrition and can increase the risk of potential disease outbreaks.

An efficient primary health care system can reduce the burden from tertiary care and serve as a shield against any further strain on an already overburdened health system. Focus on comprehensive primary health services has always been part of India’s health strategy and policies.

India adopted a decentralized healthcare model much before the Alma-Ata Declaration (1978) . It centered around the principle that inability to pay should not prevent access to health services. India launched its Community Development Program in 1952 as part of the first Five Year Plan (1951-1955) which led to the establishment of primary health centers (PHCs) and subcenters across the country.

Last two decades witnessed a gradual expansion of private healthcare services, which delivered some noteworthy health models and helped improve the overall quality of health services. This widespread expansion of healthcare, however, failed to have an equivalent impact in terms of affordability and accessibility. In fact, it allegedly paved the way for unregulated commercialization of health services.

The Indian healthcare system progressed gradually in terms of services and scale, although with a visible disparity and disconnect between availability and need. India currently ranks 145 among 195 countries on the global healthcare access and quality (HAQ) index created by Global Burden of Disease study (The Lancet 2016). There is undeniably an urgent need of reform to stem widening gap between the available health services and the disease burden faced by local communities.

Apart from an acute shortage of human resource which includes shortage of doctors by about 80 percent in community health centers (CHCs) in rural areas, the health workers have poor access of personal health safety kits and critical supplies for patient treatment.

There has been long standing demand to enhance budgetary allocation on health which is 1.2 percent of GDP at present to 4 percent – percent of GDP as recommended by WHO to strengthen the preventive healthcare mechanism with systematic attention towards clinical governance. This can be achieved through service delivery reforms, technology-driven drug procurement and distribution system, capacity building of care givers at local community level, efficient use of resources, ambulatory care especially to deal with non-pandemic treatment needs such as dialysis, immunization, maternal and child health and linkages to other referrals and social services.

In these evolving times, cultivating a culture of sharing knowledge and best practice models becomes a necessity. Optimizing communication to counter misinformation and to ensure people have the facts they need to stay healthy is essential.

A primary healthcare system that engages the community efficiently in the implementation process can pass the test of time at any given health emergency and will in turn lead to more feasible and sustainable socio – economic development of the community in the long term.

(Debapriya Sen Vaite is a New Delhi based social development professional)