Anil Parmar, vice president of community investment at United Way Mumbai, emphasizes that investing in pandemic prevention and preparedness is just as important as response. A new healthcare delivery model is required, one focused on decentralized community services and patient-centered resources

A public health system is defined as an organized effort within a country to prevent disease, prolong life, and promote the health and work capacity of its people. India’s already overburdened healthcare system has been overwhelmed when faced with the raging COVID-19 pandemic. That we will have to live with COVID-19 for the foreseeable future is a foregone conclusion. This has brought much-needed attention to COVID and conventional health infrastructure and services. The limited or lack of beds and medical services during the crisis meant few difficulties for non-Covid patients. The pandemic has undoubtedly led to more deaths and illnesses in the country, especially among the most vulnerable sections of society – women, children, people with disabilities and the elderly.

COVID-19 has disrupted normal services and the delivery of essential health and nutrition services. Women and children faced problems accessing facilities. The immunization cycle and essential services related to child nutrition have been severely affected. Much of the medical staff has been redeployed to support COVID-19 during the various waves of the pandemic. The World Health Organization (WHO), in its 2020 report on the impact of COVID-19 on non-communicable diseases (NCDs), highlighted that almost half of countries reported that patients experienced partial or complete disruption of services for diabetes, hypertension and related complications during a pandemic. One-third reported failures in cardiovascular emergency care. Multiple reports mention worsening mental health problems.

Reduced access to healthcare has also had a major impact on conditions associated with various diseases. Activities related to hepatitis B and C, HIV and AIDS have been disrupted, especially for those from vulnerable communities. Community groups such as commercial sex workers and members of the transgender community have been disproportionately affected. Such community groups have had unequal access to quality health care from the beginning, which has worsened.

The pandemic is also undoing the development gains made over the years, and has highlighted the need to rethink public health after COVID-19. Rethinking should start from the first level, ie. from primary health care services. A WHO report published in March 2022 said that household out-of-pocket expenditure on health services continues to push more than 5.5 crore people in India into poverty every year. Strong primary health care support for underserved communities can help reduce these costs. It also reduces the burden on tertiary health infrastructure and public hospitals. Needless to say about the benefits of timely examination, diagnosis and prevention of many diseases. Recently, India reached the mark of 200 crore doses of the vaccine against COVID-19, which was widely administered through primary care centers, especially in rural India. This really shows the coverage of public health care in the hinterland of the country, which needs to be strengthened to ensure decentralized quality health care.

Timely recruitment and capacity building of health workers, especially those at the primary level such as Accredited Social Health Activists (ASHAs), Auxiliary Nurse Midwives (ANMs) and Aanganwadi workers, should be prioritized. They turned out to be unsung champions in the fight against COVID-19. Compensation commensurate with their difficult work is mandatory. A demand they have repeatedly raised. Performance-related incentives can also be evaluated to increase their reach and make their services more efficient.

Investments in pandemic prevention and preparedness are just as important as response measures. A new model of health care delivery focused on decentralized community services and patient-centered resources is required. At the same time, the system of psychosocial support must be integrated into the main health care system. Awareness of mental health issues has increased recently. However, services related to these issues need to be initiated at the ground level, especially in underserved communities where hunger, security and livelihoods prevail and mental health issues are sidelined and under-appreciated. .

Public health is one of the hardest hit sectors and remains the most important sector to impact the fight against COVID-19 and future pandemics. The COVID-19 pandemic has forced us to rethink how public health care should function to make quality health care a reality for all. Health for everyone, anywhere is truly health for everyone, everywhere.

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