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The pandemic is an opportunity to rebuild our medieval public health infrastructure

While at the micro level, district-level task forces must be empowered, at the macro level, each state/UT must come up with action plan in consonance with Centre’s public health programme.

While India is struggling to fight the second wave of Covid-19, talking of a remedial strategy to firmly deal with another wave of infections may be the most appropriate exercise to undertake now. The ongoing second wave will, unfortunately, leave deep scars. People were left to fend for themselves — something that they never knew how to do, and something that was never their business. This pandemic offers us a rare opportunity to put our largely medieval public healthcare apparatus in good shape.

A third wave, if it happens, is likely to be worse. Some of the worries would be about fast ascending infections in rural areas dominated by poor medical infrastructure, the shortage of vaccines and the expected year-long timeframe to vaccinate all eligible individuals, vaccine hesitancy, constraints on sourcing of ingredients needed to make vaccines, deadlier variants of the virus, the ominous possibility of the virus impacting children, the inadequate healthcare infrastructure for dealing with such a situation, and so on.

As per the latest Human Development Report 2020, India has eight hospital beds for 10,000 people; in comparison, China has more than four for just 1,000.

The Indian government is already mobilising to address these challenges, and some of the state governments have adopted innovative ideas. A national task force (NTF) has been constituted by the Supreme Court. It will hopefully offer useful recommendations on shoring up the health infrastructure to deal with the pandemic.

It is, however, equally important that a matching, proactive executing mechanism is simultaneously thought about, and even taken into account by the NTF. It is a truism that without proper implementation a policy is merely a good-intentioned statement. It is here that India’s bureaucracy can help plug the gaps and swiftly create healthcare structures, accessible in any grave eventuality as well as normal times.

Attention needs to be paid to strengthening, and refurbishing the local public health centres (PHCs), and creating many more temporary Covid/intensive care units. These should be equipped and manned to deal with all emergency medical care, except for rare occurrences. The objective should be that no patient has to travel beyond 10 to 15 km in urban areas, and 20 to 25 km in rural regions for healthcare. This arrangement alone can reduce the likely number of fatalities. Developing the existing PHCs, which generally have plenty of open space and ramshackle structures, through public-private partnerships can be a win-win situation.

The epicentre of this decentralised programme should be at the district headquarters, which will coordinate, facilitate, and organise all activities. A managing group can be created, comprising representatives from various related departments and organisations at the district level. It can bring into its fold experts and vital stakeholders like community members, social activists, and NGOs. The managing group should be headed by the district magistrate or his senior nominee. This group can work out an action plan, and enumerate the responsibilities for different ground level officers and departments.

The district managing group can be formally notified, and bestowed with special administrative and financial powers to deliver prompt and uninterrupted services as may be defined by the state government. The group will have the authority to run the show. Some of the powers and mandate are mentioned below for illustration purposes. First, to notify and commandeer all or listed medical care centres within the district territory, public or private, to provide notified medical services during the public health emergency. Second, to make all logistics arrangements well in advance by engaging public and private assets. Third, develop medical centres with required specialisation services and the capacity in anticipation of the demand. Fourth, to maintain and upgrade existing (PHCs), ensuring, particularly in rural areas, replacements for missing medical officers, engaging additional medical and technical staff through innovative sources. Simultaneously, upgrading and using the healthcare apparatus of institutions like municipal bodies, and panchayats, and drawing on the support of anganwadi workers, and specially hired volunteers. Fifth, to declare containment zones, and to also ensure that citizens meticulously abide by the precautionary advisories and instructions. Sixth, to tackle cases of leakage, black-marketing of essential medical supplies. Seventh, to fix priorities and place special focus on rural areas in terms of speedy testing, tracing and vaccinating. Eighth, to keep the general populace informed daily of the medical and other facilities available. And to meet daily to ensure clearing of bottlenecks and to course-correct if needed.

At the macro level, each state/UT should develop an action plan, in view of its challenges, and in consonance with the public health programme laid down by the Centre. The state/ UT should constitute an exclusive public health emergency cell, comprising senior officials from all related departments, to be the focal point of decision making. State governments should also share information and progress through dashboards and other technology tools, and invite suggestions.

It needs to be underlined that dealing with a public health emergency requires nothing short of a “perfect administration”. Each state should see that such a capable implementing machine is driven by passionate team leaders. No bureaucratic rules should be allowed to obstruct the missionary spirit required here. It is hoped that the NTF will also examine the existing administrative constraints.

A bottom-up approach will not only help blunt any possible surge in the Covid wave but will also build the much-needed health infrastructure. India should not miss this opportunity to strengthen its healthcare system.

The writer is an IAS officer

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