As we move to the critical stage where some activities have been allowed in Green and Orange Zones, there is a need for a strategy that helps us learn to live with the virus

The right communication strategy and leveraging technology is an important policy to deal with the COVID-19 pandemic. As we move ahead to the critical stage wherein certain activities have been allowed in Green and Orange Zones, there is a need for a communication strategy that helps drive behavioural change and ushers in an era whereby we can learn to live with the virus. This requires effective two-way communication between the citizens and the Government, which has been the core strength of MyGov till now. It has been the endeavour of MyGov to act as a bridge between citizens and the Government and ensure citizen participation and information dissemination on platforms that most people use.

When the pandemic began, it was realised that words and phrases like “quarantine”, “social distancing” and “lockdown” needed to be communicated well as most people didn’t know what these terms meant. Social distancing was an alien concept. Hence, epidemiologists and health experts came up with Dos and Don’ts for preventing the spread of the Coronavirus. Fake news and myth busters posed another challenge that MyGov had to deal with. We had all kinds of conspiracy theories being bandied about, ranging from a Wuhan laboratory experiment gone wrong to use of hot water and garlic to kill the virus. There was a need to bust these myths and focus on making interventions like the use of masks and washing hands properly for 20 seconds the norm. This was done with explanatory infographics and videos that helped explain all these in simple language.

Towards this objective, MyGov India, the citizen engagement platform of the Government  launched several initiatives on its MyGov.in platform as also its dedicated COVID-19 page, corona.mygov.in to support the communication efforts of the Ministry of Health and Family Welfare. MyGov has a presence on almost all social media platforms that include not only the conventional ones like Facebook, Instagram, Twitter, YouTube, LinkedIn but for the COVID-19 campaign, MyGov is also using unconventional platforms like Telegram, TikTok, Helo, VMate and Likee, with an objective to reach out to all sections of people by leveraging all channels and platforms. 

Content was created in multiple languages and also sign language to ensure that everyone became part of the communication process. Videos from reputed doctors were made to ensure clear and correct messaging. MyGov also launched its MyGov Saathi Chatbot that is available on WhatsApp & FB Messenger and is also available on https://mygov.in and https://self4society.mygov.in. MyGov Saathi is a mobile-enabled platform and uses a menu-driven approach, allowing users to select available options such as “Latest update on Coronavirus in India”, “State-level status”, “Useful alerts” and “Where to get help” to access information. It provides ready access to Covid-19 related resources such as latest updates, helplines, advisories from various Central and State Government departments as well as access to Self4Society initiatives, including donation and volunteering opportunities.

Another key feature of the campaign is the ability to ensure adherence to lockdown regulations which are among the strictest in the world and have contributed greatly in limiting the spread of the pandemic till now. This was made possible by the Prime Minister’s call for the “Janata (people’s) curfew”, cheering and clapping for healthcare professionals, the 9PM-9Minute lamp-lighting initiative, showering of petals on hospitals and so on. Some may not find any merit or value in these initiatives but when we did the sentiment analysis of the social media posts, it was found that a vast majority of people supported these measures.

We also launched the pledges around these campaigns — Janata Curfew Pledge, Stay Home, Stay Safe Pledge and Fight Against Corona — which saw the participation of lakhs of people. The Citizens’ Ideas and Suggestions page saw more than 1,00,000 suggestions coming from citizens. The Innovation Challenge for technological solutions launched on MyGov led to brilliant ideas and solutions — including those on contact tracing, which has now evolved into the Aarogya Setu app. The quiz on COVID-19 has seen almost 1,00,000 entries.

These initiatives help the people get involved and once they are engaged, they feel part of the overall solution to the pandemic. It has been a very important part of our communications strategy.

The launch of the Aarogya Setu app is an important part of the Coronavirus campaign. Given the questions raised by some with regard to privacy issues, it was essential to communicate clearly what the app does, why it is required and how privacy is built into the app by design. This was done by innovative use of graphics and videos. Even celebrities like Ajay Devgn helped in creating the #SetuMeraBodyguard campaign which was also endorsed by similar videos by regional language superstars like Nirahua in Bhojpuri and Anuj Sharma in Chhattisgarhi.

Top cricketers helped in the #TeamMaskForce campaign that promoted use of masks. Campaigns around these hashtags were launched on social media platforms that helped in getting user-generated content even in regional languages that contributed to carrying the message far and wide.

The lockdown instructions were a major challenge for us. The feedback was that many people were finding it difficult to interpret the directions and there was a lot of confusion on what to do. Immediately, MyGov demystified the directions and instructions by coming up with simple, easy to read and understand infographics which became very popular. These were also translated in various languages with the help and support of a volunteer group who did it pro bono.

With the lockdown, came the challenge of catering to the migrant labourers and there were a lot of issues regarding shelter homes and feeding centres for the poor and urban homeless. MyGov collaborated with Google Maps and Map My India and put details of shelters and feeding homes of around 750 cities on Maps so that they were easy to find and locate. Google also launched a messaging service for MyGov on Google Maps which has been integrated with the Saathi Chatbot to answer queries instantly.

When the Myth Busters infographic was released, it became viral and millions of people shared it. A suggestion was received to make it available in audio format. Accordingly, these, as also COVID-19 updates, were converted into audio podcasts as part of MyGov Samvaad. These podcasts were also shared with more than 200 Community Radio Stations who translated the content and helped expand the outreach of COVID-19 messaging. Further, it was felt that we also need to address anxiety and stress specially for people during the lockdown. So, an initiative called “Positive Harmonies” was launched in which prominent musicians from across the country created special numbers for MyGov along with their messages to help manage the crisis. This has become very popular. One key feature of all these endeavours has been that all of this was managed by our teams while working from home. Team members collaborated across cities and came up with brilliant innovations. We greatly benefitted from collaborations with top technology companies, media, volunteers and various Government departments. Innovation and collaboration seem to be our strength that has not only helped us in our communications but will ultimately help us tide over this crisis.

As India completes almost six weeks of the lockdown, one realises that some of the learnings from this crisis will help us in future, too. It is possible to work remotely and not everyone needs to commute daily for work. There are collaboration tools available that can help get output, that in some cases can be better than what is possible now. If employees save three hours of commute time, it will make them happier.

Other benefits will be lesser traffic and congestion, a smaller carbon footprint and we may be addressing issues of climate change, too. In the days to come, one expects that more and more companies will adopt this and it will greatly transform lives.

(Writer: Abhishek Singh; Courtesy: The Pioneer)

The Coronavirus has posed several challenges for expectant mothers and parents due to the closure of health clinics, OPDs and Anganwadi Centres providing vital healthcare services

Human health is a prerequisite for the economic health of a country. Unless the population is healthy, the economy of a nation cannot perform. This hypothesis has been validated by the outbreak of the Coronavirus which has led the world into an economic recession. In the light of this, the importance of mother and child health (MCH) cannot be overemphasised as pregnant women, infants and children are very susceptible to infections and diseases. The Coronavirus has posed several legitimate concerns and challenges for expectant mothers and parents due to the closure of doctors’ clinics, outpatient departments (OPDs) of hospitals and the Anganwadi Centres (AWCs) providing vital healthcare services.

So the question that arises is, how can beneficiaries access healthcare/welfare services during the pandemic? Pregnant and lactating mothers and children in both rural and urban areas have already begun to suffer. For instance, the Government order to the Anganwadi workers (AWWs), to home-deliver dry rations for children and mothers, has had problems in execution. The AWWs have complained about having to travel long distances on foot because of lack of personal/public vehicles and villagers threatening and in some cases even beating the women AWWs for violating the lockdown. Plus they have to bear an added financial burden as they have not been paid money to purchase rations for the last one year and have not been provided with protective gear to save themselves from the virus.

Another challenge that has emerged is the inability of the auxiliary nurse midwives (ANMs) and accredited social health activists (ASHA) to help pregnant mothers and infants get their vaccination as well as arrange transportation to the nearest health facility for delivery, while adhering to the service level benchmarking to combat the pandemic.

While we don’t know what the future will be once the lockdown ends, here are some solutions that the Government/States can consider to address MCH-related concerns during the times of Covid.

Harness the advantage of mobile phone and internet penetration to the remotest areas of the country for geo-tagging beneficiaries and for the provision of telemedicine, using location data, call data, and Health Management Information System (HMIS) database. In this situation, the health practitioner will only advise high-risk pregnancy cases like ante-partum hemorrhage (APH), gestational hypertension (PIH/GH), eclampsia and severe anaemia. To distinguish between severe and normal cases, the programme can be administered by machine learning and Artificial Intelligence.

 With all the recent beneficiaries of the Janani Suraksha Yojana (JSY) and the Pradhan Mantri Matru Vandana Yojana (PMMVY) having been assigned Unique IDs, these should be used for direct benefit transfers (DBT) and nutritional assessment, screening of COVID-19 cases, triage referrals and referral to secondary-care hospitals.

As an emergency measure, pregnant women (especially migrant workers) travelling or in transit in the next few months and seeking institutional delivery can be imparted with the benefits of the Pradhan Mantri Jan Aarogya Yojana (PM-JAY) or Ayushman Bharat (AB) with the participation of the private sector.

Create a MCH dashboard in line with the Ayushman Bharat and PMMVY dashboard, to synchronise data, harness HMIS and Integrated Child Development Services (ICDS) database to show the facility closest to the pregnant mother for rapid welfare delivery and integration of immunisation services for home-based new-born care, so that all the essential immunisation vaccines can be given to the children below two years of age without any delay.

 The dashboard can also track the whereabouts of pregnant women (of the region in focus) and put reminders on their cell phones and on that of their family members, which would provide regular information on the precautions they need to maintain and the ways to respond if they develop Coronavirus-like symptoms and so on. These can be integrated with the existing applications of the Government and must be triaged after primary screening.

 Most women have monthly to weekly interactions with  doctors/health practitioners during pregnancy for prenatal check-ups. But in the times of the pandemic this may go missing, so it is imperative to keep them informed via digital medium. For instance, the Kilkari application of the Haryana Government can be scaled up to include video messages for women that are specific to their stage of pregnancy. Frequent live conversations with doctors/health practitioners need to be arranged to reduce anxieties and negative psychological impacts due to the spread of COVID-19 and the lockdown in effect.

 WhatsApp accounts must be set up where pregnant and lactating women are able to share their concerns and through audio and video messages. Volunteers can be roped in with the support of civil society and community networks.

Coordinators of Self-Help Groups (SHGs) in the villages must be identified to assist ASHA workers and ANMs in-home delivery of required medicines. While this would help in reducing the burden on the latter two, it would also help expand community cohesion. For this, the SHGs can be awarded certificates of appreciation that would strengthen their credit scores for availing any further loans from banks.

The Government has identified both private and public hospitals to take in Coronavirus patients in each district. The contact numbers of these hospitals should be publicised through every available medium so that the people use these when they develop COVID-19 symptoms.

 Pregnant women, who become infected, should be treated with World Health Organisation-recommended supportive therapies in consultation with their obstetrician/gynaecologist. Pregnant women and health practitioners must be informed  about these therapies without any delay.

 It is also important to record all new cases of pregnancies due to the COVID-19 lockdown, so that Government prepares for an impending “Coronial generation” after nine months and also has a ready benchmark for future shutdowns based on the lessons learnt. The existing HMIS and ICDS data, though not very reliable, can still be low hanging fruits in this regard to utilise the Digital India architecture.

 In the lockdown scenario, the Government must ensure that the duties of AWWs are notified as essential services if it does not want the health and nutrition security of women and children to be compromised. All pending payments due to the AWWs must be transferred to the relevant bank accounts without any further delays. It must be noted that the Budget 2020-21 has allocated Rs 28,600 crore for programmes that were specific to women. It is indeed a matter of concern that the reimbursement for the purchases made for preparing Mid-Day Meals for children at AWCs has not been released for over seven months in States like Jharkhand.  With the present Budget outlay, there should be no financial excuse to withhold the payments due to the AWWs, and in fact, they must be paid a three-month advance honorarium to facilitate their work and ensure their safety.

 Expanding health insurance coverage to women and children will increase their access to necessary health services more than other groups. Along with the maternal and child health programmes, this must be added with the existing public health and community services such as prenatal care, well-child care and enabling services such as case management, transportation and home visits.

 The maternal healthcare services must include mental healthcare, contraceptive services and supplies; diagnosis and treatment of sexually transmitted diseases; prenatal, intrapartum, and postpartum care; regular breast and pelvic exams (including Pap tests), in accordance with well-recognised periodicity schedules; risk assessment; adequate education and counselling to support these interventions.

For infants and children up to five years, emphasis must be on preventive services, such as immunisation and the monitoring of physical and psychosocial growth and development, with attention to critical periods in which appropriate care is essential for sound development and progress.

 A separate, more comprehensive midwifery training programme with service level benchmarking in India must be introduced on an urgent basis. Having well-trained and capable midwives would provide a better birthing experience for the mother and would reduce the burden on obstetricians.

  Women’s SHGs should be roped in for better outcomes in ensuring the provision of take home rations. There should also be certain modifications and expansion in the type of food provided, varying regionally, to meet nutritional requirements. Planning of resources is a must to avoid misallocation and panic.

With the Coronavirus crisis expected to continue and peak in the next few months, it is imperative to urgently design and implement alternate solutions which ensure institutional deliveries, facilitate treatment to the pregnant mothers and their new-borns and address MCH needs in a timely and structured manner, simultaneously adhering to social distancing and isolation norms of the Government.

(Writer: simi mehta Ritika gupta Anshula mehta ; Courtesy: The Pioneer)

All industrial units do not have the requisite capacity to meet the new standards for resuming production yet

India followed its own definitive path to tackle the menace of COVID-19, ordering the strictest 21-day nationwide lockdown first and then extending it further. In its first phase, the Government chose to save people’s lives over the economy. Yet, when it became distinctly clearer that the fight against the virus would be long-drawn, it became impossible for it to ignore livelihood issues and look for ways to get the economy started. So it allowed industrial units to run in non-hotspot areas but with a new set of caveats that is now causing more confusion than clarity. While these are early days yet and the Government has to work out sectoral codes to ensure low risk, social distancing and safety parameters, the first set of compliances seems to have put more pressure on unit owners, who have to now factor in a new overhead like safety costs. In the absence of substantial working capital from the Government, some of them are wary about opening their units because of low consumer demand, labour shortage and a poor chain of logistics. Now they are further spooked by media reports of the stringent norms that call for punitive action, to the extent of registration of an FIR, against owners found non-compliant by the slightest degree or even if one staffer was diagnosed with COVID-19, something that even a routine health check-up would not reveal at the time of re-employment. Though the Government sought to allay fears by making it clear that the provisions would be applicable only for offences “with consent, cognisance or negligence” on the part of the employers, uncertainty looms large. This is why the standard operating procedures (SOPs) issued by the Home Ministry following the partial lifting of the lockdown in several areas have drawn flak from several quarters.

Major worries are over the broad norms prescribed under the National Disaster Management Act (NDMA) that have been invoked for the first time on account of a force majeure event. First, the implementation of the Act itself will be problematic because the onus now lies with respective States to ensure adherence. As expected, without any clarification, various States have offered different interpretations on whether they should risk people’s lives by opening up the factories or keep them shut longer. Even when some have agreed, unanticipated gaps during implementation mean there has to be another review. Further, given the varied capacities of each State, it is only fair to expect a less-than-equal response from all. Other guidelines, too, appear illogical and are hard to implement at the ground level. New rules demand that workers be accommodated in the factory premises or be lodged in nearby areas so that they can be transported with ease while strictly maintaining social distancing norms. Given the previous set-up of industries, it will be impossible for them to lodge even a small group of workers. Further, the guidelines call upon the respective units to get their workers, who have fled to their hometowns, back to work. With trust deficit everywhere and in the absence of a Central assurance, employees may choose to remain in their villages. Assuming they come back, the resumption of work is dependent largely on the behavioural shift of workers — all of whom need to get accustomed to all sanitary guidelines. One lapse by them and the owner would get harassed. This is why we will need far more long-term and sustainable solutions going forward. At the moment, smaller units cannot get rolling without Government support. Half-baked rush can only spoil the gains made till now.

(Courtesy: The Pioneer)

The number of confirmed COVID-19 cases in Nepal may be low but it is not due to precautions taken by the Govt but because of the low rate of testing

With the number of COVID-19 cases rising globally, India’s neighbour Nepal is also going through a critical phase in its fight against the pandemic. A country located next to China, the nation where the COVID-19 outbreak began, its immediate vulnerabilities lie in addressing the epidemic with an existing poor healthcare infrastructure and ensuring the safety of its people. The very first case of COVID-19 was reported on January 23 in Nepal. A student who had returned from Wuhan on January 9 was admitted to a hospital in Kathmandu. With no expertise and lab infrastructure to examine such cases then, the swab tests of the student were sent to Hong Kong and had confirmed the Nepal Government’s worst fears.

Loose end: Nepal’s first COVID-19 case had recovered in the second week of February. With no new cases reported until the third week of March, overzealous Government officials went on to declare Nepal a “COVID-19 free” country. While it was the time for the Government to deploy extra measures to prepare for the outbreak, declaring the country as “COVID-19 free” without any consultation with medical experts was indeed a short-sighted and irresponsible step. The Government was very clear that it did not wish to stop the arrival of tourists in Nepal because 2020 had been declared as a tourism year and the Government had spent a lot of time and money in making its ‘Visit Nepal 2020’ campaign a household initiative. However, in the end, with the appearance of the Coronavirus, Nepal had to suspend the campaign officially, even though till today it has a total of 16 confirmed cases and no reported deaths. In 2018, tourism had contributed more than seven per cent revenue to the Nepalese Gross Domestic Product (GDP), which was expected to double this year. With the suspension of tourism for this year, the economy will have to bear the brunt.

Logistic shortage: Compared to its neighbours India and China, which have reported a huge number of cases, Nepal has seen just 16 positive cases till now. The country has conducted a total of 6,299 tests, with a little over 80 people in isolation. Amid the ongoing lockdown, Nepal is facing an acute shortage of trained human resources, required healthcare infrastructure, including speciality hospitals, safety gear and testing kits. In several cases, healthcare staff have refused to attend to their duties due to lack of Personal Protective Equipment (PPE). In the present circumstances, testing is key to contain and control the spread of the epidemic. However, with just one specialised testing lab for COVID-19 cases in the capital city for a population of more than 29 million people, Nepal is wide open to any major surge in the pandemic. While nine more temporary testing labs have been established in the last 15 days, logistical support and their testing capacity are yet to be seen. Meanwhile, Nepal has requested several countries, including India, China, Singapore, South Korea and Israel to supply medical equipment and medicines needed to combat the disease.

Missing preparedness: Over the last two decades, the Government has not paid any heed to improving the quality and quantity of healthcare facilities in the country. Against this backdrop, Nepal has faced several emergencies such as the present outbreak. A decade-long civil war from 1996-2006 was followed by a major earthquake in 2015 which claimed over 20,000 lives and destroyed 1,500 health facilities, creating an immediate need for investing in the public healthcare system. Meanwhile, no lessons were learnt from these two important events and nothing was done to better the basic healthcare infrastructure. While conflict and natural calamities have both direct and indirect effects on people’s health and the overall health system in the immediate and post-shock phase, the missing healthcare infrastructure in Nepal is a matter of major concern, particularly in the present crisis.

India extends help: As Nepal awaits replies from other countries, India has begun to send new consignments of medical supplies, including the much-needed hydroxychloroquine sulphate. During an official conversation between Prime Minister Modi and his Nepalese counterpart on April 10, the two Prime Ministers agreed “to look after the welfare and medical care of the people of the two countries currently living in each other’s territory.”

The multi-dimensional friendly relations between India and Nepal are testimony to shared socio-cultural and people-to-people contacts that have stood the test of time and various disasters. The creation of the South Asian Association for Regional Cooperation (SAARC) COVID-19 Emergency Fund is a collective effort initiated by Prime Minister Narendra Modi to bring SAARC countries onboard to fight COVID-19. Nepal has actively participated in the initiative and the initiative shall work as an additional effective mechanism in Nepal’s fight against COVID-19.

China banks on the crisis: China, on the other hand, is banking on the ongoing crisis in Nepal. China’s online supply chain Alibaba along with the local administration of its Sichuan province have donated PPE and portable shelters to Nepal. However, a significant deal to a private Chinese company to procure equipment worth more than $10 million was cancelled amid criticism. The Government of Nepal faced criticism for defying the rules in granting the contract to a private company, which has been involved in supplying low-quality products in the past. Giving in to public pressure, the Ministry of Health and Population decided to annul the tender. At this critical juncture, it is the responsibility of the Government of Nepal to ensure that logistics are procured with caution, rather than appease China with multi-million-dollar deals. On April 10, the Tibet Autonomous Region also donated medical equipment to Nepal and China and Chinese officials conducted a “handing over ceremony.” With Nepal facing a critical shortage of supplies, Chinese assistance is not free from an attempt to win over public sentiments. Something that India needs to watch out for.

Poor governance: An acute shortage of medical equipment exhibits poor governance and the inability of the Government of Nepal to safeguard the interests of its citizens who have been a cardinal factor in sustaining the economy. Notably, one-fourth of Nepal’s GDP comes from the remittances sent home by the Nepalese workforce abroad. Following the initial fears of lockdowns in host countries, thousands of Nepalese migrant workers attempted to travel back to their home country. While the closure of international flights stopped millions of  workers  from returning to Nepal from the Middle-East, Malaysia and Australia, thousands of them are stuck at the Indo-Nepal border.

This is after they undertook long and arduous journeys through land routes to cross the border checkposts. With no quarantine wards and healthcare personnel deployed at the check-posts, these workers have been desperately waiting to get back to their homes.

By stopping the returnees at the border, Nepal might have chosen to contain the spread of the COVID-19 but it is a cruel, irresponsible and inadequate attitude towards its citizens. They have been left in the open without food, shelter and exposed to Coronavirus contamination due to lack of social distancing at several places. It was as late as April 10 that Nepalese Prime Minister KP Oli requested his Indian counterpart to look after the welfare and medical needs of those stuck at the Indo-Nepal border. As India does its bit to provide food and shelter to the suffering Nepalese workforce, the Government of Nepal should have had mechanisms in place in advance for its returning expatriates. It must have in all honesty anticipated the return of its people from the neighbouring nation given the long open border. That it chose not to do anything about it and let its people suffer knowingly is something that will always be remembered by the people of the little Himalayan nation.

 The number of confirmed COVID-19 cases in Nepal may be low but it is not due to precautions taken by the Government. It is less because of the low rate of tests being carried out per day. On April 11, Nepal recorded the highest number of COVID-19 tests and the same day, three new cases were reported. For all we know, it might be the next hotspot of the world. But that will only be revealed once more testing is done.

It is time for the Government of Nepal to provide proper healthcare to its people to contain the spread of COVID-19 in the country. The present Government won a large public mandate in the 2017 elections due to Oli’s promises of a stable Government and improved economic conditions. However, poor governance, flawed economic policies and imbalanced foreign relations have endangered the lives of citizens.

(Writer: Karan bhasin; Courtesy: The Pioneer)

As we run against time in our battle to fight the virus, we need to scale up domestic manufacture of medical devices

The Coronavirus spiral was inevitable but now that it is squeezing health infrastructure and medical care staff, we are battling a second front of the disease, when it attacks the preparedness. Doctors and care-givers from around the country have complained, even threatened to go on strike, because they do not have enough personal protective equipment (PPE), namely coveralls, gloves, goggles, masks and so on. There have been reports of frontline staff making use of raincoats and anything else that they can lay their hands on. The lockdown and the migration of labour have meant that even those manufacturing these essential gear are not being able to roll them out at breakneck speed. Though there is no dearth of Indian innovation — like the Pune virologist’s version of the test kits, IITs’ collective efforts to roll out apparatus or even car companies’ offer to make ventilators — the fact of the matter is these are all small-scale efforts. What is needed is a massive rollout, which, because of policy hurdles, delay in placing orders and over-dependence, like the West, on China for crucial components, has been halted badly. Even the contracts being handled by domestic companies are of a small to middling nature, with no capabilities to scale up output. It would be easy enough to attribute the scarcity to a global trend, arguing all countries battling the coronavirus are facing it as well. But we didn’t plan it as well with the Government ordering PPEs just before the lockdown. Safety wear would now need at least three weeks to be readied domestically, considering imports are not that reliable with most infected countries dependent on factory floors in China and Southeast Asia. China has just about emerged after the first wave of the virus and its manufacturing prowess is still not 100 per cent. The Government could also not have exported 90 tonnes of medical equipment and safety gear to Serbia at this time of a national emergency, confirmed by a tweet from the United Nations Development Programme (UNDP) though denied by the Health Ministry. Leave aside N95, even the triple layer surgical masks are not available for healthcare staff. There is also the issue of facilitating working capital for these units in the time of lockdown. As for chemicals and disinfectants, India has been dependent on China for critical intermediate goods and components. With so much dependence on China, particularly for raw materials, it is difficult to find easy replacements.

As we ride this unprecedented World War III, that literally came from nowhere and hit us before we could realise it, what should be the road looking ahead? Simply prioritise our health sector and go back to home-grown drug and health equipment manufacturing. They were there before but globalisation meant these units were sidelined and lost out on the cost advantage to cheaper imports. And now that the virus may spur the process of de-globalisation as it were, we need to begin with crucial sectors that impact national safety, health and well-being. Immediately after Wuhan, the Government drew up a list of 38 drug raw materials that it wants locally produced to end the country’s dependence on Chinese imports. Some of our key life-saving drugs, including those for cardio-vascular issues, use active pharmaceutical ingredients (APIs), which are solely sourced from China. Indian drugmakers import around 70 per cent of their total bulk drugs from China. Now there is no time for committees, policy or pondering. There is already a Make in India wishlist suggesting ways to make India one of the top five medical devices manufacturing hubs in the world. Most domestic manufacturers have in pre-crisis days shut their idling units and become importers and traders themselves. We have ignored an industry that could have helped us stave off this crisis. What else explains that though there are 1,000 domestic medical devices manufacturers, only 15 have a turnover of above Rs 200 crore and the rest are less than Rs 10 crore. If they are to scale up, then they need an enabling ecosystem, a level-playing field vis-a-vis imports and assured volumes. The last won’t be difficult given India’s huge market for healthcare, projected to be the fourth largest in Asia. Post-Corona, the demand is not expected to dip but rise. This way we can easily end our import dependence by 70-90 per cent. And be self-sufficient in the time of unforeseen crisis.

(Courtesy: The Pioneer)

In a country with our population density to claim that hundred per cent source identification or tracking is even feasible is akin to believing in Santa Claus

We are going through a time of uncertainty, fear and gloom, though stories of human resolve, courage and sheer determination do give us hope for the future. We live in unprecedented times of which we have no previous experience, little knowledge and even lesser understanding. There are none here who have survived either the Spanish flu pandemic of 1918 that killed 33 million people (including approximately six million from the sub-continent) or the Bengal famine of 1942 that killed 10 million. What is, however, absolutely clear is that we are in a global war against an unforgiving and unseen enemy who respects no borders, ethnicity, class, age, religion or caste.

If we are to beat this enemy, not just physically but psychologically, socially and economically as well, we have no choice but to work together as a global community and act with compassion, forbearance and courage not just in our own self-interest but for the community at large. It finally boils down to this, if we are to call ourselves civilised. Most importantly, the time for political posturing or playing games is way past. In war, as is often said, there is no place for the runners-up.

If the information available in the public domain is to be believed, the Government has done a sterling job in limiting infections and fatalities for now, through its rapid response. Unfortunately, the figures being bandied about are coming in for increasing scrutiny for a variety of reasons. The question of what is the policy governing testing and how many tests are being done is at the crux of the controversy.

As per information available in the public domain, the existing capacity to test for the virus is 500 per day, which is being ramped up in the coming days. Thus, at present only those coming from affected countries are being screened and if their condition seems doubtful, are being tested. Those cleared in screening are expected to undergo either supervised or self- quarantine before being allowed to mingle. Tests are also being done on those who may have fallen sick after coming in contact with someone returning from abroad. In addition, the Government has also done 800 tests as on date on random patients across the country who, are at present admitted in hospitals with acute respiratory disorders.

On the basis of these tests having turned up negative the Government insists that there have been no cases of community spread. Therein lies the rub, as many known positive cases, leave aside those who are asymptomatic, have deliberately escaped from quarantine, no doubt infecting those they may have subsequently come in contact with, who in turn will infect others, which is what community spread is all about. In a country with our population density to claim that hundred per cent source identification or tracking is even feasible is akin to believing in Santa Claus. Of course, there is the possibility that the Government is aware of the true picture and hiding it from the public to avoid any onset of panic.

If that be the motivation, the Government is making a huge error as most of us are well aware as to what is happening in different parts of the world. As a matter of fact, conservative studies on the subject suggest that actual cases are about ten times the numbers that have been identified and given that the cases are doubling every three days, the number of people infected will be 1,024 times the present number within a month as simple mathematics suggests. This in our context, with total identified cases as 169 as on March 19 that has increased by one-third along expected lines on the March 20 will, in all likelihood, range between 1.7 lakh and 17 lakh by April 19, depending on which figures we wish to believe, if we do not take further steps that are needed to halt the spread. From within these numbers, as seen elsewhere, 15 per cent will require Intensive Care Unit facilities and two-three per cent will not survive.

The problem with hierarchies and the bureaucracies that run them is that they abhor vacuums, as that condition requires them to assert themselves, avoid accountability for obvious reasons and can only think and act linearly given their long-standing ethos and organisational architecture. An emergency of this kind requires lateral thinking, taking of risks and forceful interventions, all of which fall in the realm of the political leadership that now needs to step forward, provide clear directions, impart the momentum required and most importantly, accept accountability. While Prime Minister Narendra Modi has certainly shown his interest in assuming a leadership role his known dependence on the bureaucracy is a distinct disadvantage at this time.

Thus we have adopted the bureaucratic playbook to tackle the issue. As a result our response has been bureaucratic, admittedly much quicker but still along plodding linear lines with each agency and department attempting to show how efficiently they are handling challenges that they face. Forget the “All of country” model that is absolutely necessary, we have not even been able to put an “All of Government” approach in place. This is best brought out by the Prime Minister’s address to the nation on March 19. It was a motivational talk with no substantive future course of action being announced, except for a voluntary one day national “Janta (public) curfew”, which probably will be a harbinger of tougher measures in the future. In all truth, the time for motivational talks is long past, what we now need is a general who will lead us into battle. Moreover, such an approach is unviable, because by the time we take the next step another week would have passed and numbers of those infected quadrupled, adding to avoidable stress on our healthcare system and to fatalities.

It is essential that our political leaders and the average citizen comprehend the nature of the beast that we are at war with and face facts that have either emerged from experiences elsewhere or are peculiar to our situation. First, there is no getting away from the fact that we have a population of 1.3 billion and the cost of testing and providing the necessary support facilities are humungous. Obviously, no Government, whatever its efficiency, can ever provide cover for all our citizens. Second, social distancing, which include forcible quarantine, despite its flaws, appears to have emerged as the only viable alternative for keeping the Coronavirus under check and in reducing the rate of infection, till a suitable remedy is found.

The world around us has completely changed and yet we seem to be living in a time warp, hoping to avoid having to face the dragon that has felled much of the world. Let us face reality and accept that in these circumstances there is no time for half measures. Imposition of Section 144 of the CrPC, as has been done in some places, or hoping to enhance testing facilities in the coming days, which in any case is unavoidable, are measures that are simply not enough and are just too little and too late. In military terms, we need to launch an immediate blitzkrieg and in fact, have little choice but to immediately adopt measures that the Chinese and Italians did only as a last resort.

It is essential that a nationwide curfew for a minimum of 14 days be declared soonest along with other measures such as reducing the frequency of mass transit systems, banning taxis and only permitting minimum essential personnel to move out of their homes.These measures must be strictly implemented by deploying the military, assisted by the Central Armed Police Forces (CAPF), on the streets. While these are harsh and desperate measures with dire economic implications, we have no option, as we will otherwise find ourselves overwhelmed with the possibility of serious social disruptions.

Undoubtedly, the biggest problem will be faced by those whose very livelihood is dependent on their daily earnings. As in any major natural disaster this would require the Government to provide the requisite relief to all those impacted at their place of residence. This in effect requires that the armed forces be fully mobilised and deployed and tasked for conducting internal security and humanitarian and relief operations.

Time is of the essence here and discussions and committees have little meaning now and in fact these measures needed to have been implemented yesterday. 

To enable the military to mobilise and deploy would require a minimum of three-four days, in which time we must remember, the numbers of those infected would have doubled. Implementation of such measures with a warning period will also allow citizens to stock up on essentials. For those who believe that such drastic action is uncalled for, would do well to study the impact of a graduated response in countries like Italy, Spain, the United States and France. By going for broke, if nothing else, we would certainly avoid much of the stress that the healthcare infrastructure of those countries were put through, infrastructure that we are woefully short of and have little ability to scale up.

(Writer: Deepak Sinha; Courtesy: The Pioneer)

Beijing’s selective engagement with India on the Wuhan evacuations is plain confrontationist

Desperate times call for desperate measures and when a global crisis has a new name called Coronavirus with a hydra-headed manifestation, then politics should be the last concern between nations who must unitedly fight it. Unfortunately, China, which is filtering the extent of its health crisis lest it be construed as bad propaganda for its global stakes, has let that unease creep into its bilateral ties with India. Seems like the spiralling epidemic has torn the “relative calm” in the strategic partnership. A spat that could have been settled by discussion and mutual understanding has unnecessarily been allowed to gain traction. The current row stems from China’s refusal to grant permission to our military aircraft for the evacuation of several Indians from the Coronavirus-hit Wuhan. Although China facilitated the civil flights by rescue missions, it is dragging its feet over clearances for this one, attributing it to procedural norms given the disease has reached a higher degree of criticality. But India maintains that it is precisely because of this and its responsibility to protect its citizens that it was sending in the C-17 Globemaster, equipped with medical facilities, to bring back Indians, assuming they were infected. Yet in a tit-for-tat response, Beijing accused New Delhi of being selfish and holding back essential medical equipment required by local authorities and medical workers for treating patients. More, China has called upon the Indian authorities to follow the World Health Organisation (WHO) guidelines that call for resumption of all trade and personal exchanges with it to restore normalcy. Yet the world knows that when it comes to humanitarian missions, India has never held itself back. So this strong-arm and negotiatory tactics by the Chinese are not warranted. In all this bickering, not least unexpected, the Chinese response was the same as it was during the outbreak of the virus, “denial.” So the fate of around 100-odd Indians, who remain stuck in the Chinese city, is still undecided.

Besides, Beijing cannot justify its “selective” engagement with India on the evacuation process, allowing permission to some while denying it to others. As it turns out, in the same “critical period,” three other nations were allowed to operate their evacuation flights. What is incomprehensible is that just a few days ago, the Chinese authorities applauded the “kindness” shown by New Delhi in helping them tackle the outbreak. Premier Xi Jinping had himself lauded India for offering solidarity and assistance. The mixed messages are typical of the larger Chinese strategy of keeping us on our toes by speaking in a forked tongue. Despite this blow-hot-blow-cold attitude of the Chinese, the Indian Government chose to keep differences aside and sought to aggressively push itself to help China contain the virus. From agreeing to test clinical samples from abroad in its laboratories to offering help with the evacuation of people from affected areas to lifting the ban on the export of personal protection equipment — it has done it all. The least one could have expected of the Chinese, given their continued emphasis on strategic relationship and intention to look at trade and other broader areas of cooperation, was to acknowledge the role played by other nations, including India, in fighting the epidemic. But that’s too much to ask from it. In all the three sorties carried out to date, where more than 600 Indians have been airlifted, working with China has been a nightmare with the biggest hurdle coming by way of getting approvals from its authorities — Central, provincial as well as local. It must also not be forgotten that ripple effects of the spread of the virus are being felt in India, as in other nations. We, too, need to be prepared to tackle any potential crisis. India’s stand with regard to restrictions on some medical devices assumes prominence on account of our fast depleting stocks and low domestic output. In fact, the crisis has led to the deep realisation of how we are heavily reliant on the Chinese for the procurement of raw materials and key ingredients for the production of medical equipment and drugs. So much so that the Government is all set to create new opportunities for Indian firms to emerge as an alternative producing destination to fill the supply vacuum. This outbreak should serve as a warning for Indian industries to diversify their supply chains and encourage the production of critical components within India. Till we are dependent on supplies from China, it will use our weakness to leverage diplomacy.

(Courtesy: The Pioneer)

We have all heard the adgage — prevention is better than cure. Public health deals with prevention and control of diseases. It involves researching and educating people how to prevent or manage health issues. People interested in Science and want to serve the society, a career in public health is the way forward. The field of public health is varied and has many academic disciplines ranging from pure research to direct public education. To work in public health sector a master’s in Public Health is appropriate. One can also explore degree programmes in healthcare administration or community health. A few more colleges to study are:

Emergency Management and Research Institute, Secunderabad. Course: Advanced PGD in Emergency Care

Indian Institutes of Public Health, Gandhinagar, Ahmedabad. Course: Associate Fellow in Industrial Health

SRM Institute of Science and Technology: School of Public Health, Kancheepuram. Course: Associate Fellow in Industrial Health

Medvarsity Online Limited, Hyderabad. Course: Diploma in Family Medicare

Writer: Pioneer

Courtesy: The Pioneer

Malnutrition has been a public health issue in our country for which Prime Minister Narendra Modi has set the agenda through the POSHAN (Prime Minister’s Overarching Scheme for Holistic Nourishment) Abhiyaan. He has announced clear targets and visible results to be seen by 2022, the 75th anniversary of the country’s Independence. The aim is to improve nutritional outcomes for children, pregnant women and lactating mothers. The targets under the POSHAN Abhiyaan are to reduce stunting, under-nutrition, anaemia (among young children, women and adolescent girls) and bring down low birth weight by two per cent, two per cent, three per cent and two per cent per annum respectively. Additional efforts will be made to bring down stunting from 38.4 per cent (NHFS-4) to 25 per cent by 2022. With this commitment from the highest level of leadership, nutrition is a clear priority for this Government.

India’s National Health Policy (2017) as well as the National Nutrition Strategy (2017) recognise that anaemia, which is a result of iron deficiency, has harmful consequences for maternal and child survival and overall productivity of the nation. Anaemia affects roughly one-third of the world’s population. Those with anaemia have low immunity and work productivity. It adversely impacts cognitive development of children. Anaemia in pregnant women is more likely to increase the risk of post-partum haemorrhage, low-birth weight babies, pre-mature birth, still birth and maternal death.

According to the National Family Health Survey-4 (2015-16), anaemia prevalence across all ages is extremely high in India. The percentage of children, aged between six and 59 months, having anaemia is a whopping 58 per cent while the percentage of women of reproductive age having anaemia is 53 per cent. As much as 50 per cent of pregnant women at any given point of time have anaemia.

There are many causes of anaemia but iron deficiency accounts for close to 50 per cent of cases among school children and women of reproductive age group and 80 per cent in children between two and five years of age (UNICEF and WHO Joint Statement 2001). Infectious diseases such as malaria, helminth infections, TB and hemoglobinopathies are other causes that contribute to the high prevalence of anaemia.

Unlike earlier attempts made to tackle the issue, there is a convergence of various departments and Ministries to achieve the desired results under the anaemia-mukt Bharat strategy. It is pertinent to note that the programme is being implemented pan- India, involving the community. Reaching out to everyone, particularly the vulnerable sections, is an integral strategy under POSHAN Abhiyaan. For this, the Government has improved and strengthened service delivery to ensure an efficient supply chain, encouraged use of technology to reach the targetted beneficiaries and bring about behavioural change through professional counselling.

Anaemia-mukt Bharat is a critical component of the POSHAN Abhiyaan and is expected to benefit 450 million people by 2022. It is based on six interventions, including prophylactic iron and folic supplementation; deworming and behaviour change campaign focussing on key behaviours such as appropriate infant and young child-feeding practices; increased intake of iron-rich diet or fortified food; ensuring delayed cord clamping after delivery; anaemia testing by using digital methods with special focus on pregnant women and adolescents and finally, screening and treatment of non-nutritional causes of anaemia in endemic pockets, malaria included. The strategy focusses on testing and treating anaemia in school-going adolescents and pregnant women using newer technologies, establishing institutional mechanisms for advanced research in the condition and a comprehensive communication strategy.

Considering that there are several other determinants of nutrition, linkages with other initiatives of the Government have been established. The Swachh Bharat Abhiyan focuses on creating open defecation-free communities that impact the rates of diarrhoea and gut infections among children. The Pradhan Mantri Matritva Vandana Yojana provides monetary support to pregnant women and lactating mothers for adequate diet, which in turn, promotes health-seeking behaviour.

Mission Indradhanush is increasing the rate of complete immunisation of women and children while the Mother Absolute Affection (MAA) programme is a nation-wide initiative to improve infant and young child-feeding practices. The Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) ensures quality ante-natal care for pregnant women, while the school children are being screened annually for diseases and nutritional deficiencies under the Rashtriya Bal Swasthya Karyakram (RBSK).

The Ministry of Health and Family Welfare is collaborating with the Ministry of Women and Child Development (MoWCD) on activities to be carried out during the POSHAN Maah that is observed in September every year. As part of the POSHAN Maah, 2018, AIIMS, New Delhi, along with six regional centres (Rajasthan, Madhya Pradesh, Odisha, Bihar, Chhattishgarh and Uttarakhand) undertook intensive BCC along with test and treat campaigns focussed on WRA (15-49 years) and under five children.

Also, our initiative, Village Health Sanitation and Nutrition Day (VHNDS), has been strengthened to be observed as ‘POSHAN Melas’ and are being leveraged as an opportunity to reach out to the community for counselling on health-seeking behaviours. Besides VHNDS, collaborating activities with MoWCD include traditional practices such as ‘Godbharai’ and ‘Annaprashan’ as part of POSHAN Abhiyaan for increased acceptance and involvement of the community.

Providing iron and folic acid supplementation and treatment to high risk groups, prevention and treatment of communicable diseases, promoting consumption of all micro-nutrients, and more importantly, encouraging birth spacing through the use of contraception are some other initiatives being taken by the Government for a holistic and life-cycle approach to the issue.

Implementing a programme of this magnitude is by no means an easy task but the Government is committed to end the scourge of anaemia and under-nutrition by rolling it out as a jan andolan (public movement). The decline in the prevalence of anaemia will contribute in improved maternal and child survival and improved health outcomes.

(The writer is Union Minister of Health and Family Welfare)

Writer: JP Nadda

Courtesy: The Pioneer

Last year was eventful for public health in India as the government followed up on some of its key decisions announced before. Ayushman Bharat was launched  to implement select recommendations made in the National Health Policy (2017). The Mental Healthcare Act, 2017, was implemented while the Insurance Regulatory Development Authority (IRDA) mandated that mental health problems would henceforth be a part of insurance schemes. Several new health-related decisions were also taken — a series of approvals by the Union Cabinet, new bills for consideration by Parliament and setting up new medical colleges in various States. However, there is always a time lag between an idea translating into policy and programme. The initial discussion on health and wellness centres had started in 2013. The precursor of the Pradhan Mantri Jan Arogya Yojana (PMJAY) was the National Health Protection Mission, which was originally announced in 2016. Ayushman Bharat itself took off from the earlier discussion on National Health Assurance Mission of 2014 among others. The country has already suffered because of a laid-back attitude followed by a slow-paced implementation. Building upon what started in 2018, here is a wishlist for 2019.

Build on Ayushman Bharat programme: Ayushman Bharat, which was announced on February 1, 2018, was inarguably a major public health programme of the Union Government after the National Rural Health Mission (NRHM) in 2005. The Ayushman Bharat programme, with two components of health and wellness centres (for strengthening primary healthcare) and Pradhan Mantri Jan Arogya Yojana (for secondary and tertiary level hospitalisation) were credited for placing health higher on the political agenda. Yet, public health experts and journals alike continued to make the mistake of equating Ayushman Bharat with PMJAY, often forgetting  that the health and wellness centre component is foundational for the success of PMJAY as well. It was not without reason that health and wellness centres as envisaged in Ayushman Bharat were launched on April 14 last year at Bijapur, Chhattisgarh, months before PMJAY was launched on September 23, 2018 at Ranchi, Jharkhand.

Much of 2018 was spent on planning for scaling up the healthcare scheme, so this year should be utilised for an accelerated implementation. More attention should be paid to getting more health and wellness centres going through state-specific innovations and increased utilisation of a range of service packages under PMJAY, especially in greenfield states, with efficient mechanisms for fraud detection. It will serve well if a detailed roadmap and execution plan for Ayushman Bharat is developed with proper funding, approved and placed in public domain, which will enhance its accountability at various levels.

States showing leadership in better health regimes: Towards the end of the year, the Uttarakhand government launched the breakthrough Atal Ayushman Uttarakhand Yojana, which covers 100 per cent of the State’s population compared to the proposed 40 per cent in Ayushman Bharat-PMJAY. Health is a State subject in our country and the success of any initiative by the Centre is largely dependent upon the additional inputs by the States. This year,  we expect Karnataka, Meghalaya and Punjab to also take the lead and announce similar total population coverage under PMJAY. Besides this, it would be reasonable to expect that the newly-elected Government at the Centre in May extends the coverage with AB-PMJAY from the existing 40 per cent families to an additional 20 per cent of families. It should also announce a roadmap to cover 80 per cent or more population by 2022.

Basti dawakhanas in Hyderabad: The Greater Hyderabad Municipal Corporation (GHMC), in collaboration with the Telangana Government, launched 17 basti dawakhanas (or slum health clinics) in Hyderabad in April 2018. These facilities in the State are inspired by the mohalla clinics of Delhi and comprise the first urban local body-led community clinic initiatives in the country. Though they are not much in the limelight because of the distance from Delhi, initial reports suggest that basti dawakhanas are equally popular. The outcome of these two initiatives can change the way States and urban local bodies plan primary health services and prompt more States to take such initiatives to strengthen primary healthcare.

Reforms in medical education: The decision for revision in MBBS curriculum, with inclusion of courses on attitude, ethics and communication, was undertaken last year. The revised curriculum, the first after 21 years, will be implemented from the 2019-20 academic year. This comes at  a time when issues of unethical practices in medicine and violence against doctors are gaining ground, a phenomenon documented in the book, Healers or Predators?: Healthcare Corruption in India, written by Samiran Nundy, Keshav Desiraju and Sanjay Nagral. The other pending reform concerns the Medical Council of India through the National Medical Commission Bill, which is still awaiting discussion in Parliament. In 2019, there is a need for consensus among political parties to reform healthcare education and delivery systems to root out corruption.

Tackling air pollution to make  air breathable: In India, air pollution is a major risk factor for both acute and chronic respiratory diseases. It is documented as a key aggravator in a 2017 study on the state-level burden of diseases in the country. However, for the third year in a row, air quality has grabbed national and global headlines. The air quality index continues to be a cause of serious concern.  

Air pollution is not limited to Delhi or north India but cities across the country have poor air quality with around 70 cities breathing bad as India undergoes a huge infrastructure overhaul. It has been estimated that if air quality standards meet global standards, people in India would live 1.7 to 3.0 years longer. The National Clean Air Programme (NCAP) was launched in India in April 2018, with a plan to reduce air pollution in 100 identified cities. It is now proven that efforts on improving air quality will be a high return investment in the form of better health, higher worker productivity and increased life expectancy. So this year, there is a need for developing multi-sectoral interventions, led by Prime Minister Narendra Modi and Chief Ministers of various States, for clean air. After October 2019, the phase II of ‘Swachh Bharat Mission’ can very well be focussed on ‘Clean air for all.’

Opportunities ahead: The year ahead is an opportunity for India to show global leadership in health. In September, the United Nations General Assembly (UNGA) will hold its 74th session on universal health coverage (UHC). Also, the World Health Organisation’s (WHO) annual World Health Day 2019 theme is around UHC with a focus on primary healthcare. These are additional opportunities for the country to assume a leadership role in advancing UHC, accelerate implementation of ongoing initiatives and work upon strengthening the healthcare system, by providing attention on all aspects.

The momentum generated in the last two years, the high political and public visibility of Ayushman Bharat and the competition among States to better their healthcare records are positive peaks in the graph. For long,  healthcare and education have been on the lower spectrum of allocations of the GDP. Hope we look at these crucial asset sectors and push up our development indices.

(The writer is a leading public health expert based in New Delhi)

Writer: Chandrakant Lahariya

Courtesy: The Pioneer

Rural areas in India is reeling under acute shortage of physicians and lack of proper healthcare infrastructure. Only when we learn from our failures can we do a course correction.

As a part of the Sustainable Development Goals (SDG), India committed to achieve Universal Health Coverage (UHC). However, its total healthcare expenditure (under five percent of its GDP) resulted in sub-optimal outcomes. With less spending, India faces a severe shortage of hard infrastructure and talent along with regional imbalances in healthcare delivery.  Although rural India accounts for about 70 percent of the population, it has less than one-third of nation’s hospitals, doctors and beds, resulting in large disparities in health outcomes across States.

As India’s health system faces multipronged challenges, deficiency of doctors has emerged as one of the biggest roadblocks in the making of a new healthcare ecosystem. Currently, there is a shortfall of nearly two million doctors and four million nurses. Moreover, doctors’ numbers are also skewed towards a few States. According to NATHEALTH’s Aarogya Bharat Report- “India Healthcare Roadmap for 2025”, healthcare services are expected to generate demand for 15 million to 20 million new jobs for doctors and other health professionals by 2025. In spite of such huge prospects, India continues to face severe shortage.

India has less than one doctor for every 1,000 citizens, which is less than the World Health Organisation (WHO) standard that prescribes a doctor population ratio of 1:1,000. If Ayush practitioners are included, India has 1.3 doctors for 1000 population. A Medical Council of India (MCI) report suggests that in July 2017, there were a total 10,22,859 allopathic doctors registered with the MCI or with state medical councils. As per the Aarogya Bharat Report, the shortfall of doctors is likely to continue till 2039. India is passing through a critical phase, and to deal with the situation, it needs urgent structural reforms.

National Medical Commission — managing it professionally: India needs to be in mission mode to bridge the critical gap in available health professionals. The Government is all set to restructure the way India manages the supply side of medical professionals. The National Medical Commission (NMC) Bill, which is expected to be tabled in the Parliament during the monsoon session, will address several issues related to doctors’ deficiency. It is promising to note that the Government has carefully dealt with the concerns expressed by the Indian Medical Association (IMA) and other experts and their suggestions were incorporated to modify the Bill, which was approved by the Cabinet early this year.

Issues related to screening tests for doctors with foreign medical qualifications, “bridge course” for Ayush practitioners to practise modern medicine, fees and seats by private institutions have also been resolved. Apart from scope, the constitution of the Commission has also been restructured with number of nominees from States and Union Territories in the NMC going up to six from three. To give it a professional character, the NMC will comprise 25 members, of which, at least 21 will be doctors.

Pride of medical professionals: The pride and status of medical professionals of all cadres is waning. There is an utter disregard for the attempts to provide basic amenities to doctors in rural areas. Apathetic management for staff and lack of professional protection during healthcare delivery further aggravates the problem. This holds back healthcare providers to take innovative steps suitable for local needs. There is an absence of reward for excellence or punishment for failures in the system.

In order to cope up with ‘doctors’ deficiency’ in rural areas, the Governments must develop model villages and blocks. The concept of model group housing at block level or primary healthcare level should be considered, where Government employees of all departments could be provided accommodation and required facilities like school, playground, community centre, supermarket et al could be bestowed in the neighbourhood. This concept would allow holding, retaining and recruiting fresh talent by facilitating their stay and improvising their quality of life comparable with their counterparts in the city.

The way forward: Prioritising areas with critical shortage of healthcare professionals especially doctors will be important. Moreover, regulations that enable private participation in medical education need to be created. Exploring public-private partnership (PPP) models to enable a rapid increase in medical education seats needs to be given priority. Focusing on primary care can help reduce hospitalisation rates. And telemedicine and remote monitoring tools can be used to widen the reach of existing doctors and increase their productivity. The implementation of Pradhan Mantri Rashtriya Swasthya Suraksha Scheme under Ayushman Bharat Mission, clearly indicates that Prime Minister Narendra Modi, with innovative doable solutions, prefers to act as a radical plastic surgeon rather than the cosmetic one, to change the lives of rural ailing population. ‘Doctors’ deficiency’ remains a big challenge and to fulfil the dream of ‘Swasth Bharat’ (Healthy India), this has to be taken up by all stakeholders on an urgent basis.

Writer: Daljit Singh/Anjan Bose

Courtesy: The Pioneer