Equity in health is the fair and equitable opportunity for each individual to realize his or her full potential in all aspects of health and well-being. India has made rapid progress over the past decade in improving access to health care. However, as with many countries, access to health care is often determined by the ability to pay for services and proximity to health care infrastructure. People in poor, rural, and tribal communities often have limited or no access to hospitals, treatments, or vaccines. Health outcomes also vary differently around socioeconomic dimensions such as gender, income, education, and geography.
While the symptoms reported in recent cases of the latest CoVID-19 Omicron variant have been largely mild, experts believe it will take weeks to understand just how severe the true variant is. It will be important to understand some of the lessons learned from the response to previous COVID waves because this can help improve the way communities and healthcare organizations respond to health emergencies in the future.
During both waves, goodwill support was received from various public and private sources including civic-minded citizens. However, it has been largely limited in its impact because it has only addressed critical failures in the value chain – such as supplying oxygen cylinders, building hospitals or delivering meals. This fragmented approach did not take into account the interconnections that exist across the value chain.
For example, many field hospitals were unoccupied due to a lack of trained medical staff or a lack of oxygen supply – putting pressure on area-wide specialist care hospitals. In some cases, oxygen concentrators and ventilators have remained unused because they lack skilled local resources for installation, operation and maintenance. People were not tested because labs were either far away, curfews imposed in lockdown conditions, or because they needed to balance daily work with pay against time lost traveling to medical facilities. Labs struggled to manage the backlog of tests and deliver results in a timely manner. Patients cannot be transported in home care/health centers due to lack of ambulances.
Civic authorities across states, counties, and cities quickly recognized the advantage of adopting a centralized, citizen-centric approach based on a supervised home care model with local participation at the grassroots level. This approach revolved around identifying needs across the healthcare value chain and patient ecosystem and largely led to equitable outcomes.
A 5-step approach to view the entire healthcare infrastructure and response to the pandemic is as follows:
- Deployment of an integrated command and control center Leverage low-cost, fast-to-deploy, and replicable open-source tools for hospital workers and front-line workers. This will be complemented by analyzes to enable the identification of hotspots and the dissemination of standardized procedures for patient triage and care across the patient lifecycle. Such an approach would reduce wastage in allocating scarce resources, near-instant updates of patient health records, and timely identification of all urgent needs in the region to strengthen healthcare and epidemic response.
- Enabling Virtual Healthcare Active patient management systems and programs with participation of local grassroots community organizations such as local self-governing bodies (panchayats), government approved health activists (Asha/Nurse Auxiliary/Midwife/Anganwadi staff). This would help enhance public awareness about preventive/investigative epidemic protocols, bring about changes in behavior and combat reluctance to vaccinate. These systems can be developed as required by engaging medical students to communicate remotely with patients and support telehealth services to reduce pressure on medical professionals
- Comprehensive assessment of medical infrastructure Create a platform for identifying, prioritizing and integrating healthcare needs so that the value chain/ecosystem can be strengthened. This can be achieved by providing field hospitals with ICU beds/ventilators, oxygen concentrators, cylinders, ambulances, oximeters, thermometers for home crews, awareness campaign brochures or engaging with mobile pharmacy providers to support in-home vaccination and in-home laboratory testing.
- awareness building – Partnering with reputable public health organizations to deliver the latest regional contextual content tailored to the target demographic across urban, rural, and tribal populations
- Prepare for the pandemic Build playbooks of the necessary repeatable and scalable capabilities so that standardized processes can be built, tested and deployed while health care personnel are appropriately trained to implement them.
India has made great progress during the last decade due to the concerted efforts of the central and state governments. The pandemic has exposed weaknesses in our healthcare programs, our primary healthcare infrastructure is being strengthened by advanced healthcare models and insurance capabilities, and targeted investments are being made to address structural weaknesses. Creating digital health capabilities should enable the ecosystem to work together to expand healthcare availability across the country. Quality healthcare must be provided at reasonable costs and access must be expanded beyond 1/2/3 tier cities in India.
There is merit in the socioeconomic argument that we need to achieve and ensure equitable health outcomes across all of India’s diverse groups. Our response to CoVID-19 shows that looking at health care in its entirety and calling for immediate action will spark an outburst of creative ideas that can address the root causes of health inequality in the long term while developing sustainable measures to address the immediate. Need.
Rohan Lobo, Partner, Deloitte India
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