The health crises from pandemics, climate change, war & strife etc., have been accelerating in recent times. India is equally vulnerable to these irrespective of where, in an interconnected and interdependent world, they start. India should do what is in its control to prevent future crises.
Strengthening disease surveillance
As a member of the World Health Assembly, India is bound by International Health Regulations that require member countries to deploy robust surveillance and alert systems. Rapid reporting of a novel pathogen with the potential for a pandemic is key to mounting responses to arrest the spread. Integrated Disease Surveillance Program (IDSP) and its Integrated Health Information Portal (IHIP) are designed to strengthen the area of disease surveillance. While traditional epidemiological surveillance methods are in usage, the ongoing Covid-19 pandemic demonstrated the power of digital and molecular technologies in strengthening surveillance systems. Wastewater genomic surveillance methods have a unique advantage in disease surveillance and are being put to use in some the countries says Dr Krishna Reddy Nallamalla, President, InOrder Regional Director (South Asia), ACCESS Health International National Digital Health Blueprint (NDHB) has outlined the digital architecture for a national health information system consisting of unique health ID, national registers for health professionals and facilities, personal health records based on interoperable standards, federated health exchanges etc. Ayushman Bharat Digital Mission (ABDM) has been launched with the objective to build a national digital health ecosystem. Upon implementation, India will have a robust information system that will further improve the ability to detect novel illnesses at their beginnings.
Most pandemics have their origin in animals and other living species. Surveillance of zoonotic diseases and pathogens has become a fundamental part of disease surveillance under the concept of ‘One Health’. Emerging social and cultural changes are bringing human beings closer to zoonotic pathogens that have the potential to jump into human beings. National Institute of Virology (NIV) is setting up an exclusive facility in Nagpur to develop surveillance systems under the concept of ‘One Health’. In addition, the rising spectre of antimicrobial resistance (AMR) requires newer approaches to monitor AMR across health systems. There is a need to network all microbiological laboratories and mandate sharing of data in order to have effective surveillance of AMR.
Rapid response systems
India established National Disaster Management Authority (NDMA) in 2005 under Disaster Management Act to mount rapid responses in times of natural calamities like cyclones, floods, earthquakes, gas leaks etc. In fact, the act was invoked to manage the Covid-19 pandemic as a national disaster. NDMA is under the ministry of home affairs (MHA). Similar authority is needed to mount an effective and rapid multi-sectoral coordinated response in situations of epidemics and pandemics. National Disaster Response Force (NDRF) is organized around paramilitary lines with people drawn from the IPS cadre heading the force. There is a need for National Pandemic Response Force drawn from health and other social systems. A special fund may be created to support rapid responses.
Stockpiles of essential health goods
Health systems are normally designed to handle health needs during normal times. They are very poorly designed to handle the type of surges that we witnessed during the Covid pandemic. National stockpiles of personal protective equipment, tests, essential drugs and equipment like ventilators and dialysis machines etc., are designed to face these surges. The quantities should be arrived at considering the peak surges witnessed and anticipated, the breakdown of global supply chains, and the threat of hoarding during a crisis. The holding cost of these stockpiles is minuscule compared to the devastation the pandemic brought to the economy.
National Registers of Health Professionals and Facilities
A single source of truth about the health workforce and healthcare infrastructure is essential to plan the response during a health crisis. On one side, health systems are driven to be efficient to slow galloping healthcare costs. On the other, we need enough surplus capacities to handle unexpected surges in healthcare demand. Data is needed to pool and redistribute these resources during a crisis. The utility of pooling resources from both public and private healthcare systems was clearly demonstrated in Mumbai. This may be the only way to bring a balance between efficiency and resilience. Planned national registers under ABDM assume more importance in the context of the pandemic that we witnessed.
Planning health workforce for the next pandemic
While infrastructure and health goods could be ramped up fast, the health workforce cannot be manufactured at short notice. Planning as per traditional workforce benchmarks is not sufficient for rapidly evolving healthcare systems and unexpected surges in healthcare demands. Critical care competencies that were in greatest demand amongst both doctors and the nursing community have to be made essential as part of graduate training itself so that those competencies can be leveraged during crisis situations. Strategies and plans to pool and allocate resources will be helpful during crises since the concept of reserves does not exist and is not cost-effective in the health workforce. We need to plan for strengthening public health professionals with needed competencies in disease surveillance and epidemiology. The role of community health workers (ASHAs) was evident during the pandemic. Plans to strengthen the cadre should be in place.
Financial protection systems
Suffering from financial hardships was greater during the pandemic than the illness itself for the majority of low- and middle-income populations. Social protection systems for securing food (public distribution systems) and jobs (MGNREGA) etc., came to the rescue of many. Health insurance systems failed to live up to the expected role of protection during a health crisis to prevent catastrophic health expenses that push people into poverty. Hence, there is a need to further strengthen social and health financial protection systems, especially for informal labour.
Infodemic became a greater problem than the pandemic itself. A well-defined communication strategy and robust systems are not only essential during crises but also can be put to effective use during normal times. The harm from misinformation is becoming greater day by day.
Hence, it is now time to learn from what we went through last two years, to strengthen identified weaknesses on priority, adapt innovations that sprouted across the country, and give greater impetus to some of the major health reforms under the Ayushman Bharat program (Health & Wellness clinics to strengthen primary health care, Pradhan Mantri Jan Arogya Yojana for financial protection to 100 million families, Digital Mission to integrate and transform national health information system, and Health Infrastructure Mission etc.,) launched prior to the pandemic and during the pandemic. We have to strengthen our health and social systems to secure people’s health from future shocks.
Dr Krishna Reddy Nallamalla. The author is President, InOrder Regional Director (South Asia), ACCESS