A commentary by 21 noted experts including Biocon chief Kiran Mazumdar Shaw and Dr Devi Shetty in the June 12 issue of The Lancet medical journal has recommended eight “urgent actions” to prepare for a possible resurgence of COVID-19 in India.
Observing the spread of COVID-19 in rural India which has driven the country into an immediate health emergency, The Lancet journal proposed the recommendations which need to be undertaken by the Centre and state governments “to amplify and synthesise what must be done urgently.”
THE EIGHT RECOMMENDATIONS
- The organisation of essential health services must be decentralised. A one-size-fits-all approach is untenable since the numbers of COVID-19 cases and health services differ substantially from district to district. Appropriate technologies could have a role in streamlining the management of resources and supplies, such as hospital beds, oxygen, ambulances, and funeral resources.
- There must be a transparent national pricing policy and caps on the prices of all essential health services – ambulances, oxygen, essential medicines and hospital care. Hospital care should not require any out-of-pocket expenditure and costs should be covered by existing health insurance schemes for all people, as has been done in some states.
- Clear, evidence-based information on the management of COVID-19 must be more widely disseminated and implemented. This information should include suitably adapted international guidelines for home care and treatment, primary care, and district hospital care in local languages that incorporate local circumstances and clinical practice. The guidance must also emphasise what not to do and ensure that only evidence-based therapeutics are used. It should also provide information to help prevent increasingly concerning reports of other impacts of COVID-19, including secondary infections such as mucormycosis.
- All available human resources across all sectors of the health system, including the private sector, must be marshalled for the COVID-19 response and adequately resourced, particularly with sufficient personal protective equipment, guidance on the use of clinical interventions, insurance, and mental health support.
- State governments must decide on the priority groups for vaccination on the basis of evidence to optimise the use of available vaccine doses, which can be incrementally expanded as supplies improve. Vaccination is a public good and should not be left to market mechanisms.
- Community engagement and public participation must lie at the heart of India’s COVID-19 response. Grassroots civil society has historically had a crucial role in people’s participation in health care and other development activities, such as in strengthening the COVID-19 response in Mumbai.
- There must be transparency in government data collection and modelling to enable districts to proactively prepare for the likely caseloads in the coming weeks. Health system personnel require data on age and sex disaggregated COVID-19 cases, hospitalisations, and mortality rates; community-level coverage of vaccination; and community-based tracking of the effectiveness of COVID-19 treatment protocols and long-term outcomes.
- The profound suffering and risk to health caused by loss of livelihoods should be minimised by making provisions for cash transfers by the state to workers in India’s vast informal economy who have lost their jobs, as is being done by some state governments. Formal sector employers must be required to retain all workers, irrespective of the status of contracts, through a government commitment to offer compensation to these companies when the economy revives.