Pandemic & Public Health System

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TOPIC: General Studies 2

• Health and Governance

In news: India currently has over 140 confirmed cases of COVID-19. The government has been quick to adopt a multipronged strategy, including issuance of clear guidelines to ministries for coordinated action, imposition of travel restrictions, suspension of visas, large-scale screening and contact tracing as well as regular dissemination of information to the public. Mounting a swift response involving all stakeholders in a country of India’s scale and diversity is undoubtedly commendable. With these measures in place we can be confident that India will be able to successfully limit the spread of the disease. 

Meanwhile in Italy, the number of coronavirus cases and deaths continue to surge. Doctors and nurses are under increasing pressure and are calling out for help while medical supplies run out rapidly. 

In the US, dozens of health-care workers have fallen ill with COVID-19, and more are quarantined after exposure to the virus, an expected but worrisome development as the U.S. health system braces for a surge in infections. 

India and COVID-19

COVID-19 has no vaccine or certain treatment. It is a virus whose spread is faster than anything the world health community and governments have ever handled before. As medical sciences work round the clock to develop vaccines and medicines and governments grapple with tough decisions, the responsibility of prevention extends equally to society.

Possible effective antiviral medications are being explored. A vaccine will take a year or more to develop. Therefore, the public health measures that needs to be used in the meantime are:

• Containment through quarantine of exposed people
• Isolation of infected individuals
• Border and travel restrictions
• Social distancing
• Venue closings
• Public education especially pertaining to personal measures to help prevent transmission, surveillance, and diagnostic testing. 

Towards a resilient public health system

In an increasingly globalised and rapidly urbanising world, the risk of such outbreaks spreading quickly to all parts of the world is only becoming higher. The need of the hour is to build a resilient public health system that can prevent diseases, promote good health, and respond quickly to minimise loss of life when faced with an outbreak of this magnitude.

Increase spending on public health: 

• The government needs to enhance funding for health to at least 2.5% of GDP as stated in the National Health Policy (NHP), 2017. 
• States, too, have a critical role to play in meeting the NHP target of increasing health expenditure to more than 8% of their budget by 2020. 
• We need to ensure that a large share of the funds goes towards preventative care.

A focal point for public health at the central level, with state counterparts:

• Such an agency would be responsible for performing the functions of disease surveillance and response, monitoring health status, informing and educating the public, as well as of providing evidence for public health action. 
• In order to be effective, the agency would also need to be legally empowered to enforce compliance from other public authorities, as well as citizens. This is crucial because several factors require inter-sectoral action to achieve a measurable impact on population health.

• The legislation, possibly in the form of a Public Health Act, would clearly confer specific powers on the agency for taking action to promote public health, especially in situations of “public health nuisances”. 

Essential to institute a public health cadre in states, with officials trained in disciplines such as epidemiology, biostatistics, demography, and social and behavioural sciences: 

• NITI Aayog has consulted a wide range of stakeholders on developing a model public health cadre that draws upon various best practices. 
• The 13th Conference of the Central Council of Health and Family Welfare (CCHFW) has resolved to establish a public health and management cadre in states by 2022. CCHFW is an apex advisory body that recommends broad lines of policy action in health-related areas.

Train front-line workers—like Accredited Social Health Activists (ASHAs), Auxiliary Nurse Midwives (ANMs), and Multi-Purpose Workers (MPWs)— 

• To promote healthy behaviours among people, and identify early signs of a disease outbreak in communities. 
• Given the inherent information asymmetry in health, and the fact that we live in world where misinformation can spread rapidly, appropriate channels are necessary for ensuring that people are aware of diseases, their symptoms, as well as mechanisms for prevention and treatment. 
• The National Medical Commission Act, 2019 includes enabling provisions for creating a cadre of mid-level service providers who can also play a vital role in screening people for early signs of illness in rural areas.

Efforts must be made to reinforce disease surveillance, and response: 

• This requires the list of notifiable diseases to be expanded, along with steps for integrating health facilities in the private sector in disease reporting as part of regular surveillance systems. 
• Infrastructure for surveillance, including adequate numbers of suitably equipped laboratories for testing samples, also needs to be strengthened.

The need of the hour is to build a resilient public health system that can prevent diseases, promote good health and respond quickly to minimise loss of life when faced with an outbreak of this magnitude.