Covid has strengthened our health systems

As the curtains dropped on a rather unforgettable year, the World Malaria Report 2020 brought cheer for India. Reported malaria cases were down by 46 per cent in 2019 compared to 2018. India accounted for the largest decline in malaria cases in the South-East Asia in 2000-19. The National Vector Borne Disease Control Programme (NVBDCP), which has been relentless in driving the malaria elimination goal, deserves much of the credit.

Yet, it is premature to declare victory over malaria. India still accounted for 88 per cent of cases in South-East Asia in 2019. Even as the absolute burden is declining, it is getting progressively harder to maintain the momentum. It is like being in the last mile of a marathon. The finish line must be crossed. Will Covid-19 put malaria elimination by 2030 out of India’s reach? Or will Covid-19 help reshape our response to challenges in the health sector? We believe that it will help to accelerate malaria elimination in India.

Financial commitment

The Finance Minister, presenting the Budget earlier this month, strongly positioned Health and Wellbeing as one of the six crucial pillars for an Atmanirbhar Bharat. This is reflected in the allocation for these sectors, which will nearly double in 2021-22.

A new centrally sponsored scheme, the PM Atmanirbhar Swasth Bharat Yojana, will improve capacities in the health system, and enhance India’s ability to detect and cure new and emerging diseases. Coming in the wake of the Covid-19 pandemic, this is a much-needed welcome shift, with the health sector finally getting its due.

While India has managed to keep the Covid-19 mortality rate at low levels, there is consensus among India’s policymakers that public spending needs to go up. Increased spending will help to upgrade health infrastructure in the country, including at the primary level, over the next six years. This will strengthen primary healthcare and extend the reach of malaria services in rural and remote areas, for the most vulnerable populations, where malaria is increasingly concentrated.

Information dissemination

The Ministry of Health and Family Welfare and States such as Kerala have used dashboards to disseminate information on Covid-19 cases and deaths. Dedicated websites have been created to share advisories, guidelines, and standard operating procedures on a regular basis.

Mobile apps such as Aarogya Setu and GoK – Kerala Direct have been used for contact tracing, disseminating information on risk and prevention, and checking the spread of fake information. These actions have contributed to enhanced transparency, expedited sub-national response to a fast-evolving pandemic, and furnished critical data for real-time response. Malaria elimination efforts will certainly benefit from embracing similar measures.

Responsive regulation

Regulation has aided policy in India’s Covid-19 response. A central feature has been balancing safety and swiftness. A good example is the set of guidelines issued by the Central Drugs Standards Control Organisation (CDSCO) for development of vaccines with special consideration for Covid-19 vaccines.

In another instance, the Indian Council of Medical Research (ICMR) approved the use of a diagnostic machine used for drug-resistant TB for Covid-19 screening and confirmation. This machine, which can rapidly test for TB, Covid-19, and HIV at the same time, is portable and especially useful in States that lack strong laboratory networks, a necessity for carrying out RT-PCR tests.

Covid-19 has underscored the importance of an enabling regulatory framework for vaccines, drugs, diagnostics, and other health-related technologies, which can strengthen our response to multiple diseases including malaria.

Governance and coordination

A Group of Ministers (GOM) was constituted by the Central government in February 2020 to review, monitor, and evaluate preparedness against Covid-19. Eleven Empowered Groups, which were subsequently replaced by six larger groups, were also set up to deal with various aspects of Covid-19.

These groups, headed by senior government officials, are coordinating a range of issues including Covid-19 management plan, medical infrastructure, availability of essential medical equipment, human resources, coordination with partners (private sector, NGOs, international organisations), economic and welfare measures, communication, public awareness, data management, and supply chain and logistics management.

Task Forces have also been set up at State and village levels to strengthen effective monitoring and surveillance of Covid-19. Multi-sectoral coordination cutting across different levels of government has helped India launch a more effective response to Covid-19. This is an important lesson for the response to malaria and other diseases.

What next?

Public policy is often associated with long periods of stability that are interrupted by instances of dramatic change. These are often driven by shocks such as Covid-19. It is because of the latter that we have a unique policy “window of opportunity” to reimagine how we respond to challenges in the health sector.

Be it malaria or other diseases, we can learn much from the Covid-19 crisis and its management. Increasing health spending, enhancing accountability and communication mechanisms, improving regulatory capabilities, and strengthening coordination across sectors and levels of government will help us defeat future pandemics and old enemies like malaria.

Let us not waste this crisis. Initiatives such as ‘Atmanirbhar Bharat Abhiyaan’ and ‘Ayushman Bharat’ provide the perfect platforms to align these priorities and transform health and healthcare in India.

Mahatme is a Rajya Sabha MP and Member of Parliamentarians for Malaria Elimination Group; Tandon is Health Director, RTI; and Gupta is Director Country Acceleration, Asia Pacific Leaders Malaria Alliance