Healthcare reforms shouldn’t be transient

Giridhara R Babu/K Srinath Reddy | Updated on April 22, 2020

Initiatives such as tele-consultation, home-delivery of drugs and alternative medicines mustn’t end with the pandemic

The public health emergency imposed by Covid-19 has posed unprecedented challenges and, at the same time, offered unique, innovative solutions for long-standing problems plaguing healthcare delivery in India. These innovations should not be limited to the period of emergency alone but should be extended beyond that. We list several such extraordinary initiatives that can transcend and extend beyond the Covid-19 crisis.

On March 25, the nominated board of governors presently steering the Medical Council of India issued Telemedicine Practice Guidelines. This in itself is an extraordinary step since, for years, the use of tele-consultation for managing patient care faced a series of hurdles. There was ambiguity due to the lack of clear guidelines, further impeded by the 2018 judgment of the High Court of Bombay negating the legitimacy of prescriptions through telemedicine. In India, till now, there was no legislation or guidelines on the practice of telemedicine through video, phone, or Internet-based platforms (web/chat/apps, etc).

The guidelines issued permits a registered medical practitioner (RMP) to provide telemedicine consultation to patients from any part of India. It stipulates that the RMPs should adhere to existing professional and ethical norms and standards. The Ministry of Health has also stated that an online training programme will be made available to RMPs. It is time India followed up these ephemeral measures with legislative measures to permit the practice of telemedicine, thereby reaching care to millions of Indians.

Earlier, legal provisions also banned home delivery of drugs. It was noted that such distribution may lead to adverse health consequences. The Ministry of Health authorised the delivery of essential medicines to poor people on March 26, 2020. This step was taken to reduce the risk of viral transmission by limiting the movement of people during the lockout. Continuity of this service in the future can benefit the severely sick, the disabled, and the elderly who cannot travel to health facilities.

India has about one psychiatrist for every 200,000 people. During the ongoing Covid crisis, a psycho-social toll-free national helpline was established to address the constant stream of calls from people experiencing anxiety and distress. As mental health is a growing concern in the country, continuing this support through toll-free helpline numbers for all mental health issues will be helpful to any distressed person.

Alternative medicine

For years, several pleas to involve professionals from alternative medicine to treat common ailments were disregarded by the authorities despite the mal-distribution of doctors — with 1.3 doctors per 1,000 people, and most of them available only in urban areas. The assignment of these professionals to address emergencies was also blocked. Capacity-building for alternative medicine professionals will help bridge the gap in demand for health professionals working in isolated areas.

On March 29, a plan for capacity building of health professionals, including dentists and AYUSH practitioners, was notified by the ministry for addressing Covid-19. Continuing this provision will ensure that these healthcare professionals can play a critical role to play in not just slowing the spread of this infection but for continued engagement in public health activities. On March 30, insurance cover of ₹50 lakh was announced for health workers for a package of services. If continued, this initiative is innovative and encourages healthcare workers as they fight against dreaded diseases.

Rapid detection of Covid cases requires a wide range of diagnostic tests to control the rapidly spreading disease. On March 31, the Central Drugs Standard Control Organisation (CDSCO) and ICMR fast-tracked the approval of the rapid diagnostic kits, which take 2.5 hours to process and can scale up the testing to 1.5 lakh a week. The government needs to continue the fast-track approval process for essential medical equipment and drugs. This will reduce significant out-of-pocket expenditure and help strengthen the commitment to universal health coverage.

On April 4, the Arogya Setu app was launched by the government to track cases of Covid, designed to break the infection chain and directly connect the healthcare system with citizens. The app empowers the public with information on safety measures, when to get tested, and how to seek further help. As the name suggests, it is a bridge connecting the measures taken by the Government and society at large. It should get strengthened beyond the Covid pandemic situation, for controlling diseases such as TB. In combination with the delivery of drugs to home, we might be looking at the most efficient path to India's ambitious goal of eliminating TB by 2025.

Tech tools

In the first week of April, a series of technological solutions were implemented in India. IIT Bombay developed the Corontine app to identify and isolate Covid carriers. Also, hands-free door openers in the isolation wards were advised on April 2. An AI-enabled chatbot was built by volunteers in Karnataka, designed to help far-flung populations obtain information and seek help regarding the pandemic.

Similarly, several organisations have deployed their digital tools for case detection, contact tracing, and ensuring quarantine, which are integral to contain the spread of Covid. On April 6, Corona Kavach was released to disseminate information on Covid to the citizens via mobile alerts. It allows users to be better prepared to identify nearest testing laboratories and vendors of masks. A modified avatar of this can be used in the future to raise health awareness. On the same day, Sri Chitra Institute of Medical Science developed a ventilator system based on an artificial manual breathing unit (AMBU). Also, Jawaharlal Nehru Centre for Advanced Scientific Research (JNCASR) developed a one-step curable anti-microbial coating capable of killing the influenza virus.

With ingenuity, the efficiency and access-enhancing solutions implemented during the Covid crisis can be transformed into enduring upgrades of the health system. The innovations spurred by the crisis can be the tipping point for transformational changes. Are we ready to accept and integrate these once the panic around the pandemic settles down?

(Babu is Head, Lifecourse Epidemiology, and Reddy is President, Public Health Foundation of India. Views are personal)

Published on April 21, 2020

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