Needed, smart testing and tracing for the hidden populations

The Covid-19 pandemic has cast a blinding spotlight on the ever-prevalent health inequities in India owing to an insufficient public health system, unequal and sub-optimal resource allocation, social determinants typically influenced by the burden of population and poor infrastructure. Long after the battle against the virus ends, vulnerable communities — the most poor and marginalised, people with disabilities and people living their lives in harrowing inequity — will continue to suffer the effects of the socio-economic burden induced by the pandemic.

Increasing access to quality testing facilities has the potential to curb the detrimental impacts of Covid-19 through early intervention that can avert exorbitant out-of-pocket costs. It can also play a vital role in bridging health inequities and improving the health of the marginalised population. The only way to break the spread of coronavirus is to adopt immediate measures so that the infection load can be quickly detected and controlled, through smart and inclusive testing and tracing.

Testing infrastructure

As the virus makes its way into the hinterlands, cases may arise but may not appear visible. This is because our testing infrastructure along with being already burdened, may also not be evolved or sophisticated enough to exhaustively cover hidden populations — those living in rural and tribal areas, hilly, remote regions and within dense forests. It is imperative to understand that persons living in these pockets suffer from several pre-existing health conditions, often undiagnosed, making their propensity to contract, suffer and possibly die from severe illness like Covid, if left undiagnosed and therefore, untreated, very high.

In addition, on-ground insights suggest that demand for testing services is sparse, primarily due to fear of consequences on testing positive — loss of wages, uncertainty around receiving sustenance and emergency supplies, and even social ostracisation. Their apprehensions are heightened by lack of accurate information, rampant misinformation, and low levels of awareness on benefits of early testing and tracing.

Empowering communities

The only way to salvage the situation is by involving and empowering communities to increase uptake of testing through trusted peer networks while protecting privacy of individuals. Sensitising local community leaders to create health champions can achieve positive health outcomes.

The immediate need is to develop an equitable and cost-effective testing and tracing strategy such that the right testing solutions are accessible to the most vulnerable populations at the opportune time. It has been abundantly clear from countries, like South Korea, Taiwan and New Zealand that such a smart testing and tracing roadmap can significantly minimise the scale of morbidity and mortality even for the most neglected populations. These countries leveraged their inherent technological capacities along with a well charted testing and tracing plan and community support to curtail the spread of the virus and have been quite successful at it.

Recognising that patients from diverse populations are more trusting of doctors from their own neighbourhood, expanding community-based testing in underserved areas can also help to encourage those who may be distrustful of the healthcare system and more at risk to delay care. By co-locating testing sites at trusted community facilities, organisations can tap into local networks to target and expand data collection efforts in the areas that have the greatest need.

When Covid diagnostic testing in vulnerable communities is tailored to the needs and culture of the community, it automatically becomes easier for people to access testing. This is a key prerequisite for successful testing and, therefore, protection of communities in places that carry the heaviest burden of the disease — particularly for those located in high-risk neighbourhoods that need the most support.

Demographic data

The collection and analysis of demographic data gleaned from community-based testing is key to helping us better identify and address the gaps that have been created by systemic inequity in the healthcare system. This pandemic has illustrated the power of community health and demonstrated that the overall health of a nation largely depends on the health of its communities, specifically its most vulnerable. Now and when planning for future health crises, it is critical that we remember that our local infrastructure is the backbone in the creation of a stronger, healthier national healthcare system.

Historical health inequities in underserved areas have been highlighted by Covid but won’t end once the outbreak does. Increasing access to testing in minority communities not only has the potential to limit the detrimental impacts of Covid on our most at-risk population but can also play a vital role in bridging historical and current health inequities and improving population health.

Now that the world has successfully stepped into the optimistic vaccine era, the stakes are even higher. While a safe and effective vaccine can expedite our exit from the pandemic, it also has the potential to further widen the existing inequities. Despite India’s latent vaccine manufacturing capabilities, India will have to proceed strategically.

Target high-risk groups

If indeed our goal is to minimise morbidities and mortality by targeting high-risk groups in the first phase, then hidden populations should certainly make the cut. This would certainly be a challenge given the lack of health data in these populations as well as systems mistrust by communities who have not had the best experience with the health system. Given the nature of the vaccines, and its limited availability in the first few months, it is important to deliberate on harnessing tools at our disposal.

For vaccination to serve its purpose truly and effectively, it should be preceded by low cost and high-quality testing and tracing to uncover vulnerable populations who are at greater risk of contracting the disease but hidden from the mainstream. In the foreseeable future, it would be in the best interest of the country to pursue a strategic testing and tracing roadmap for equitable outcomes through cost-effective and accessible solutions and scalable technologies. This strategy will be crucial to identify groups and chart a pathway to reach them in the most optimal manner possible such that the virus transmission is arrested effectively.

The writer is Partner, Swasti Health Catalyst

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