Editorial . . . . .
The Healthcare system has become increasingly centralised, expensive, and impersonal over time. Such care is inaccessible, unresponsive, and unaffordable in a country where healthcare costs are low, most healthcare expenditures are out-of-pocket, and the majority of the population continues to live in rural areas or on the cities’ outskirts. Decentralised, distributed, and responsive health system will be more effective and sustainable in both normal and crisis situations.
In March 2020, the Indian government declared a state-wide lockdown in response to the declaration of COVID-19 as a pandemic and its rapid spread. Families found it difficult to get treatment for non-COVID ailments due to restrictions on movement and fear of catching COVID-19. Many private healthcare providers have closed their doors to them, and government health facilities have drastically cut their service offerings.
During the first few months of the lockdown, safe birthing, immunisation services, and tuberculosis notification all suffered severe reductions. Patients seeking treatment at cancer hospitals were far fewer, and patients in need of eye care were kept away from hospitals. Access to and availability of healthcare other than for emergency COVID treatment decreased considerably during the second wave of the epidemic.
However, in some areas, healthcare provision was either unaffected, saw a rise in demand, or bounced back fast after the pandemic and subsequent lockdown. In India, we work with three such organisations that span levels (primary, secondary, and tertiary), healthcare domains (eye care, cancer care, and primary healthcare), and geographic locations (remote rural, rural and urban). We argue for a decentralised and distributed healthcare system in post-COVID India based on these experiences.
The lockdown highlighted the importance of teams throughout the healthcare spectrum being prepared and encouraged to reorganise their tasks. The lesson for a decentralised system is that job redistribution and role shifting from sub-specialists to specialists, specialists to generalists, and generalists to non-physicians are crucial. It necessitates investments in the training, equipping, and supporting of cadres of health workers and professionals to carry out the tasks entrusted to them. The use of technology is critical in such a distributed network to enable coordinated treatment and preserve the quality of service.
Our country India has achieved great progress in the delivery of healthcare in the country during the last few decades. It has been one of the greatest sectors in terms of employment and income, and it is rapidly expanding. In India, healthcare is primarily provided by either public or private providers. Public health focuses on providing primary care through community-based health programmes, with the goal of lowering death and morbidity from various communicable and non-communicable diseases. Basic health services are supplied through sub-centres and primary health centres, while secondary and tertiary care is given by better-equipped establishments such as community health centres, district hospitals, and medical colleges, which are generally located at district headquarters. Tier I and II cities are where the private sector is most concentrated. When inequities and problems with egalitarian, accessible, and high-quality healthcare are examined geographically, the discrepancies and challenges become apparent.
Over the years, the National Health Policies have aided in the development of a more inclusive healthcare system in the country, with the goal of reaching Universal Health Coverage (UHC) in a graded manner. The testing of the COVID-19 pandemic in even the most developed healthcare systems throughout the world has inevitably rattled the foundations of India’s healthcare system. Both the private and public sectors collaborated in the overall response to the pandemic. Private Indian healthcare companies rose to the occasion and have been giving the government all of the resources it requires, including testing, isolation beds for treatment, medical personnel, and equipment at government COVID-19 hospitals, as well as home healthcare.
India’s private healthcare industry has made a considerable contribution, accounting for over 60% of inpatient care. Most private hospitals began their plans in reaction to the COVID-19 pandemic, which included considerable investments in infrastructure for quarantine and treatment, as well as appropriate medical supplies and increased labour. In addition, due to delayed medical tourism and elective procedures, hospitals and labs have seen a significant drop in revenue. According to the government advice, OPDs (outpatient departments) were also closed for virtually the whole year. The healthcare industry, in collaboration with the central and state governments, devised a sophisticated response plan to combat the pandemic, which included the establishment of dedicated COVID-19 hospitals, isolation centres, and technology-enabled resource mapping. The Indian government also used technology to efficiently manage the outbreak, developing a variety of programmes at both the central and state levels.
The Aarogya Setu smartphone app, which helped with syndromic mapping, contact tracing, and self-assessment, was widely utilised across India. The response management, which included delivering critical things in containment zones, teleconsultations with patients, bed management, and real-time monitoring and review by authorities, was supplemented with such technological platforms. The COVID pandemic brought these issues to the forefront even further. It has also necessitated a more decentralised, distributed, and responsive system redesign. Our Jammu and Kashmir government should also come forward and redesign and relook the policies and programmes to tackle such pandemics in future.