As the world began to respond to the pandemic, the premise was that LMICs (low and middle-income countries) like India would have major problems, since the developed countries didn’t do well. This was supported by health security indicators which rank the US and UK at first and second position. Not only did this idea have to bite the dust, but India also showed how to swiftly mount a response, inspire countries in the region and emerge as a vaccine powerhouse for the world. 2020 is a year that belongs to South Asian nations, regarding how well the region did its best in healthcare, although much of the action remains.
2020 can be better remembered as a year for prioritising health. Although it requires many course corrections, health was on election manifestos, in public discourse, and on everyone’s mind. 2020 is also a watershed moment for showcasing India’s capacity for innovative solutions that usher in hope to resolve chronic problems plaguing healthcare delivery.
These include massive scale-up of supply chain systems for healthcare services, fast-tracking the review of rapid diagnostic kits and vaccines, use of technology such as Aarogya Setu or other apps. There are caveats to this optimistic scenario. First, ethics and efficacy of interventions are as important as the speed of delivery. Next, tech solutions cannot be black mystery boxes but should complement the health system’s existing capacity and strengths. A review of ideas used during the crisis can guide the initiation of transformational changes in the future.
At times, the country heard from epidemiologists, virologists and immunologists in shaping the Covid-19 response. One would not expect an economist to do heart surgery, but we still heavily rely on a popular doctor or economist’s advice on how to manage epidemics.
If nothing else, 2020 should be remembered for the need to create and nurture a competent and professional public health workforce. This is possible by hiring and offering better salaries for domain experts and investing in improving their efficiency through constant training and reorientation. All these experts need to undergo leadership development programmes focusing on improving the overall quality and efficiency of the health system response.
State’s efforts in sharing data are underreported
While many people did not know what the Indian Council of Medical Research (ICMR) was before the pandemic raided our lives, most may not yet know the National Cooperative Development Council, the premier agency for detecting and controlling outbreaks in India. Experts are mostly consulted when there is a crisis, and quickly forgotten after the crisis is over. 2020 is a reminder for strengthening and providing autonomy to our agencies so that research priorities are addressed, and drugs and vaccines are regulated for safe and ethical use.
Doing so will provide useful and timely information to healthcare workers and the public alike, and swiftly mount responses to any health emergencies. The role of communication in healthcare was showcased in 2020. Every citizen has a right to get accurate and timely information about health. It is the government’s responsibility to partner with people in ensuring that they are empowered with better information.
Karnataka’s efforts in sharing detailed data are underreported and underappreciated. The State also had consistent support from technical advisory groups responsible for shaping the response. It is time for transparency to be the driving force in generating, using and disseminating public data. Governments should take offence if the immense amount of data generated is not analysed or used; it is a national waste not to share or use it for corrective action. The country can have an open data policy to promote usage of data to help implementation.
While pandemic management got much-deserved attention, the National Family Health Survey-5 results released in the latter part of the year were not much deliberated in public space. The survey shows a growing burden of risk factors and poor health in several states. For any meaningful changes in the overall scenario, significant investments will have to be made to build the capacity of health staff, improve nutrition and promote healthy behaviour through the life course to prevent non-communicable diseases. Primary healthcare services, including screening, early diagnosis and timely treatment, need strengthening. The feeder pipe of illness is filled with inadequate resources, inaccessible healthcare and unhealthy lifestyle.
2020 was for health, mostly because of health and other frontline workers. Our respect and appreciation of their work is necessary, but not sufficient to take care of their livelihood and career growth. Similarly, every block needs a competent public health workforce and leadership to promote health. A healthy India can be envisioned only if more generousallocations are made of all healthcare expenditure on preventive and health-promoting services. 2020 witnessed healthcare providers adapt several innovative approaches. Like the economy, passengers are waiting for the business class to get in.
LMIC countries are watching the rollout of Covid-19 vaccines in a few countries. This is a marker of the inequities which exist in the world. Understanding this imbalance, India should lead the way in building partnerships and collaborations, especially focusing on supporting developing countries. India has a rare opportunity to improve the public health workforce and influence agencies such as the World Health Organisation in helping the LMICs. The newfound collaborations of healthcare professionals with other scientists need to develop partnerships necessary for a world with fewer inequities.
Finally, we need to reimagine a world we live in, with many more zoonotic diseases emerging in the days to come. The way people move, the animal food we eat, how we interact with domestic and wild animals, the age structure and our health status determine the genesis and our response to these diseases. Correspondingly, disease control efforts are not prioritised in several countries. An important lesson here is to strengthen the public health system and surveillance, as the indomitable determinants of each state’s ability to reduce the overall adversities related to any health emergency.(Dr Giridhara R Babu is Professor, Head-Lifecourse Epidemiology at the Indian Institute of Public Health, PHFI, Bengaluru)