As half of the Greek alphabets are used up in naming the variants of SARS-CoV-2, the year 2021 is ending without an end to COVID. This is the best time to look at how healthcare in Karnataka has evolved this year. Despite considerable capacity augmentation, the second wave caught all of us unaware. However, the state has to be credited with unprecedented augmentation in the capacity of all types of beds (ICU, oxygenated and regular), oxygen supplies and referrals. (Figure-1)
The Government had to reserve 50% of the beds in private hospitals through a notification to treat COVID-19 patients. This not being sufficient, Government had to set up step down hospitals in association with private hospitals and hotels. In Bengaluru alone, private hospitals tied up with 32 hotels providing over 1200 beds for treatment facilities to recovering COVID-19 patients. Yet, patients not requiring 24x7 medical attention/hospitalization continued to occupy the hospital beds, creating an artificial shortfall in beds for patients seeking new admissions. In the wake of any health emergency in future, such transient and inequitable care mechanisms cannot be relied upon as a sustainable model.
In addition to pandemic management and surveillance, best practices were implemented to improve laboratory infrastructure, facilitate sample flow to regional genome sequencing labs, and improve tertiary care facilities. Some of the best practices can be sustained with minor modifications. For example, Chronic care management can employ tiered admission processes (CCC, DCHC, or DCH) and mobile teams to oversee home care. Tele-checking the patients' vital signs can help ensure continuity of care. Using non-profit and professional groups to introduce COVID-19 vaccination can be institutionalized to promote occupational health. Tele-ICU may be scaled up to provide emergency and intensive care throughout Karnataka. The state capped the prices for COVID19 tests, HRCT, digital X-ray and bed costs; similar measures can help reduce out of pocket medical expenditure, promoting universal health coverage.
Strengthening Comprehensive Primary Health Care (CPHC) is essential to prevent disease, ensure a continuum of care and reduce the burden on secondary and tertiary hospitals. Karnataka has been ranked the number one state in establishing Health and wellness centres (HWC) to deliver healthcare to communities. Specifically, the planned 11,595 HWCs can prevent and control the escalating burden of Non-Communicable Diseases (NCD). 15% of the Karnataka citizens have diabetes. In comparison, 25% have hypertension prevalence as per the recent NFHS survey, which is partially a result of the growing burden (>30%) of overweight or obesity in the state. HWCs can implement screening and management of NCDs at the community level, including the long-ignored mental health problems. Data from the Karnataka State Police reveal over 850 suicide and attempt to suicide cases have been reported from March 2020 and May 2021. Many have taken this drastic step due to fear, unemployment, poverty and other social reasons. More as a function of better reporting or actual burden, Karnataka also witnessed the highest share of domestic violence. The Government should prioritize investments in promoting mental health. Karnataka's health helpline has done good work, averting 2,062 suicides in the last eight years. Strengthening HWCs would be a game-changer in this regard as their service also includes screening and basic management of NCDs, including mental health ailments.
The results from NFHS-5 have shown improvement in nutritional status with a reduction in stunting and wasting. However, anaemia remains a significant problem among women and children at 47.8% and 65.5%, respectively. (Figure 2) The Government's decision to include egg and banana in the mid-day meal is welcome. Also, more focus needs to be paid to sanitation and hygiene as it is a vicious cycle; without adequate sanitation, the nutritional gaps cannot be addressed. Mathrupoorna is a brilliant initiative of meal supplementation for pregnant and lactating women that has taken a back seat due to COVID and needs to be boosted further by engaging stakeholders within the community.
Karnataka has been a model state in its fight against COVID. To sustain the gains achieved so far, it is crucial to ramp up surveillance and be vigilant in the fight against multiple variants and waves; it is equally important to build a robust and resilient health system for proactive handling of the multidimensional aspects of health.
Deepa R is a Senior Research Associate, and Giridhara R Babu is a professor, head of life course epidemiology at the Indian Institute of Public Health, PHFI, Bengaluru.