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COVID has spelt a lockdown for routine health services

There have been innumerable stories of the suffering of non-Covid patients across the country during the lockdown and after, and official data is now available to show the extent to which routine health services were unavailable and the scale of its impact.
The number of fully immunised children fell by over 15 lakh in the three-month period from April to June compared to the same months last year. The number of institutional deliveries fell by about 13 lakh. The registered number of TB patients undergoing treatment fell to almost half of what it was last year. People seeking cancer treatment as outpatients fell by over 70%.

Hard-won progress on several national health goals, including the programme to bring down infant and maternal mortality or those to treat TB, malaria and non-communicable diseases such as heart diseases, diabetes and cancer, has suffered a severe setback.

The data also suggests that the impact was more in urban areas than in rural ones and in private healthcare facilities more than in public ones. However, there’s a caveat. The health ministry’s Health Management Information System (HMIS), launched in 2008, includes data entered daily from every government facility right from the primary health centres. However, data from private facilities is not so robust. “HMIS data’s main limitation is that it doesn’t manage to capture much data from the private sector. But it is a pretty good indicator of the utilisation of government facilities and reflects trends in usage quite accurately,” explained Dr T Sundararaman, former director of the National Health Systems Resource Centre (NHSRC).

The data reveals that institutional deliveries fell by 28% from 45 lakh in April-June last year to just 32 lakh this year, an indication of how many women may have been forced to have deliveries at home, perhaps even without any medical assistance.
There could also be a large number of unwanted pregnancies in the coming year as there was a huge drop in services related to contraception, including sterilisations after delivery, distribution of pills and post-delivery insertion of intra-uterine devices (IUDs).
Overall, allopathic outpatient consultations dropped to almost half from over 38 crore in April-June last year to 19.5 crore this year. For instance, ophthalmic outpatient consultations saw a huge reduction from over 80 lakh to just 22 lakh. There were such sharp disruptions in outpatient treatment for major comorbidities for Covid—diabetes, hypertension and heart diseases. Without timely medical care, doctors expect many of these conditions to have worsened leading to increased morbidity and mortality in the coming months.

Inpatient admissions also halved for men and women including for typhoid, respiratory illnesses like asthma and COPD, TB and vector borne diseases like malaria and dengue. There was also a 60% fall in the number of major and minor operations.
The reduction in cardiac emergencies based mostly on anecdotal evidence from doctors till now, is borne out by the HMIS data. Cardiac emergencies halved in this period. So did accident and trauma cases.

Most of the preventive healthcare services such as screening programmes for diseases and deficiencies in schools were almost totally disrupted as schools and anganwadis remained closed. Millions of pregnant women and school children missed getting iron and folic acid tablets meant to tackle widespread anaemia. Millions of new mothers and their babies missed getting their entitlement to free medicines, diet, diagnostics and many other services under the Janani Shishu Suraksha Karyakram (JSSY). – TOI

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