India Is Rapidly Moving Towards A Multidisciplinary Health System

How are you coping with the shortage of doctors and nurses during the covid-19 pandemic, considering that there is a surge in demand for healthcare services across India?

India is rapidly moving away from a doctor-centric health system to one that is increasingly multidisciplinary, one that is being led by the doctor, but involves various kinds of specialized health workers to increase system efficiency. This could not be more relevant than in the case of covid-19. Here, we have taken an approach of streamlining care provision in a staggered manner and, perhaps for the first time, defined and mapped roles of each of these workers specific to covid-19, while mapping their availability for each district and state.

India has about 70 lakh health workers of various categories, according to the health ministry’s detailed data review in September 2019. We estimate the availability of about 920,000 qualified allopathic doctors and specialists, 1.55 million nurses, about 750,000 nurse associates, or auxiliary nurse midwives (ANMs), about 200,000 dentists, almost 600,000 AYUSH qualified practitioners, about 1.1 million pharmacists, about 700,000 qualified allied and healthcare professionals, including those in laboratories, radiology, physiotherapy, optometry, occupational therapy, nutrition, and life sciences. In addition, we also have close to 1 million ASHA workers who take care of outreach services. While we definitely acknowledge the maldistribution of staff, there is no “absolute shortage” as is commonly perceived.

Several medical and AYUSH students have been readied to undertake field surveillance under the guidance of a field supervisor, who needs to have the necessary public health expertise. In the intensive care units, we are training respiratory therapists and physician associates to stand by along with anaesthesiologists and intensive care unit (ICU) specialists, and help them cater to a large number of critical patients, as they are well trained in the management of ventilators.

How many patients are on ventilators at present? How do you plan to cope with any shortage that may arise with covid-19 cases continuously increasing?

As of now, about 3% patients are on ventilators or oxygen support. More than 6,000 ventilators are already available in dedicated covid-19 hospitals in the country. In addition, orders have been placed for nearly 60,000 ventilators. We expect supplies to commence towards the end of this month. While preparing hospital ICUs and covid-19 care facilities, the approach is one of graded response, rather than creating infrastructure for the worst-case scenario at one go. Under this approach, hospital facilities are created at a certain level and are enhanced as soon as utilization crosses a pre-determined level. Looking at the number of patients on ventilators at the moment and the rate of growth, there is no shortage of ventilators at this moment. Moreover, the growth rate of covid-19 cases has been slowing down over the past few days as a result of the national lockdown and social distancing measures.

Is there any shortage of masks, especially the N95 variety, more so as many state governments have made masks mandatory for people stepping out of their homes, and penalising them for not wearing one?

The use of surgical and N95 masks is required for medical personnel who spend the whole day in close proximity of covid-19 patients and for infected people to prevent them from infecting others. Whenever people use these masks needlessly, they tend to create shortages for healthcare personnel who genuinely need these masks. Home-made reusable face covers have been recommended by the health ministry. Making such face covers at home and wearing them will strengthen our resolve to combat covid-19 and help reduce transmission of the disease. All citizens of the country should use reusable face covers if they have to venture out of their homes.

Has the health budget suffered because of the covid-19 pandemic? If yes, how? Which programmes may suffer because of this?

The government of India has opened its purse strings to ensure there is no shortage of funds to combat this national health crisis. Significant investments, to the tune of ₹15,000 crore for “India COVID-19 Emergency Response and Health System Preparedness Package” have already been announced. We have placed orders for medical supplies worth more than ₹5,600 crore. The finance ministry is working to ensure there is no shortage of funds to tackle the current crisis.

The impact on the ongoing schemes will depend on the success of our efforts to contain the spread of covid-19, and the economic costs incurred in fighting it. At this stage, it is premature to estimate the degree to which our programmes will be impacted. Having said that, it must be noted that while the world economy is projected to shrink because of this crisis, India is still projected to have a positive growth rate. Several positive steps have already been announced by the government and the Reserve Bank of India. I am sure India will be able to bounce back with the minimum possible impact on our economic growth.

India has the lowest testing rate for covid-19. Even when we have enough testing capacity, why is the government not increasing the number of tests?

The testing strategy has to differ from country to country with regard to population, availability of infrastructure, prevalence and spread of the disease and the stage of transmission of the virus. There have been wide differences in the approach followed by countries such as South Korea and Japan.

The Indian Council for Medical Research (ICMR) has been continuously studying the spread of covid-19 and recommending the optimal testing strategy. While the number of laboratories and test kits is being increased steadily, current trends and our success in reducing the rate of transmission indicate that our strategy is working well.

What is the impact of covid-19 on the Indian education system?

The National Eligibility cum Entrance Test-Undergraduate (NEET UG) had to be postponed because of logistic constraints and the need for social distancing. Colleges have been closed down for the moment. However, junior and senior residents, as well as final-year MBBS students, are continuing to serve and constitute an integral part of our workforce to combat the disease.

How are you tackling any shortage of PPEs? How do you ensure the quality of PPEs?

PPE coveralls were not produced in India before the covid-19 outbreak. Even before the first case in the country was detected, the ministries of health and textiles got together to engage with domestic manufacturers to start producing them locally. These indigenous new fabrics and coveralls were then tested for quality.

After some initial setbacks, domestic manufacturers were able to rise to the challenge. Today, we have more than 50 approved domestic producers with a combined production of around 60,000 coveralls per day.

As soon as exports from major manufacturers started resuming in the last week of March, we approached several foreign aggregators through the ministry of external affairs to supply PPE kits to us.

At the beginning of the outbreak, there were around 275,000 PPE kits in India. Far from being depleted, this stock has risen to 419,000 now, even as they are being used continuously for protection of our healthcare personnel. Strict quality control is being maintained while procuring PPEs from any source. PPEs that failed quality tests have not been supplied to states. The specifications have been conveyed to state governments also, and they have been requested to ensure that any procurement at their level must also confirm to the Union health ministry’s quality standards.-Livemint