New Delhi: In its June 12 issue, ‘The Lancet’ medical journal has addressed the coronavirus crisis witnessed in India and recommended eight “urgent actions” that need to be taken to tackle the resurgence as the pandemic spreads into rural populations.
The comment in ‘The Lancet’ journal was authored by 21 experts, including Biocon chief Kiran Mazumdar-Shaw.
“India confronts an immediate emergency to save lives and reduce suffering. On behalf of the Lancet Citizens’ Commission, we propose eight recommendations for the central and state governments that share responsibility for the health of India’s people,” the comment reads.
Here are the eight “urgent actions” suggested by the authors in ‘The Lancet’ journal to help India:
- The organisation of essential health services must be decentralised. A one-size-fits-all approach is untenable since the numbers of Covid-19 cases and health services differ substantially from district to district. District-level working groups that have the autonomy to respond to rapidly changing local situations must be empowered to receive funds and resources to coordinate efforts across all sectors of the health system, from front-line workers to tertiary care.
- There must be a transparent national pricing policy and caps on the prices of all essential health services — ambulances, oxygen, essential medicines, hospital care, and the like. Hospital care should not require any out-of-pocket expenditure and costs should be covered by existing health insurance schemes for all people, as has been done in some states. All local governments must be allocated their grants as recommended by the Fifteenth Finance Commission.
- Clear, evidence-based information on the management of Covid-19 must be more widely disseminated and implemented. This includes guidelines for home care and treatment, primary care, and district hospital care in local languages. It should also provide information to help prevent increasingly concerning reports of other impacts of Covid-19, including secondary infections such as mucormycosis.
Underline the essential non-Covid-19 health services that must remain fully accessible in specific facilities – eg, for tuberculosis, maternal and child health, and emergency medicine.
Specific guidance should be offered by the central government on the appropriate use of Indian systems of medicine, especially for prevention and health promotion interventions, such as yoga.
- All available human resources across all sectors of the health system, including the private sector, must be marshalled for the Covid-19 response and adequately resourced, particularly with sufficient personal protective equipment, guidance on the use of clinical interventions, insurance, and mental health support.
“We support the implementation of the decision to deploy final-year medical students and AYUSH students in the Covid-19 response; this policy should be extended to nursing and paramedical students,” the authors stated.
- Central systems to procure and distribute Covid-19 vaccines free of cost should be established in a departure from the current policy of decentralised procurement through state governments. State governments must decide on the priority groups for vaccination on the basis of evidence to optimise the use of available vaccine doses, which can be incrementally expanded as supplies improve.
- Community engagement and public participation must lie at the heart of India’s Covid-19 response. Active collaboration must be encouraged between government and civil society organisations to create and disseminate accurate information, enabling home-based care, emphasising prevention, helping navigate access to life-saving treatment, and promoting vaccination.
- There must be transparency in government data collection and modelling to enable districts to proactively prepare for the likely caseloads in the coming weeks. Health system personnel require data on age and sex-disaggregated Covid-19 cases, hospitalisations, and mortality rates; community-level coverage of vaccination; and community-based tracking of the effectiveness of Covid-19 treatment protocols and long-term outcomes.
- The suffering and risk to health caused by loss of livelihoods should be minimised by making provisions for cash transfers by the state to workers in India’s vast informal economy who have lost their jobs, as is being done by some state governments.
The comment states that the formal sector employers must be required to retain all workers, irrespective of the status of contracts, through a government commitment to offering compensation to these companies when the economy revives. If lockdowns are deemed necessary, they must be announced well in advance and entail planning for all essential services, the experts stated.
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