<div dir="ltr"><div class="gmail_default" style="font-size:large"><br></div><div class="gmail_default" style="font-size:large">
<p class="MsoNormal" style="line-height:normal;margin:0cm 0cm 8pt;font-size:11pt;font-family:Calibri"><b><span style="font-size:16pt;font-family:"Times New Roman"" lang="EN-GB">Ten lessons from the
Covid-19 pandemic for India’s health system<span></span></span></b></p>
<p class="MsoNormal" style="line-height:normal;margin:0cm 0cm 8pt;font-size:11pt;font-family:Calibri"><b><span style="font-size:12pt;font-family:"Times New Roman"" lang="EN-GB">We must start by recognising the centrality of
public health services and initiating a system upgrade.<span></span></span></b></p>
<p style="margin-right:0cm;margin-left:0cm;font-size:12pt;font-family:"Times New Roman""><span lang="EN-GB">It is said that good decisions come from experience,
although experience often comes from bad decisions. While we debate official
decisions taken during the novel coronavirus epidemic in India, <b>we need to use the experience generated in
this process as a source of learning, both for the present and the future</b>. <span></span></span></p>
<p style="margin-right:0cm;margin-left:0cm;font-size:12pt;font-family:"Times New Roman""><span lang="EN-GB">In a two-part series, I focus on the health system aspects
of this epidemic, which has produced the most devastating public health
emergency in the last century of human history. I distill ten key lessons which
might make us somewhat wiser, at least in hindsight. Here are the first five. <br></span></p><p style="margin-right:0cm;margin-left:0cm;font-size:12pt;font-family:"Times New Roman""><br><span lang="EN-GB"><span></span></span></p>
<h3 style="margin:2pt 0cm 0.0001pt;line-height:107%;break-after:avoid;font-size:12pt;font-family:"Calibri Light";color:rgb(31,77,120);font-weight:normal"><strong><span style="font-family:"Calibri Light"" lang="EN-GB">1. Public health services, the lifeline of
societies, need an upgrade.</span></strong><span style="color:blue" lang="EN-GB"><span></span></span></h3>
<p style="margin-right:0cm;margin-left:0cm;font-size:12pt;font-family:"Times New Roman""><b><span lang="EN-GB">Public health
services, politically neglected for decades </span></b><span lang="EN-GB">in most
Indian states, <b>have proven their
irreplaceable value during this crisis. Although despised by the rich and
middle classes, they are shouldering the lion’s share of not just preventive
and outreach services but also clinical care.</b> Nearly 80%-90% of critical
Covid-19 cases are currently being treated by public health services. <span></span></span></p>
<p style="margin-right:0cm;margin-left:0cm;font-size:12pt;font-family:"Times New Roman""><b><span lang="EN-GB">States with robust
public health systems</span></b><span lang="EN-GB"> like Kerala <b>have been far more successful</b> in
containing Covid-19, compared to richer states like Maharashtra and Gujarat,
which have under-staffed public health systems.<span></span></span></p>
<p style="margin-right:0cm;margin-left:0cm;font-size:12pt;font-family:"Times New Roman""><span lang="EN-GB">Given this background, <b>now
is the time to reinvent and rejuvenate public health services across the
country, for which health budgets must be substantially upgraded.</b> India’s
measly public health expenditure – at 1.15% of its gross domestic product –
must take a quantum leap and be more than doubled to reach the goal of 2.5% set
by the National Health Policy 2017, while being further increased to 3%-4% of
the GDP in medium term.<span></span></span></p>
<p style="margin-right:0cm;margin-left:0cm;font-size:12pt;font-family:"Times New Roman""><span lang="EN-GB">For large states like Uttar Pradesh, Bihar, Maharashtra and
Gujarat, per capita spending on health is well below national average of Rs
1,765 annually – under Rs 5 per day. All states should upscale their health
budgets to reach Rs 3,800 per capita, at 2019 prices – the level attained by
Himachal Pradesh and surpassed by smaller states like Goa, Mizoram and Sikkim.
This is possible if state governments spend at least 8% of their total budget
on health and the Union government share is hiked, bringing this to 50% of
total public health spending.<span></span></span></p>
<p style="margin-right:0cm;margin-left:0cm;font-size:12pt;font-family:"Times New Roman""><span lang="EN-GB">Further, <b>we need to
critically re-examine</b> Niti Aayog’s <b>recent
proposal to privatise large district hospitals. Imagine if hundreds of district
hospitals across the country had been managed by a large number of
disconnected, profit-oriented private medical colleges during the epidemic.
Rapid response and district-level coordination would have ended in chaos. While
planning for public health systems expansion and rejuvenation, proposals for
handing over public health assets to private players should now be permanently
shelved.</b><span></span></span></p>
<h3 style="margin:2pt 0cm 0.0001pt;line-height:107%;break-after:avoid;font-size:12pt;font-family:"Calibri Light";color:rgb(31,77,120);font-weight:normal"><br><strong><span style="font-family:"Calibri Light"" lang="EN-GB"></span></strong></h3><h3 style="margin:2pt 0cm 0.0001pt;line-height:107%;break-after:avoid;font-size:12pt;font-family:"Calibri Light";color:rgb(31,77,120);font-weight:normal"><strong><span style="font-family:"Calibri Light"" lang="EN-GB">2. Primary healthcare must be given primary
importance within health services.</span></strong><span style="color:blue" lang="EN-GB"><span></span></span></h3>
<p style="margin-right:0cm;margin-left:0cm;font-size:12pt;font-family:"Times New Roman""><b><span lang="EN-GB">Wherever the
Covid-19 epidemic has been well contained</span></b><span lang="EN-GB">, as in
Kerala, <b>it has been primarily due to
action at the primary health care level.</b> All public health activities
required for epidemic control – including testing, early detection of cases and
various preventive measures – are being carried out by PHC-level staff, despite
often being overburdened due to inadequate staffing in many states.<span></span></span></p>
<p style="margin-right:0cm;margin-left:0cm;font-size:12pt;font-family:"Times New Roman""><span lang="EN-GB">In this context, we see that the proportion of the Union
health budget allocated for the National Health Mission, which is focussed on
supporting primary and secondary health care, was reduced to 49% in 2020-’21
from 56% in 2018-’19, while the share for health insurance schemes, focussed on
higher level hospitalisation care, has more than doubled to 9% from 4% in the
same period. <b>The declining trend for
support to PHC must be reversed and at least 70% of all health budgets must be
earmarked for this less glamorous but vitally important frontline level of
care.</b><span></span></span></p>
<h3 style="margin:2pt 0cm 0.0001pt;line-height:107%;break-after:avoid;font-size:12pt;font-family:"Calibri Light";color:rgb(31,77,120);font-weight:normal"><br><strong><span style="font-family:"Calibri Light"" lang="EN-GB"></span></strong></h3><h3 style="margin:2pt 0cm 0.0001pt;line-height:107%;break-after:avoid;font-size:12pt;font-family:"Calibri Light";color:rgb(31,77,120);font-weight:normal"><strong><span style="font-family:"Calibri Light"" lang="EN-GB">3. Outreach-based strategies are core to
epidemic control, while generalised lockdowns come at high costs.<span></span></span></strong></h3>
<p style="margin-right:0cm;margin-left:0cm;font-size:12pt;font-family:"Times New Roman""><b><span lang="EN-GB">Most known models of
effective control of Covid-19 </span></b><span lang="EN-GB">– South Korea,
Kerala, Bhilwara, Sangli and others – <b>are
based on rigorous implementation of intensive outreach-based public health
measures. These are centred on extensive testing and case identification,
isolation and treatment of cases, meticulous contact tracing, home quarantine
of contacts, and localised restrictions on movement in some cases.<span></span></b></span></p>
<p style="margin-right:0cm;margin-left:0cm;font-size:12pt;font-family:"Times New Roman""><span lang="EN-GB">Although implementing these measures requires certain
health system preparedness, <b>there is no
substitute for such outreach strategies. <span></span></b></span></p>
<p style="margin-right:0cm;margin-left:0cm;font-size:12pt;font-family:"Times New Roman""><span lang="EN-GB">On the other hand, various modelling exercises and <span><span class="gmail-MsoHyperlink" style="color:blue;text-decoration:underline">expert public health analyses</span></span> have argued that
<b>generalised lockdown-type restrictions
imposed on the entire population are of relatively less value for containing
transmission, and definitely cannot supplant the set of outreach measures
mentioned above.</b> Now, despite huge social and economic costs being exacted
by widespread lockdown, the level of political and administrative emphasis
given to this generalised restrictive measure is much higher than the attention
given to implementing outreach measures.<span></span></span></p>
<p style="margin-right:0cm;margin-left:0cm;font-size:12pt;font-family:"Times New Roman""><span lang="EN-GB">Looking at the South Korean experience, where the epidemic
was largely contained through intensive testing and outreach measures without
resorting to general lockdown, it is worth speculating whether the Covid-19
outcome in India might have been qualitatively different if the level of
political priority for lockdown versus outreach-based public measures had been
reversed.<span></span></span></p>
<h3 style="margin:2pt 0cm 0.0001pt;line-height:107%;break-after:avoid;font-size:12pt;font-family:"Calibri Light";color:rgb(31,77,120);font-weight:normal"><br><strong><span style="font-family:"Calibri Light"" lang="EN-GB"></span></strong></h3><h3 style="margin:2pt 0cm 0.0001pt;line-height:107%;break-after:avoid;font-size:12pt;font-family:"Calibri Light";color:rgb(31,77,120);font-weight:normal"><strong><span style="font-family:"Calibri Light"" lang="EN-GB">4. Frontline health workers are critical to
protect and care for us.<span></span></span></strong></h3>
<p style="margin-right:0cm;margin-left:0cm;font-size:12pt;font-family:"Times New Roman""><span lang="EN-GB">Daily news tells us that <b>the real heroines and heroes during Covid-19 response have been the
frontline health workers</b> – including nurses and doctor, auxiliary nurse
midwifes, accredited social health activists, field and hospital health staff. <b>Working at considerable personal risk</b>,
often without adequate personal protection, toiling long hours daily, sometimes
even subjected to violence, these lakhs of unnamed stars are protecting all of
us.<span></span></span></p>
<p style="margin-right:0cm;margin-left:0cm;font-size:12pt;font-family:"Times New Roman""><span lang="EN-GB">At least in keeping with enlightened self-interest, <b>what we need to ensure is that health
workers are provided with the minimum basic requirements to fulfil their duties
effectively, now as well as after the epidemic</b>. This requires large-scale
regular appointments to ensure that huge understaffing is eliminated and
workload of existing staff is rationalised.<span></span></span></p>
<p style="margin-right:0cm;margin-left:0cm;font-size:12pt;font-family:"Times New Roman""><span lang="EN-GB">In Maharashtra alone, there are estimated over 17,000
vacancies in public health and 11,000 vacancies in medical education, where
long-overdue recruitments are expected now. Linked with this, <b>large numbers of contractual health staff
working without job security need to be urgently regularised</b>.<span></span></span></p>
<p style="margin-right:0cm;margin-left:0cm;font-size:12pt;font-family:"Times New Roman""><span lang="EN-GB">An estimated 275,000 contractual staff work and around nine
lakh ASHAs work at various levels as part of the National Health Mission alone,
often receiving less than one-third the salary of permanent health staff
performing similar tasks. Major shortages of personal protective equipment for
frontline health staff during the epidemic highlight the need to <b>ensure proper working conditions for all
health workers, including living quarters and transport in rural areas. Much
more than occasional clapping and thali beating, it is imperative to ensure
that those who protect our health and lives can themselves live and work with
dignity.<span></span></b></span></p>
<h3 style="margin:2pt 0cm 0.0001pt;line-height:107%;break-after:avoid;font-size:12pt;font-family:"Calibri Light";color:rgb(31,77,120);font-weight:normal"><br><strong><span style="font-family:"Calibri Light"" lang="EN-GB"></span></strong></h3><h3 style="margin:2pt 0cm 0.0001pt;line-height:107%;break-after:avoid;font-size:12pt;font-family:"Calibri Light";color:rgb(31,77,120);font-weight:normal"><strong><span style="font-family:"Calibri Light"" lang="EN-GB">5. Wealthy cities may not be healthy cities,
unless urban health systems are created.</span></strong><span lang="EN-GB"><span></span></span></h3>
<p style="margin-right:0cm;margin-left:0cm;font-size:12pt;font-family:"Times New Roman""><span lang="EN-GB">The coronavirus epidemic is highly urban focussed – half of
the confirmed Covid-19 cases have been reported from 15 predominantly urban
districts of India, including Delhi and Mumbai. <b>This epidemic has exposed the vulnerable underbelly of India’s
glittering metropolises, where major gaps exist in urban health services and
urban planning. Many large urban conglomerations lack comprehensive public
health services, especially in suburbs and newly-developed areas.</b><span></span></span></p>
<p style="margin-right:0cm;margin-left:0cm;font-size:12pt;font-family:"Times New Roman""><span lang="EN-GB">The National Urban Health Mission launched in 2013 seems
stuck in a policy traffic jam – even in the current year, its allocated budget
was just Rs 950 crores, barely 1.4% of the Union health budget, amounting to
just Rs 2 per urban person per month.<span></span></span></p>
<p style="margin-right:0cm;margin-left:0cm;font-size:12pt;font-family:"Times New Roman""><b><span lang="EN-GB">Municipal
corporation funds for health are often focussed on existing hospitals, leaving
little scope for expansion of services to newer areas or strengthening primary
health care. The status of basic urban services – housing, water supply,
sanitation and environmental management – is even worse, especially in slums</span></b><span lang="EN-GB"> which house at least 30% of urban India. <span></span></span></p>
<p style="margin-right:0cm;margin-left:0cm;font-size:12pt;font-family:"Times New Roman""><b><span lang="EN-GB">Hence, the urgent
need to launch a massive programme for revamping of urban health services
focussed on primary healthcare, along with major upgradation of urban living
conditions, especially in “non-notified” slums which must be recognised as
integral to the city. Our cities cannot be considered “developed” without developing
their health-related systems.<span></span></span></b></p>
<h1 style="text-align:center;margin-right:0cm;margin-left:0cm;font-size:24pt;font-family:"Times New Roman";font-weight:bold" align="center"><span lang="EN-GB">
<hr width="100%" size="2" align="center">
</span></h1>
<h1 style="margin-right:0cm;margin-left:0cm;font-size:24pt;font-family:"Times New Roman";font-weight:bold"><span style="font-size:14pt" lang="EN-GB">Lessons from a pandemic: How
India can reform its private healthcare sector<span></span></span></h1>
<p style="margin-right:0cm;margin-left:0cm;font-size:12pt;font-family:"Times New Roman""><span lang="EN-GB">The novel coronavirus pandemic is the most devastating
public health emergency in the last century of human history. It is making
countries around the world take a hard look at their health systems.<span></span></span></p>
<p style="margin-right:0cm;margin-left:0cm;font-size:12pt;font-family:"Times New Roman""><span lang="EN-GB">In India, instead of just planning a “return to normal”
once we are past the immediate crisis, <b>it
is time to begin a society-wide debate about the need for a paradigm shift in
our health system.</b><span></span></span></p>
<p style="margin-right:0cm;margin-left:0cm;font-size:12pt;font-family:"Times New Roman""><span lang="EN-GB">In a two-part series, I have attempted to distill ten key
lessons for India’s health system. The first part focussed on why it is
imperative to recognise the importance of public health services and the need
to upgrade them. This part looks at what lessons can be drawn from the epidemic
for better engagement of the public and private sectors.<span></span></span></p>
<h3 style="margin:2pt 0cm 0.0001pt;line-height:107%;break-after:avoid;font-size:12pt;font-family:"Calibri Light";color:rgb(31,77,120);font-weight:normal"><br><strong><span style="font-family:"Calibri Light"" lang="EN-GB"></span></strong></h3><h3 style="margin:2pt 0cm 0.0001pt;line-height:107%;break-after:avoid;font-size:12pt;font-family:"Calibri Light";color:rgb(31,77,120);font-weight:normal"><strong><span style="font-family:"Calibri Light"" lang="EN-GB">6. Tertiary healthcare schemes must not be
given primary importance.</span></strong><span lang="EN-GB"><span></span></span></h3>
<p style="margin-right:0cm;margin-left:0cm;font-size:12pt;font-family:"Times New Roman""><span lang="EN-GB">The much-projected Pradhan Mantri Jan Arogya Yojana under
Ayushman Bharat was supposed to be a game changer: it allows patients to access
private hospitals using a government insurance scheme. <span></span></span></p>
<p style="margin-right:0cm;margin-left:0cm;font-size:12pt;font-family:"Times New Roman""><span lang="EN-GB">However, one month after National Health Authority offered
free Covid-19 testing and treatment in private hospitals under this scheme, <span><span class="gmail-MsoHyperlink" style="color:blue;text-decoration:underline">only 300-odd patients</span></span> had used this insurance
scheme for Covid-19 treatment. This is a miniscule number, considering that
around 10%-15% of Covid-19 cases – around 9,000 to 13,000 patients – might have
required hospitalisation until now.<span></span></span></p>
<p style="margin-right:0cm;margin-left:0cm;font-size:12pt;font-family:"Times New Roman""><b><span lang="EN-GB">While accepting that
private hospitals have a role to play in caring for severely ill Covid-19
patients, the health insurance scheme mode of engaging private providers
appears inadequate. </span></b><span lang="EN-GB">No wonder several state
governments have decided to requisition private hospitals to supplement public
health facilities, as a more dependable arrangement. <span></span></span></p>
<p style="margin-right:0cm;margin-left:0cm;font-size:12pt;font-family:"Times New Roman""><span lang="EN-GB">It is also notable how <b>certain
“medical superstars” from prominent corporate hospitals, who regularly speak on
TV programmes championing such schemes, have nothing substantial to offer
during this unprecedented health emergency.</b> If we compare the responses of
public health services and health insurance schemes in the current epidemic, we
might agree that actions speak louder than words, especially during a crisis.<span></span></span></p>
<h3 style="margin:2pt 0cm 0.0001pt;line-height:107%;break-after:avoid;font-size:12pt;font-family:"Calibri Light";color:rgb(31,77,120);font-weight:normal"><br><strong><span style="font-family:"Calibri Light"" lang="EN-GB"></span></strong></h3><h3 style="margin:2pt 0cm 0.0001pt;line-height:107%;break-after:avoid;font-size:12pt;font-family:"Calibri Light";color:rgb(31,77,120);font-weight:normal"><strong><span style="font-family:"Calibri Light"" lang="EN-GB">7. The market never regulates healthcare in
public interest. States must ensure this.</span></strong><span lang="EN-GB"><span></span></span></h3>
<p style="margin-right:0cm;margin-left:0cm;font-size:12pt;font-family:"Times New Roman""><b><span lang="EN-GB">While the public
health system has gone into overdrive to tackle Covid-19, the response from
private healthcare providers – responsible for 70% of healthcare provisioning
in India – has been muted.</span></b><span lang="EN-GB"> There have been reports
of massive overcharging of Covid-19 patients, with rates charged in Mumbai by
certain private hospitals being up to Rs one lakh per day.<span></span></span></p>
<p style="margin-right:0cm;margin-left:0cm;font-size:12pt;font-family:"Times New Roman""><b><span lang="EN-GB">Many private
hospitals and clinics have shut down or have been refusing suspected Covid-19
patients. This has highlighted once again that unregulated markets invariably
fail in case of healthcare, being unable to allocate this essential service
rationally or equitably.<span></span></span></b></p>
<p style="margin-right:0cm;margin-left:0cm;font-size:12pt;font-family:"Times New Roman""><span lang="EN-GB">In light of frequent overcharging, it is notable that the
Maharashtra government issued an order requiring all private hospitals in the
state to cap rates for over 170 medical procedures, based on the charges agreed
upon with insurance companies. <span></span></span></p>
<p style="margin-right:0cm;margin-left:0cm;font-size:12pt;font-family:"Times New Roman""><span lang="EN-GB">Regulation of private hospitals, on the backburner in the
state for six years, is now back on the agenda. <b>As we move past the epidemic, it is important that comprehensive
regulatory measures, resisted by influential private sector lobbies until now,
be systematised and legally institutionalised </b>through implementation of
appropriate Clinical Establishments Acts.<span></span></span></p>
<p style="margin-right:0cm;margin-left:0cm;font-size:12pt;font-family:"Times New Roman""><b><span lang="EN-GB">Concerns over
overcharging, problematic quality of care, and unnecessary procedures by
unregulated private hospitals require long term solutions.</span></b><span lang="EN-GB"> The Covid-19 crisis can open opportunities for change.<span></span></span></p>
<h3 style="margin:2pt 0cm 0.0001pt;line-height:107%;break-after:avoid;font-size:12pt;font-family:"Calibri Light";color:rgb(31,77,120);font-weight:normal"><br><strong><span style="font-family:"Calibri Light"" lang="EN-GB"></span></strong></h3><h3 style="margin:2pt 0cm 0.0001pt;line-height:107%;break-after:avoid;font-size:12pt;font-family:"Calibri Light";color:rgb(31,77,120);font-weight:normal"><strong><span style="font-family:"Calibri Light"" lang="EN-GB">8. Private healthcare providers must fulfill
public health obligations, now and in future.<span></span></span></strong></h3>
<p class="MsoNormal" style="line-height:normal;margin:0cm 0cm 8pt;font-size:11pt;font-family:Calibri"><b><span style="font-size:12pt;font-family:"Times New Roman"" lang="EN-GB"><br></span></b></p><p class="MsoNormal" style="line-height:normal;margin:0cm 0cm 8pt;font-size:11pt;font-family:Calibri"><b><span style="font-size:12pt;font-family:"Times New Roman"" lang="EN-GB">For decades, governments
encouraged private healthcare to run as a lucrative “industry” led by
profit-maximising corporate hospitals. During the epidemic, it became obvious
that commercial private players cannot be left to their whims as they need to
fulfil important public health obligations. However, there is hardly any legal
framework to ensure that these obligations are routinely ensured.<span></span></span></b></p>
<p class="MsoNormal" style="line-height:normal;margin:0cm 0cm 8pt;font-size:11pt;font-family:Calibri"><span style="font-size:12pt;font-family:"Times New Roman"" lang="EN-GB">For
example, the Maharashtra government has invoked the archaic Epidemic Diseases
Act 1897, among other laws, to ensure that private doctors mandatorily treat Covid-19
patients. State governments in Rajasthan, Madhya Pradesh and Chhattisgarh have
taken over private hospitals for Covid-19 care. While requisitioning private
hospital beds for Covid-19 care in Maharashtra, officials emphasised that
“charitable” private hospitals running on government-subsidised land have
public obligations.<span></span></span></p>
<p class="MsoNormal" style="line-height:normal;margin:0cm 0cm 8pt;font-size:11pt;font-family:Calibri"><b><span style="font-size:12pt;font-family:"Times New Roman"" lang="EN-GB">Emergency measures, like
requisitioning private hospitals highlight the fact that private healthcare
providers have public health obligations that should override commercial considerations
if required.</span></b><span style="font-size:12pt;font-family:"Times New Roman"" lang="EN-GB"> These include notifying cases of communicable diseases, cooperating for
implementing public health measures, observing patients’ rights, and treating
poor patients free of charge in case of “charitable” private hospitals. Now is
an opportune time to discuss robust frameworks to ensure that these obligations
will be observed by private hospitals even in “peacetime”.<span></span></span></p>
<h3 style="margin:2pt 0cm 0.0001pt;line-height:107%;break-after:avoid;font-size:12pt;font-family:"Calibri Light";color:rgb(31,77,120);font-weight:normal"><br><strong><span style="font-family:"Calibri Light"" lang="EN-GB"></span></strong></h3><h3 style="margin:2pt 0cm 0.0001pt;line-height:107%;break-after:avoid;font-size:12pt;font-family:"Calibri Light";color:rgb(31,77,120);font-weight:normal"><strong><span style="font-family:"Calibri Light"" lang="EN-GB">9. Public health demands active public
involvement. States and people must work in synergy. <span></span></span></strong></h3>
<p class="MsoNormal" style="line-height:normal;margin:0cm 0cm 8pt;font-size:11pt;font-family:Calibri"><span style="font-size:12pt;font-family:"Times New Roman"" lang="EN-GB"><br></span></p><p class="MsoNormal" style="line-height:normal;margin:0cm 0cm 8pt;font-size:11pt;font-family:Calibri"><span style="font-size:12pt;font-family:"Times New Roman"" lang="EN-GB">Kerala’s
Covid-19 control experience demonstrates that <b>outreach-based public health strategies become effective due to
proactive social engagement.</b> Panchayat representatives, community
volunteers and women’s groups worked with public health staff to implement
public health activities. <b>Pending any
vaccine or definitive treatment for Covid-19, the main plank of epidemic
control currently is various forms of modification in social behaviour that can
be ensured only with high-level social awareness and people’s informed
participation.<span></span></b></span></p>
<p class="MsoNormal" style="line-height:normal;margin:0cm 0cm 8pt;font-size:11pt;font-family:Calibri"><b><span style="font-size:12pt;font-family:"Times New Roman"" lang="EN-GB">Hence, public health services
need to develop platforms for health system-community interface,</span></b><span style="font-size:12pt;font-family:"Times New Roman"" lang="EN-GB"> including active community
members, panchayat representatives and civil society groups, from village and
primary health centres to district and state levels.<span></span></span></p>
<p class="MsoNormal" style="line-height:normal;margin:0cm 0cm 8pt;font-size:11pt;font-family:Calibri"><b><span style="font-size:12pt;font-family:"Times New Roman"" lang="EN-GB">These participatory bodies,
relevant during and beyond public health emergencies, must foster “broad
spectrum involvement” – not just implementing official programmes, but also
promoting awareness campaigns, facilitating entitlements for vulnerable and
excluded groups, monitoring delivery of services towards addressing service
gaps, and providing inputs for local health planning.</span></b><span style="font-size:12pt;font-family:"Times New Roman"" lang="EN-GB"> Frameworks such as
community-based monitoring and planning in Maharashtra, and social audit-based
models in several states need to be generalised as core components of public
health initiatives, since <b>health
programmes initiated from above are most effective when working in tandem with
social mobilisation from below.<span></span></b></span></p>
<h3 style="margin:2pt 0cm 0.0001pt;line-height:107%;break-after:avoid;font-size:12pt;font-family:"Calibri Light";color:rgb(31,77,120);font-weight:normal"><br><strong><span style="font-family:"Calibri Light"" lang="EN-GB"></span></strong></h3><h3 style="margin:2pt 0cm 0.0001pt;line-height:107%;break-after:avoid;font-size:12pt;font-family:"Calibri Light";color:rgb(31,77,120);font-weight:normal"><strong><span style="font-family:"Calibri Light"" lang="EN-GB">10. Illness can attack anyone. We need Right to
Healthcare to protect everyone.<span></span></span></strong></h3>
<p class="MsoNormal" style="line-height:normal;margin:0cm 0cm 8pt;font-size:11pt;font-family:Calibri"><span style="font-size:12pt;font-family:"Times New Roman"" lang="EN-GB"><br></span></p><p class="MsoNormal" style="line-height:normal;margin:0cm 0cm 8pt;font-size:11pt;font-family:Calibri"><span style="font-size:12pt;font-family:"Times New Roman"" lang="EN-GB">The
Covid-19 epidemic is concentrated in cities and has affected the middle class.
Therefore, “public opinion” – often another name for middle class opinion – is
currently focussed on health concerns. With the critical role of public health
services highlighted and “ailments” of commercialised private healthcare
further exposed, <b>this epidemic might
change the way society views healthcare. Since Covid-19 affects everyone, it
holds potential for building social solidarity around health concerns, traditionally
weak</b> in most of India.<span></span></span></p>
<p class="MsoNormal" style="line-height:normal;margin:0cm 0cm 8pt;font-size:11pt;font-family:Calibri"><b><span style="font-size:12pt;font-family:"Times New Roman"" lang="EN-GB">This setting is appropriate for
taking forward Right to Healthcare, which by definition must be universal.
Legal provisions for ensuring this would primarily involve revolve around state
governments, while national frameworks must be supportive. Health system
transformations required to support the Right to Healthcare would involve
developing Universal Health Care systems in various states – based on expanded
public health services, massive increase in public health spending, and
regulated involvement of private providers – organised to provide free, quality
healthcare for everyone.<span></span></span></b></p>
<p class="MsoNormal" style="line-height:normal;margin:0cm 0cm 8pt;font-size:11pt;font-family:Calibri"><span style="font-size:12pt;font-family:"Times New Roman"" lang="EN-GB">Assuming
action upon the lessons outlined in this two-part series, there is no reason
why the Right to Healthcare and Universal Health Care cannot be achieved in
most states across India in the next five years. <b>This can become reality, provided political will is generated within
governments from above, and is mobilised among wide sections of people from
below.</b><span></span></span></p>
<p style="margin-right:0cm;margin-left:0cm;font-size:12pt;font-family:"Times New Roman""><b><span lang="EN-GB">It may soon be an
opportune time to launch a massive and sustained social movement, demanding
sweeping health system reforms and health rights for all. This should involve
diverse sections of society</span></b><span lang="EN-GB">, which together
constitute the silent majority – working people in rural and urban areas,
socially oppressed sections of the population, groups among the middle class,
health workers and professionals – <b>who
all have a stake in transforming the health sector.<span></span></b></span></p>
<p style="margin-right:0cm;margin-left:0cm;font-size:12pt;font-family:"Times New Roman""><span lang="EN-GB">These 10 lessons could be signposts while developing the
movement for a new kind of health system in India, which ensures universal
health care based on health rights for all. <b>We owe it to ourselves, and to coming generations of Indians, to draw
lessons from this once-in-a-century pandemic, and do our best to act upon hard
earned lessons. We may not experience such a turning point again in our
lifetimes.</b><span></span></span></p>
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<p class="MsoNormal" style="margin:0cm 0cm 8pt;line-height:107%;font-size:11pt;font-family:Calibri"><em><b><span style="font-family:Calibri" lang="EN-GB">This two-part article published in
Scroll is by Dr Abhay Shukla, a public health professional and national
co-convenor of Jan Swasthya Abhiyan (People’s Health Movement, India). The
author would like to acknowledge the contribution of Ravi Duggal.<span></span></span></b></em></p>
<p class="MsoNormal" style="margin:0cm 0cm 8pt;line-height:107%;font-size:11pt;font-family:Calibri"><span lang="EN-GB"><a href="https://scroll.in/article/962794/what-lessons-does-the-covid-19-pandemic-hold-for-indias-health-system" style="color:blue;text-decoration:underline">https://scroll.in/article/962794/what-lessons-does-the-covid-19-pandemic-hold-for-indias-health-system</a><span></span></span></p>
<p class="MsoNormal" style="margin:0cm 0cm 8pt;line-height:107%;font-size:11pt;font-family:Calibri"><span lang="EN-GB"><a href="https://scroll.in/article/962793/lessons-from-a-pandemic-how-india-can-reform-its-private-healthcare-sector" style="color:blue;text-decoration:underline">https://scroll.in/article/962793/lessons-from-a-pandemic-how-india-can-reform-its-private-healthcare-sector</a><span></span></span></p>
<p class="MsoNormal" style="margin:0cm 0cm 8pt;line-height:107%;font-size:11pt;font-family:Calibri"><span lang="EN-GB"><span> </span></span></p>
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