In the past several years, India has transitioned into a new chapter in public health. The onset of the COVID-19 pandemic underlined the importance of upgrading the public health system. While stakeholders have devoted themselves to improving the accessibility and availability of health services, there is still much to be worked upon when implementing high-impact strategies.

As we approach the third anniversary of the pandemic, there is reason to hope that the learnings of this trying period will be translated into sound public health policies.

Robust Public Healthcare System

Public healthcare does not solely involve treating individuals. It is founded on the five principles of affordability, availability, accessibility, acceptability, and accommodation. Healthcare providers must take on the challenge of protecting the community from illnesses by targeting and deploying epidemiological measures.

Alongside medical attention, preventive healthcare and health outreach campaigns are to be utilized to minimize the transmission of diseases. Furthermore, to serve those most in need, it is essential to provide free and accessible primary care, medication, and diagnosis, while safeguarding vulnerable populations from excessive expenses resulting from secondary or tertiary care hospitalization.

The health sector is influenced by healthcare policies and systems. Public healthcare systems across the globe serve to extend life, improve the health of its citizens, and fight diseases caused by microorganisms like viruses and bacteria. According to the CDC or Centers for Disease Control and Prevention, public health systems include various organizations that provide vital health services within a specified area.

This article highlights core issues in India’s public health sector learned during the current pandemic and emphasized on the need for urgent action based on these lessons.

The COVID-19 outbreak brought to light the advantages and drawbacks of India’s social, financial, and healthcare systems. It is crucial to reflect on what we learned, educate ourselves, and commit to developing more durable, resilient healthcare systems that offer health safety to everyone. The outbreak taught valuable lessons that apply across the world.

Countries that learned from prior health crises and planned for future were the ones that performed better. Countries that prioritize universality over individuality as a principle succeeded in collective responses. The countries where their citizens believed in their leadership and government had achieved better outcomes. Finally, countries that invest in research and development have a clear advantage in fighting against the pandemic.

India’s social, financial, and health systems have been both challenged and exposed by the COVID-19 pandemic. It is essential to pause and contemplate, gain knowledge, and dedicate ourselves to developing more robust and adaptable health systems that can provide health safety to everyone. Valuable lessons have been learned globally from the pandemic. Nations with resilient public health and primary healthcare systems saved more lives. Countries that empowered and involved their communities demonstrated resilience. Nations that learned from prior health crises and made their systems ready for future ones did better. Countries that prioritized universalism over individualism have responded effectively as a collective action. Countries with credulous leadership and government have performed well. Lastly, the role of a health research institutes that invest in research and development is paramount as they have an edge in their response to the pandemic.

Covid-19 Takeaways

One of the significant takeaways from the COVID-19 pandemic was the necessity for resilience. It entails focusing on handling disruptions in supplies, the sudden absence of healthcare workers, and the mismatch between demand and supply for materials, including vital oxygen. The significance of local manufacturing in preserving supplies and exercising stewardship in utilizing scarce and essential resources such as medicines and oxygen was well- acknowledged during this period.
In the future, it will be crucial to establish robust systems to ensure the quality of locally manufactured products and sustainable oversight mechanisms for ensuring the appropriate utilization of resources. It will require the establishment or expansion of regulatory bodies with the ability to carry out this activity.

Ways to Improve Public Health System

There exist numerous approaches to enhance public health systems. These include stimulating the creation and production of medical equipment, vaccines, and personal protective equipment within the country and increasing funding for medical research.

The system necessitates investment and measures to be taken in the short and long term to establish stability within the public health system.The global COVID-19 pandemic has exposed a significant deficiency in healthcare infrastructure worldwide, including India, which has long struggled to meet established health infrastructure benchmarks. According to the Human Development Report 2020, the national ratio of hospital beds to individuals is only five per 10,000 people. This insufficiency was further exacerbated during the pandemic, leading to extreme stress on medical infrastructure. Governments worldwide were compelled to establish temporary and makeshift hospitals to manage the growing number of patients. It became clear that traditional infrastructure development methods were too slow in meeting the needs of a burgeoning population.

To address such a situation, a dual strategy is required, including a longer development cycle that may necessitate more extensive, slower interventions and an immediate system that can be deployed. In unprecedented scenarios like the COVID-19 outbreak, nimble and agile systems must be implemented to enhance existing infrastructure.

Infrastructural development and investment

A robust public health infrastructure is the bedrock of all public health services, ranging from immunization to chronic illness prevention programs and emergency readiness. It must encompass health departments, workforce education and training, data and information systems, planning, and collaborations.

A well-developed infrastructure is essential to enhance the quality of health care services, including treatment, diagnosis, and overall patient welfare. Currently, there exists a significant gap between the quality of public healthcare infrastructures and private healthcare infrastructures. Therefore, bridging this gap is necessary. The healthcare system should be capable of providing a comprehensive health promotion, prevention, and self-care module to the entire population. Improved infrastructure will result in faster and more affordable healthcare services. A well-equipped infrastructure will enable the public health system to deliver long-term, patient-centred services of high quality, both for planned care and unexpected pandemics.

The pandemic has highlighted the significant gap in the doctor-to-population ratio, which stands at 1:1500. The patient-to-hospital bed ratio is also unfavourable, especially during times of crisis. This situation presents an excellent opportunity to reconsider how healthcare infrastructure is planned, particularly for the rural population that comprises the majority of the country.

To meet the needs of the population, there is a pressing need for more healthcare professionals. It inevitably means establishing more medical colleges. The shortage of trained professionals is not limited to doctors alone but also extends to trained nursing staff, who are essential for the day-to-day functioning of hospitals. To address the shortage, solutions like attaching medical colleges to existing government healthcare centres and setting up training facilities as compulsory add-ons to existing medical colleges can be explored.

Acquiring the appropriate talent to meet the demand for skilled healthcare professionals is becoming increasingly challenging due to rapid headwinds. In addition, it is equally important to improve the skill set of the existing workforce. Organizations such as the International Institute of Innovation & Technology will ensure that technology plays a significant role in the healthcare industry in the future, with AI and digital interventions being utilized at all stages, from awareness and diagnosis to treatment and recovery. Therefore, healthcare professionals working in public and private provider facilities must be trained to a certain level of technical proficiency to provide quality healthcare support, even in rural areas.

The current healthcare education system in India lacks focus on management and public health skills. Although doctors receive training in individual clinical treatment, they must be rarely exposed to learning opportunities that enable them to manage healthcare facilities and programs or perform population health duties.

To support community health involvement, disease surveillance and response systems, health promotion and prevention programs management, monitoring and evaluation, leadership, and team management of funds and other resources, a wide range of competencies are required. A public health cadre should not be limited to doctors. They will be trained as an inter-professional cadre that includes nurses, epidemiologists, social workers, policy and management experts, engineers, and social scientists. It will enable them to work in inter-professional teams that address the full spectrum of population health needs within India’s complex health system.

It is crucial to make a substantial investment in public health infrastructure. Presently, the funding for establishing diagnostic laboratories, healthcare facilities, and necessary equipment is insufficient. Moreover, even in areas where diagnostic infrastructure is available, it is outdated and consists of deteriorated machines that often malfunction or provide inaccurate assessments. Such a situation is as hazardous as not having diagnostic support at all. The allocation of funds in the budget is inadequate to finance new infrastructure, and most of the budget is expended on maintaining the existing infrastructure and compensating medical staff.

It is crucial to upgrade, modernize, and expand the infrastructure in the healthcare sector. Both public and private entities should increase their investments in this area. While it is significant to establish more medical education, research, and development facilities and innovation centres such as I3TK, it is also necessary to rethink the approach to delivering care.

The development and cost-effective digital diagnostic devices are a feasible solution that offers convenient, quick, accurate, and low-cost access to diagnostic support in all terrains and climatic conditions. This approach will also aid in early disease identification and prevention, resulting in fewer claims for insurers and better utilization of healthcare allocations by the government. Sufficient funding and determination are critical in achieving the goal of providing quality healthcare and a better life for all Indians.

Role of connected health in public health

The implementation of digitization and connected healthcare has the potential to improve the accessibility and availability of healthcare services, while empowering a significant portion of the population. The COVID-19 pandemic has underscored the importance of technology on a substantial level, with telehealth and remote patient monitoring being widely adopted as essential technologies during the crisis.

The utilization of technology has proven to be successful in training healthcare professionals, digitizing medical records, identifying, and diagnosing health issues, and other related applications. Patients can benefit from health-related data, which enables them to receive personalized and proactive care more efficiently. Medical devices and services are designed with the patient’s needs in mind. Connected health technology seamlessly integrates all the vital components of a healthcare system, providing medical facilities, services, and care to everyone, anytime and anywhere.

India still faces significant challenges in healthcare, particularly regarding accessibility, affordability, and quality. Serious issues such as inadequate infrastructure, insufficient healthcare workers, incorrect diagnoses, incorrect treatment, high costs, and limited access to medicines have caused millions of deaths annually and left countless patients without primary care. To address these challenges, India must leverage data and technology to create connected health solutions that reduce human error and provide specialist expertise to rural and semi-urban populations, where over 70% of the country’s residents live. By utilizing digital platforms to train and empower primary healthcare clinicians in rural and semi-urban areas, they can make informed decisions focused on managing chronic illnesses, moving towards a more proactive/preventive approach to care instead of reactive, which is one of the biggest reasons for the high mortality rate in India.

Role of Digital Channels

During the pandemic lockdowns, telemedicine played a pivotal role in reducing the movement of people and preventing crowded medical facilities. Digital platforms and apps were extensively used to provide healthcare services, becoming an essential part of public health efforts. Incorporating health services through digital communication channels was especially beneficial for people in remote areas with limited access to medical services, providing them with much-needed assistance.
The utilization of healthcare data and disease surveillance is of utmost importance in preventing and managing future pandemics. During the pandemic, the healthcare industry has utilized data to track the spread of the virus and monitor the overall health of the population.
Making health systems data available to researchers can offer valuable information on ways to enhance the efficiency and efficacy of healthcare services and evaluate the effects of new health policies and approaches.

Way forward

Improving the readiness and responsiveness of public healthcare institutions, developing high-quality healthcare infrastructure, and increasing community involvement in healthcare will improve public health and help manage future pandemics. All stakeholders must work together to reinforce the public health system.

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