First-hand account of being a part of the public health system in India
I recently completed my graduation from Simon Fraser University, Vancouver, Canada. A couple of months before the COVID-19 pandemic had most of the world completely under lockdown, I had the opportunity to intern with the Indian Ministry of Health and Family Welfare. It turned out to be a great learning experience as during my two-month internship, I visited different public health institutions such as HIV Testing Centre, Tuberculosis (TB) clinics, primary health centres in rural regions and slums in Mumbai. I was privy to discussions with numerous public health professionals regarding national health programmes and the current challenges in the Indian healthcare system. Most notably, I had the opportunity to attend Indian Union Health Minister Dr. Harsh Vardhan’s lecture on public health and how the government is prepared to combat the pandemic.
Apart from the sessions and field visits, I was assigned to conduct a case-control study by analysing community health volunteers based on their communication skills and the effectiveness of public health training. In just 10 days, I visited 19 different health posts in various parts of Mumbai and observed how community health volunteers communicate with their patients. These interviews included observations on how volunteers disseminate knowledge as well as create awareness through door-to-door visits. In this study, I used a sample size of 40 volunteers ranging from the age group 24-67 years. Basically, three generations of community health volunteers. After acquiring the necessary data, I did a statistical analysis using different software such as SPSS and R studio to solidify the hypothesis. Furthermore, I prepared a 30-minute presentation to the senior faculty members regarding the research along with a 5,000-word report to the director as a handbook for future interns. Here are some of the findings.
Problems
There are approximately 5,000 community health volunteers in Mumbai. I was surprised by the lack of recognition they get even though they are the main bridge between the general public and the healthcare system. At the same time, the heavy workload of 1,000 door-to-door visits per week is overwhelming, especially, when there are literally no social benefits except INR 5,000 monthly (approx. HK$ 510). Volunteers who have worked for more than 30 years have no pensions or any other benefits. Something which is disheartening and demotivating for the new generation of health volunteers. To resolve these problems, active participation and advocacy are critically important for all stakeholders in the health system.
However, there is a shortage of research studies in this dimension. India has been successful in eradicating polio and smallpox — key milestones in healthcare history. Currently, India has proposed to eradicate Tuberculosis by 2025. Personally, I feel that it is highly impractical as a strong cultural stigma, under-reporting and lack of public health infrastructure are some of the main barriers. I also discovered that the health policies and regulations to run the system smoothly, haven’t been updated post-independence. However, the weakest aspect of the system is not the policies but the enforcement and political will to implement these initiatives. In addition, the current system is majorly focusing on the clinical aspect of health and neglecting the promotive and preventive aspects of public health.
In the last decade, there have been 750 new medical colleges inaugurated in the country for training physicians and nurses. However, only 50 public health institutes have been created in the same period. There has been a marginal increase of 5.7% in the health budget in the latest union budget 2019-2020. The health budget compromises only 1% of the total budget which is well short of the proposed 2.5%. If you interpret the current data, the Indian health system has inadequate preparation for any epidemic that is to happen in the recent future. There is a high deficiency when it comes to health researchers in the system. If these factors are not addressed immediately, there are high chances that India could become the next Italy or Iran.
Suggestions
For a country having a population of more than 1.3 billion, India had conducted only 25,000 tests for COVID-19 until March 25. Whereas British Columbia, a Canadian province with just five million people, had conducted more tests in comparison. Testing times like these require more than a top-down approach from the government. A decentralised bottom-up approach amongst the residents is equally important. Every individual should focus on personal hygiene and research more about health-related information from accredited sources rather than news circulated on social media.
Creating a panic situation and excessive buying of health products such as sanitisers or masks is selfish and meaningless. By hoarding necessary products, you are depriving vulnerable communities such as elderly people or those who have pre-existing conditions or life-threatening diseases, of basic care. The ongoing pandemic is a war and no one should take it lightly. Nationwide lockdowns and curfews can only slow down the pandemic but not contain it. Solidarity amongst individuals, governments as well as international countries is the need of the hour to combat the pandemic that’s wreaking havoc.
