Another wave of COVID-19 pandemic may surface whenever there is an increase in the number of vulnerable people either because they did get infected in the past or are not vaccinated. Yet, it can be effectively countered with a revamp of public health surveillance from primary health to State level to reduce the intensity and ensure adequate care is available at an affordable cost at an accessible location, say public health experts.
“Public health involves several inter-connected activities conducted simultaneously, starting from the village to the State Health Directorate. At each level, specific skills are required and the complexity increases as one moves higher,” explains Indian Institute of Public Health (IIPH)-Hyderabad director G.V.S. Murthy.
For instance, ASHAs or Accredited Social Health Activists are the interface between the public health system and the community, with one for every 1,000 persons. With increase in non-communicable diseases (NCDs) like diabetes and hypertension and the challenge of infectious diseases like COVID-19, an additional ASHA will be required for every 1,000 people.
“ASHAs are the eyes of the health system in the community and will know of any unusual event like prolonged fever or severe respiratory infections or any other complaints. They can immediately warn the female health workers at the sub centre (Auxiliary Nurse Midwives or ANMs) of unusual incidents. ANMs can report to the medical officer at the Primary Health Centre (PHC). This will improve the speed of response to any outbreak,” he says, in an exclusive interaction.
ANMs should be trained to identify danger signals calling for immediate attention, like COVID. They need to be provided tablets or smartphones to communicate with a medical officer who in turn should be trained and made responsible for surveillance of outbreaks.
PHCs should have diagnostic facilities, fully functional laboratory, rapid test kits for detecting infections like COVID and isolation facilities for mild presentations of infectious diseases. If necessary, they should be authorised to use local schools or community buildings as isolation centres. Oxygen facilities can be provided for immediate management before transfer, if need be.
At the next level, Community Health Centres will continue all PHC activities plus have a trained block level epidemiologist — one who can be chosen from an existing senior staffer to focus solely on public health response. At the district level, an epidemiology and public health surveillance unit should be set up headed by a trained public health professional with all vertical promotional avenues.
Dr. Murthy is clear that ‘clinicians’ should not be allowed to shoulder this responsibility, unless they decide to leave clinical practice and remain in the public health cadre pathway for the rest of their career. At the State level, six to eight public health cadre positions should be created with specific responsibilities for controlling outbreaks, monitoring, surveillance, training of peripheral staff, compiling data and planning the response based on available scientific evidence.
“This cadre is the need of the hour and the Director of Public Health should come from these ranks,” adds the director.
