How to control outbreaks? Go hyper-local

The city’s public healthcare system is often overwhelmed by the seasonal outbreak of diseases such as Dengue, Cholera, Gastroenteritis etc

Primary Healthcare Centres (PHCs) are at the heart of the evolving decentralised system. They need to be upgraded to tackle all diseases with the same efficiency as the pandemic. Credit: DH Photo/ B H Shivakumar

Can the now unfolding decentralised, ward-level battle strategy against Covid-19 morph into a robust template to combat all post-pandemic epidemics and seasonal diseases in the city? Can citizen groups, Primary Health Centres (PHCs), local doctors and nurses stay connected in the future to make healthcare more accessible, effective and democratic?

Indeed, the pandemic second wave is the immediate focus of the decentralised system spreading across the city. But the key question remains: Can this evolving structure and learnings be made sustainable after the cases decline and public concerns over the pandemic wane?

The need is real. The city’s public healthcare system is often overwhelmed by the seasonal outbreak of diseases such as Dengue, Cholera, Gastroenteritis and other ailments. As patients struggle and rely on costly private healthcare, the PHCs are found wanting in resources, staff and outreach.

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Prevention first

A localised, decentralised healthcare strategy can help the government adopt a robust process that promotes disease prevention before things go out of control, opines Dr Pragathi Hebbar, an Assistant Director at the Institute of Public Health (IPH).

“We know the pattern of seasonal infectious diseases, how and when they strike and spread. At the ward, citizen level, a checklist can be prepared to take stock of the prevailing situation. Many milder cases can be treated this way,” she elaborates.

Being active communities, Residents Welfare Associations (RWAs) can connect with households, entire layouts and apartment complexes. These groups, contends Dr Pragathi, could seamlessly reach out through the last-mile, creating healthcare awareness, precautions. Information could be dispersed in a streamlined manner.

Tacking misinformation

This last-mile collaborative effort can also tackle the large-scale spread of misinformation when diseases and epidemics spread to the community. “Such misinformation is rampant through social media platforms. It is very important to be vigilant against such mischief. Doctors and other medical experts at the local level can dispel the myths.”

But the decentralised template combining PHCs with Anganwadis is nothing new, reminds Tara Krishnaswamy, Co-Founder, Citizens for Bengaluru. “This is not a new concept. But the fact is that we have not properly implemented what was constitutionally envisaged through the 73rd and 74th amendments for decentralised healthcare,” she explains.

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Strengthen system

Vaccination, basic testing and prevention are all part of this model. “We now need to strengthen the system. We need to pay the Asha and Anganwadi workers who currently don’t get even the minimum wages. The PHCs need to be staffed adequately with doctors and nurses and equipped with proper infrastructure.”

Now, where do the citizen groups, RWAs and ward committees come in? “Going even below ward panels, we can have booth-level volunteers first do a survey of doctors, nurses and other health professionals in the neighbourhood. They can be the first persons to call within the booth’s jurisdiction.”

Booth-level surveys

A one-time survey can create a database of healthcare personnel, well-stocked local pharmacies, closest hospitals and ambulances available within the manageable booth-level. The big idea is this: Once this system is in place during the pandemic, it should not be dismantled.

This is exactly what the Bangalore Apartments Federation (BAF) wants to do with its positivity group formed during the pandemic first wave last year. Explains Vikram Rai from the Federation, “Providing targeted help, the group has over time emerged as a collective of well experienced volunteers, and experts adept at data sharing.”

Resilience platform

Rai has now proposed to convert the group’s momentum to a community resilience platform. “People’s attention will come down before a third wave strikes. They don’t bother about a problem when there is no problem. To change this, the group can be part of an emergency response system.”

This could mean training and skilling volunteers in, for instance, dealing with an apartment resident who has a cardiac arrest. “The thinking behind the Ward DETER Committees as a decentralised mechanism needs to be institutionalised. Without losing momentum, it needs to go beyond Covid.”

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Opportunity

The message is clear: Though belated, the emergence of a decentralised mechanism should be seen as a very strong opportunity to establish a permanent, collaborative healthcare system.

Active citizens, citizen groups and healthcare experts working with an empowered, well-equipped, well-staffed, decentralised Bruhath Bengaluru Mahanagara Palike (BBMP) could give the city a formidable defence against all future healthcare challenges, Covid and non Covid. The template is finally ready for activation.