Strengthen primary healthcare

A NEW URGENCY

Healthcare facilities that respond effectively to emergencies have a few things in common: trained personnel, connected digital technologies, effective referral and remote support facilities, monitoring and evaluation mechanisms in place with smart and real-time analytics, respectful care, and financial prowess.

In sum, we can be prepared for any catastrophe if we have strong, connected, efficient, responsive, and equitable public health systems - this has been validated by the Covid-19 pandemic.

Our Primary Healthcare Centres (PHCs) have been providing basic healthcare around reproductive and child health, infectious diseases, non-communicable diseases, preventive health care outreach, among others. As Health and Wellness Centres (HWCs) under the ambit of the Ayushman Bharat Yojana, the primary health care delivery system is aimed at achieving holistic health.

It is thus essential that these first points of healthcare delivery are well-staffed, well-equipped, and well-connected so that they reduce the burden on the tertiary health facilities.

The PHCs are also essential providers of maternity and childcare services. With the focus on increasing institutional deliveries and preventing maternal and neonatal deaths, the need to strengthen intra and immediate postpartum care is significant.

It requires that we empower healthcare providers at the PHC level to manage deliveries on their own. Continuous learning processes must be implemented so that providers can respond to regular cases and some complications with agility and effectiveness.

With better case management skills, care providers can be empowered to eliminate the entirely preventable cases of infant and maternal mortality. Of the 27 million women who reach the stage of delivery, over 56,000 mothers die during or within 48 hours of delivery, as do 50% of neonates. While 27% of maternal mortality cases are due to haemorrhage, 11% die due to sepsis and 9% due to obstructed labour.

For neonatal mortality, 34% of incidents are due to infection and 19% due to birth asphyxia. Delays in transportation and initiating care further contribute to the quantum of entirely preventable deaths.

Technology can serve as a powerful tool to aid clinically trained healthcare providers even in the remotest of locations. Digitally tracking cases, building in telemedicine support to address case complication and seamless referrals made with real-time transmission of patient documentation are some examples of how technology can be woven into the care continuum.

Digital approaches can also ensure that the basics are in place to successfully conduct operations; deaths often occur due to the lack of basics, like an oxytocin injection to induce labour or control maternal bleeding after childbirth, or an oxygen cylinder to prevent neonatal hypoxia -- a condition in which a neonate is deprived of adequate oxygen supply to meet metabolic demands.

Easy to adopt and implement, digitisation across the care continuum can also be scaled with ease across the country. At their heart are two aspects: software and hardware, and the willingness to adopt approaches that yield more positive outcomes.

Rajasthan and Madhya Pradesh are today benefiting from such an approach. With support and technical assistance from private companies and not-for-profit organisations, some facilities here are piloting the use of simple handheld tablet devices that empower healthcare providers to make faster and better data-based decisions, 24 hours before, and 48 hours after birth.

From admission to discharge, all documentation is digitised and made available to all care providers instantly, giving them more time with patients. Healthcare providers also access government-published learning modules, guidelines and tutorials in engaging multimedia formats, in an interesting gamified format that helps them learn and revise the latest clinical guidelines on basic emergency obstetric and neonatal care.

By bringing data-based decision-making to the fore, health centres are empowered to identify and manage high risk-patients with more agility and effectiveness. Till date, over one lakh high-risk cases have been detected, and over 2.2 lakh live birth deliveries have been made successfully using this approach.

By empowering nurses to successfully handle high-risk complicated cases without a referral, the strain on the healthcare system has been mitigated. We need such pilots to be taken to scale and to be applied to all aspects of healthcare delivery.

The Covid-19 crisis has highlighted the significance of patient triage in a healthcare facility. Triage helps prioritise patients based on their current medical condition and clinical need at that hour. In facilities where this digital approach has piloted, tablets are placed in triage area and thereafter at important patient checkpoints like pre-labour wards, labour room, pre-natal care wards etc.

Patient information

Crucial patient information is entered into the application on the patient’s arrival in the facility and is updated with new levels of care. The application also alerts healthcare providers of high-risk cases thus helping swiftly navigate the patient to either the ward, the labour room or the operation theatre. In a nutshell, this care model has indirectly established the correct processes for patients to get appropriate care without any delay.

The Covid-19 pandemic has also highlighted the significance of infection prevention. This should be the cornerstone of our healthcare system. Regular and rigorous training of healthcare workers in standard operating procedures for infection prevention, control and monitoring adherence, ensuring required materials and supplies are made available, are key.

When healthcare workers internalise these standards, the quality of healthcare rises significantly and so does the demand for services. This necessitates the need for sustained capacity-building.

For long, many PHCs suffered from low footfall underscoring the need for quality, hygiene and required equipment and supplies. Quality of services cannot be compromised even in the remotest of health centres or for the poorest of citizens.

With access to affordable and quality primary healthcare, communities are less likely to travel long distances to tertiary care hospitals, usually based in city centres or in other states, and strain their resources. With access to timely care, they are also more likely to recover quickly.

If suitably strengthened, India’s 25,000 PHCs and 5,300 community health centres can be powerful assets of a more resilient healthcare delivery system against any clear and present danger like the Covid-19 and of the unknown tomorrow.

(Sridhar is Director-India, MSD (Merck) for Mothers; Bahl, Programme Head, Reliance Foundation, and Dr Budharaju, Public Health Consultant, Tata Trusts)