by Rupak Chattopadhyay
President, Forum of Federations, Canada
Member, National Forum & President, Global Coalition Against TB
Thepandemic of 2020 was an unprecedented public health emergency. In the span of a year, it has led to 2.6 million deaths globally and disrupted the lives of billions everywhere. As the world’s largest vaccination campaign gets going in India, it is important to reflect on the experiences of the last year. Coordinated action between central, state, district and sub-district levels has been critical to tackle Covid-19; moreover, grass-root leaders in partnership with frontline health workers played a key role in sensitizing communities to undertake preventive measures to stem the spread of the disease. These important learnings need to be studied closely and embedded into campaigns to eliminate other infectious diseases such as or TB.
Strengthening institutional ground-level structures to defeat TB
Following the 73rd and 74th amendments, there already exists in India a constitutionally mandated local government system through the institutions. These can be used effectively to deliver health services to every corner of India. Under the system, various platforms such as the Village Health, Sanitation and Nutrition Committee (VHSNC), Panchayat meetings, and Village Health and Nutrition Days provide an opportunity to not only track availability and quality of , but also shape community behavior and create ownership among communities.
In many states across the country, these structures were utilized during the response to Covid-19, where Panchayat Leaders worked closely with frontline health workers like ASHAs and ANMs to raise awareness, dispel misconceptions around Covid-19 and inform people about and the importance of preventive measures. Panchayats, community-based organisations and frontline health workers were also central to the Covid-19 response by undertaking door-to-door screening of returning migrant workers to identify cases and refer them to care. As the lockdown lifted, panchayat leaders in certain districts also adapted the screening process to identify people showing symptoms of TB, which are similar to those of Covid-19 – this approach was later included as a guideline by theto undertake bi-directional screening of Covid-19 and TB patients.
Alongside the grassroots and community-driven approaches, one also saw the importance of real-time tracking of services in a disaggregated manner to understand region-specific challenges. This enabledadaptations based on the prevailing situation at the district and sub-district level. Local health workers were a crucial component for the collection of disaggregated and real-time data which fed into strategies to address local realities. Structures such as Rogi Kalyan Samitis in Odisha and similar ones in Kerala and Maharashtra which are peripheral decision making composite health units helped to ensure accountability and transparency in governance, which led to an improvement in quality of services and facilitated local responsiveness, besides improving service integration and inter-sectoral coordination.
Investing in a new TB vaccine critical to end TB
The last few years has seen a paradigm shift in the prioritization of TB by the highest levels of government, followed by holistic strategies being introduced with an aim to diagnose and treat every active TB in India. However, evidence shows that only a new and more effective TB vaccine would be critical to eventually eliminate the disease. The vaccine race to tackle Covid-19 has shown us the importance of public private partnerships and the power of political will and resolve –by combining expertise across sectors and ushering in a coordinated approach for research and development, we can achieve tremendous progress. Given India’s capacity in vaccine production and scientific ability, India must lead the way in the development of an effective TB vaccine as well. While there are several vaccine candidates in the pipeline, policy and government focus will be critical to take them out of the laboratory and into commercial use.
As thespeech already stated in detail the centrality of health as a contributor to the prosperity of the country. One must also learn from past experience that public health programmes that managed in a more decentralized manner with local input and participation, within the context of a national framework, are more successful. This is the approach that needs to be prioritized for other existing national public health threats, such as TB.
The larger objective of affordable, equitable and Universal Health Coverage can only be achieved by building synergies between the government apparatus, civil society and deeper engagement of local communities. Many national governments and global institutions have already started investing heavily in strengthening systems through decentralization. India cannot afford to overlook this imperative.
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