Relying on serendipity is not enough

Abstract

The novel coronavirus has caused a global public health crisis, and impacted countries irrespective of their development status. The health system preparedness has varied across countries, necessitating a hard look at how resilient health systems can be built to withstand the onslaught of sudden pandemics and epidemics. India has been grappling with the onslaught of COVID-19 since the last 6 months of the current year, bringing into focus the ability of its health system to withstand the pressures of dealing with such a pandemic. In this context, the paper analyses India's health sector by focusing on infrastructure, personnel, financing and governance, to enable a better understanding of the extent of resilience in India's health system. Using data from the latest household survey on health, the paper also looks at the disease profile of care seekers to illustrate why COVID transmission is likely to be rapid in the country, the potential impact of COVID care on non-COVID care, the groups that are most likely to forego care due to the lockdown and the diversion of resources to COVID care, choice of providers and out-of-pocket expenditure evidenced from such choice. The paper concludes that a country cannot effectively deal with a pandemic and reduce its socioeconomic impact by trying to fix its health system in real time. The lesson from the COVID era would be for India to immediately start with the much delayed health sector reforms, beginning with a substantial jump in public health financing, if impact of future epidemics and pandemics are to be minimised.

Re-evaluating Our Knowledge of Health System Resilience During COVID-19: Lessons From the First Two Years of the Pandemic

“…Health systems had to adapt multiple structures and functions to respond to the continuously changing nature of the pandemic with growing knowledge on the virus. 8 - 28 Systems adapted to prevent and control transmission while trying to provide essential health services and COVID-19 services simultaneously, 13 , 15 , 17 - 32 adopting strategies like implementing telehealth services and incorporating private providers into public systems responding to both needs. 16 , 22 …”

“…The emphasis on learning is on individual country systems learning from previous successes or shocks to create a successful response to COVID-19 8 - 10 , 13 - 16 , 33 - 37 with no clear definition of how a successful response is defined. For example, prior to COVID-19, health systems in Australia had learned from previous shocks of brush fires and a SARS (severe acute respiratory syndrome) outbreak how to mitigate widespread, system-level challenges.…”

“…Sustained, long-term investment in public health systems, particularly infrastructure and human resources, is noted as widely lacking in many systems. 13 , 14 , 17 , 17 , 18 , 20 , 23 , 29 , 63 - 66 The presumed result is a system that is less flexible and less able to mobilise surge capacity. 64 Although large amounts of financial resources have been allocated to public health and health systems for COVID-19, it has often been in the context of previous periods of austerity, underfunding, and streamlining to create more efficient medical systems.…”

“…There is agreement that the breadth of COVID-19 requires better integration and awareness of interdependence during the response. 9 , 13 - 16 , 18 , 22 , 23 , 28 , 31 , 34 , 40 , 43 , 47 , 49 , 50 , 52 , 56 , 69 First, health systems should be collaborating, coordinating, sharing information, and making decisions with civil society, academic, the private sector, and other government sectors (eg, education, labor), which required good communication skills and adept leadership at the national level. Doing so might help health systems absorb or adapt, assist in decision-making, and overcome diverse objectives across sectors.…”

“…Second, health systems should be strengthening internal links, such as those between healthcare facilities or between public health and clinical medicine, and links with international bodies and other health systems. 13 - 15 , 39 Interdependence was also raised in the context of solidarity among actors to avoid competition over resources and keep the response cohesive. 12 , 14 , 59 , 63 Working in a multisectoral way towards a common goal was seen as a learning process that required clear, aligned roles at all system levels, training on interdisciplinary and interprofessional values, developing cross-sectoral plans, and allowing new ways of working together to develop.…”