Based on recent developments, and announcements in the public domain, including deliberations at the recent Indian Public Health Association Conference 2022 held at Pune, India from 23 Sep to 25 Sep 2022, it emerges that there is a welcome change in the planned approach of the Govt of India, possibly keeping in view the desire for Universal Health Coverage to which India is a signatory at the United Nations in 2019.

https://www.who.int/news/item/23-09-2019-who-welcomes-landmark-un-declaration-on-universal-health-coverage

It can be inferred that there is a paradigm shift to “All Services for All people” from the earlier “Some Services for Some People, More for those in need“.

By championing the Health and Wellness Centre concept, by pushing for health insurance provision at the family level, by focusing on the prevention paradigm, through the Ayushman Bharat scheme, the Govt of India apparently is moving towards the long awaited wellness concept instead of focusing on curing illnesses alone. Someday it will be time for the people too, to realise and appreciate that they now need to take their health in their own hands and be responsible themselves too, to lead healthy lives!

Reportedly, budgetary allocation is no longer being done disease or group wise (i.e not separately for Diabetes / Hypertension or Mother and child health or Mental health etc). The Central Govt has consolidated the myriad accounts that existed earlier, to streamline the entire process, and bring in more transparency and accountability. During the COVID pandemic, with increased awareness of all things related to health, many may now know that “Health” in India, is a ‘State’ subject, wherein State Govts assume responsibility for healthcare for people in their State, and where the States too have to contribute for Health budgets, and not just expend monies from the Central Govt. And more importantly, that on ground expenditure of Health budgets is done in a major proportion by the State Govts rather than by a distant ‘Kendriya Sarkar’ (central govt).

Reportedly, in 2022, more than INR 1.5 lakhs crores have been firmly allocated for infrastructure in the States under the Ayushman Bharat Health Infrastructure Mission & Fifteenth Finance Commission for the next four years, being monitored by the Govt of India through a dedicated web based Project Management System portal. 

It has clearly been communicated to the healthcare machinery & bureaucracy at the State levels, that the Govt of India is focusing on infrastructure while leaving provision of manpower and planning and delivery of healthcare services to the States as per the action plans for Comprehensive Primary Health Care.

Guidelines for Public Health cadres have also been promulgated by the central Govt in 2022. New components for the primary healthcare system such as Critical Care Blocks, and Block Public Health Units have been introduced. The States need to seize this opportunity (truly carpe diem), and revitalize their healthcare systems, leapfrogging over the infrastructure thrust of the central govt and emancipating their own peoples through proactive initiatives.

Our States must appreciate that this keeping pace with the aspirations of the people and a global thrust towards Universal Health Coverage, needs to be done on an urgent basis.

A potential approach with great promise, is to co-opt the extensive intellectual resource pool of Govt medical colleges to constitute state level think tanks to chart the way ahead.

For this, the Department of Medical Education and the Department of Public Health / National Health Mission team at the State level, need to work together, to collaborate, to synergise, and actually walk the talk! These both serve the same clientele and answer to the same hierarchy. Its just the silo walls between medical academia and the primary healthcare that need to be demolished. Easier said than done!

Think Global, Act Local!  Our people need to become vocal about this… thus the envisaged crucial and increasing role of Panchayati Raj Institutions and an empowered electorate to educate themselves.

Yeh Dil Maange More…. Till this is the clarion call of society, the pace will be laggardly and sluggish, despite best intentions of the Govt at the Centre.

Hence in summary, for the discerning reader, especially those in the corporate CSR  or philanthropic sector the relevant inferences  and actionable inputs for the future are as follows:-

1. Comprehensive Primary Health Care (CPHC) is the only viable approach for the next 25 years at least, with all its components, made available to all people, including in cities (and not just in cities).
2. Healthcare needs to be planned for hyperlocal delivery and finetuned to situational requirements and circumstances through a participatory approach including the local medical colleges and healthcare system and also NGOs and most importantly the people (and not just their elected representatives).
3. Tribal areas, hilly areas, mountainous areas, LWE affected areas, riverine areas, deserts, peri urban underserved agglomerations, etc etc require specific approaches customised to their peculiar situations.
4. A one size fits all, prescriptive , template based approach in healthcare will not work, and will definitely not sustain.
5. Standalone vertical healthcare programs will eventually require to be subsumed with the CPHC approach.
6. Seamless integration of activities, capabilities and facilities across the primary healthcare system, with decentralized implementation and dashboard based monitoring is the future. The Ayushman Bharat Digital Health ID will be the keystone of the ecosystem and will be a game changer for patient and healthcare provider alike
7. Health & Wellness Centres should become the preferred mode of delivery of CPHC, with an emphasis on health promotion activities. The shift to seek to deliver or obtain only disease management through these HWCs needs to be resisted at all levels, despite the evident temptation.
8. Overly ambitious expectations should not be retained for the HWCs. The service delivery depends entirely on a newly created cadre with unproven skillsets (the Community Health Officer) placed in challenging circumstances. These CHOs will require consistent technical support and handholding, besides motivation and morale boosting. Effective mentoring by appropriately qualified healthcare professionals is essential
9. The AAA troika (ASHA, Auxiliary Nurse Midwife, Anganwadi Worker) are the most powerful women in India today, having the power to bring about change, and transform society. Our Hon’ble Prime Minister had aptly stated, possibly during his Independence Day speech of 2018, that these frontline workers need recognition from the community and the healthcare system, to motivate them (and of course, appropriate remuneration too). Just for the record, in 2022 ASHA workers have been conferred the WHO Director-General’s Global Health Leaders’ Award in recognition of their valuable health services to the people in rural areas.
10. Capacity building and capacity maintenance of personnel at the peripheral echelons of the primary healthcare system, through academic partnerships and mentoring from the medical college network should be preferred to promote ownership and a feeling of belonging and involvement. NGOs and other international agencies can play a major role in facilitating this process of capacity building and its sustenance.
11. Community mobilization and participation are going to become the key areas of focus in improving health of the nation, through strengthening of the Panchayati Raj Institutions.
12. Human beings do not exist in isolation. They need potable water, safe food, clean air, comfortable habitation, hygienic surroundings, livelihoods , education, entertainment, to be (and remain) healthy.   
13. Lateral integration with Swacch Bharat Mission is essential for any health focused initiatives. Health cannot exist in isolation. Health flourishes best with hygiene and sanitation- Swachh Bharat, Swasth Bharat. 
14. There cannot be health without proper nutrition. The Poshan (nutrition) Abhiyaan is a multi-ministerial convergence mission with the vision to ensure attainment of malnutrition free India soon. The time frame for achievement of this goal may be unrealistic, however it is inescapable that unless we have holistic development and adequate nutrition for pregnant women, mothers and children, society cannot make the required strides towards an India wanting to own the 21^st century.
15. Human resources management, with a focus on attraction and retention of skilled personnel, needs to be accorded due importance and priority. Despite all technological advances, which patient or patient’s family in need of healthcare assistance will be truly satisfied without an engagement with a healthcare worker in person. Hi-Tech is fine, High-touch will remain equally and more important probably.
16. Public Health personnel are to be compartmentalized into (a) healthcare professionals, (b) administrative professionals and (c) management professionals, (each group catering to different aspects of public health), instead of the current situation where Public Health graduates with non medical backgrounds are endeavouring to perform all roles with varying degrees of competence and capability. 
17. Give healthcare workers of all categories, especially clinical doctors, the respect and recognition that is their due, and appropriately reimburse them for it. Ensure that remuneration for medical doctors is commensurate with Central Govt scales to ensure uniformity and to stem rural – urban ‘brain drain’.
18. Administrative personnel must focus on working conditions at healthcare facilities and also not assign unrealistic workloads to Healthcare Workers at all levels including medical professionals.
19. Regulation of the role and scope of NGOs should be a reality in the near future, to ensure not just synchronicity with the Govt’s vision for healthcare and the people’s aspirations for healthy lives, but also for compliance with public health ethics and population rights. 
20.  Technological methods and innovations including apps and HMIS software in the arena of public health may be registered centrally, to ensure benefit across the nation. States may be encouraged to share plans and proposals for innovations in advance, to ensure no redundancy or overlap with existing innovations, which can then be scaled up and rolled out nationally by a coordinated initiative, instead of disjointed multiple approaches. With health data portability being essential in the future, it is prudent for this to be implemented sooner than later.

Please do connect with me for any further discussion or insight that you may desire. I will be glad to help your team chart out action plans to tackle areas of your interest in population health. I happily collaborate with anyone and everyone in the greater interest of Health for All!

The time for action is now, if we want to see the India we dream of at 100 years post Independence.

As a disclaimer, these above are my personal views based on an unbiased professional assessment of the current situation. And are not intended to be critical of, or reflective in any way or to be construed as representing any Govt policy.

Work from Home, and even otherwise, most of us fully appreciate the unacknowledged contribution of our Domestic Assistants in making sure that all is well on the household front.

We have a responsibility in taking care of our Domestic Assistants, to reciprocate their taking care of us and our families. Let us make all efforts to get them and their eligible family members vaccinated at the earliest, and guide them on a daily basis to adopt COVID Appropriate Behaviour, not just around us, but at home in their personal spaces too.

During this pandemic, in civil society, it has been observed that there is a tendency for regulation and enforcement to go overboard at times, driven by misplaced apprehensions and baseless fears. Let us work together with the volunteers in society and in our Housing Societies, to dispel misconceptions by providing clear and actionable guidance within and outside the house.

Bottomline
Simple steps to maintain personal safety and hygiene at home start with guiding our Domestic Assistants suitably. Guide, encourage and support them to keep everyone safe.

Please do share the info sheets with your family, friends and colleagues. And do suitably translate and convey verbally to those around you who will benefit from it.

In India as of 19th Jun 2021, though we have had many cases of COVID-19 across the country, affecting all strata of society (2,98,23,546 cases to date- as per mohfw.gov.in) , to give us a reality check, just about 2 out of every 100 Indians has experienced the disease, and the large majority of those, have got through unscathed with mild or asymptomatic infections. Maybe an even larger number did not get diagnosed, but suffered all the same. This would indeed be the most likely scenario given the state of reporting of diseases and the fragmented healthcare system.

By now, over a year and a half into the pandemic, we may personally know someone who has had COVID-19, or we may ourselves have been affected.

Even if you have been infected, and recovered, you still need to wear a mask at all times, when interacting with others, while maintaining physical distance. It is also advisable to take the vaccine (any), about 90 days after recovery. However, do check with your doctor, as these recommendations are evolving and updated frequently by the Govt of India based on emerging evidence.

If you are one of those who has recovered, you need to pay special attention to avoiding known long-term effects on your respiratory system, by continuing efforts at deep breathing exercises and eating healthy.

Bottomline Those who have recovered from COVID-19, can get infected again. They need to continue COVID Appropriate Behaviour and take a vaccine when available / when due.

Recovery and restoration of baseline health and fitness after COVID-19 is a challenge for many. Fortunately, a sensible approach will reap dividends when prudence is kept the bedrock.

For those who have never exercised or just waddled their way through life so far, before COVID, this is the time to seriously consider taking up some form of exercise that is sustainable. Do not rush into a gym membership, or buy that expensive cycle, without first figuring out what should be the path to exercise that you will tread on nimbly, in the decades ahead, to stay healthy.

For those of you, who were “into fitness”, reconsider your goals, and reset your standards.

You must and should take it slowly!

“Listen to your body” – this is keystone of any approach that you choose to adopt in the days ahead.

We have become accustomed to hearing ever so often, “No Pain, No Gain”, however our new lexicon has to adapt and evolve to the new mantra “Pain, No Gain!”, meaning that if you are finding any exercise or exercise level ‘hard’, it is definitely not good for you, especially if you are recovering from COVID-19!

If you have any medical problem with your heart from before, or had any effect on your heart while you were sick with COVID-19, it is essential that you consult an allopathic medical professional to ascertain your fitness to resume physical exertion.

Please get active!

Note to Self: this is different from exerting! Whatever your medical condition, you will benefit from making a beginning, with baby steps at first, to move around. Begin first by getting around your house, indoors, and then move outdoors. Exertion can be a later step.

You can begin with deep breathing exercises, do these at home, while seated comfortably, do these daily. Applicable for everyone, irrespective of whether you have had COVID-19 or not.

Bottomline
Now is the time to contemplate taking up some form of exercise in a graded manner after you recover from COVID-19. Listen to your body carefully. Don’t push yourself!

Modern times, pandemic times, as people constantly in search of quick fixes, for everything in our life, we would be searching online for what we can do to get back into ‘shape’ (whatever that may mean to you personally!) . Hence this next section is just what the doctor prescribed!

Your health is in your hands (or your legs), but every journey in your life, begins with making up your mind first! You are the one who has to undertake all required actions to keep yourself healthy and well.

So, why waste further time. Just do it!

Exercise is beneficial not just for promoting recovery from COVID-19, but also serves to safeguard you from many lifestyle and other diseases.

The right time to start is now.

Bottomline
Exercise is good for you. Begin any exercise with the intent of sustaining a healthy lifestyle through old age too.

Just begin whatever it is you choose to do, today. Listen to your body , while at it!

Please do share the above info sheets with your family, friends and colleagues. And do suitably translate and convey verbally to those around you who will benefit from it.

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