Keep health front and centre

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Keep health front and centre

Friday, 01 May 2020 | simi mehta Ritika gupta Anshula mehta

Keep health front and centre

The Coronavirus has posed several challenges for expectant mothers and parents due to the closure of health clinics, OPDs and Anganwadi Centres providing vital healthcare services

Human health is a prerequisite for the economic health of a country. Unless the population is healthy, the economy of a nation cannot perform. This hypothesis has been validated by the outbreak of the Coronavirus which has led the world into an economic recession. In the light of this, the importance of mother and child health (MCH) cannot be overemphasised as pregnant women, infants and children are very susceptible to infections and diseases. The Coronavirus has posed several legitimate concerns and challenges for expectant mothers and parents due to the closure of doctors’ clinics, outpatient departments (OPDs) of hospitals and the Anganwadi Centres (AWCs) providing vital healthcare services.

So the question that arises is, how can beneficiaries access healthcare/welfare services during the pandemic? Pregnant and lactating mothers and children in both rural and urban areas have already begun to suffer. For instance, the Government order to the Anganwadi workers (AWWs), to home-deliver dry rations for children and mothers, has had problems in execution. The AWWs have complained about having to travel long distances on foot because of lack of personal/public vehicles and villagers threatening and in some cases even beating the women AWWs for violating the lockdown. Plus they have to bear an added financial burden as they have not been paid money to purchase rations for the last one year and have not been provided with protective gear to save themselves from the virus.

Another challenge that has emerged is the inability of the auxiliary nurse midwives (ANMs) and accredited social health activists (ASHA) to help pregnant mothers and infants get their vaccination as well as arrange transportation to the nearest health facility for delivery, while adhering to the service level benchmarking to combat the pandemic.

While we don’t know what the future will be once the lockdown ends, here are some solutions that the Government/States can consider to address MCH-related concerns during the times of Covid.

Harness the advantage of mobile phone and internet penetration to the remotest areas of the country for geo-tagging beneficiaries and for the provision of telemedicine, using location data, call data, and Health Management Information System (HMIS) database. In this situation, the health practitioner will only advise high-risk pregnancy cases like ante-partum hemorrhage (APH), gestational hypertension (PIH/GH), eclampsia and severe anaemia. To distinguish between severe and normal cases, the programme can be administered by machine learning and Artificial Intelligence.

 With all the recent beneficiaries of the Janani Suraksha Yojana (JSY) and the Pradhan Mantri Matru Vandana Yojana (PMMVY) having been assigned Unique IDs, these should be used for direct benefit transfers (DBT) and nutritional assessment, screening of COVID-19 cases, triage referrals and referral to secondary-care hospitals.

As an emergency measure, pregnant women (especially migrant workers) travelling or in transit in the next few months and seeking institutional delivery can be imparted with the benefits of the Pradhan Mantri Jan Aarogya Yojana (PM-JAY) or Ayushman Bharat (AB) with the participation of the private sector.

Create a MCH dashboard in line with the Ayushman Bharat and PMMVY dashboard, to synchronise data, harness HMIS and Integrated Child Development Services (ICDS) database to show the facility closest to the pregnant mother for rapid welfare delivery and integration of immunisation services for home-based new-born care, so that all the essential immunisation vaccines can be given to the children below two years of age without any delay.

 The dashboard can also track the whereabouts of pregnant women (of the region in focus) and put reminders on their cell phones and on that of their family members, which would provide regular information on the precautions they need to maintain and the ways to respond if they develop Coronavirus-like symptoms and so on. These can be integrated with the existing applications of the Government and must be triaged after primary screening.

 Most women have monthly to weekly interactions with  doctors/health practitioners during pregnancy for prenatal check-ups. But in the times of the pandemic this may go missing, so it is imperative to keep them informed via digital medium. For instance, the Kilkari application of the Haryana Government can be scaled up to include video messages for women that are specific to their stage of pregnancy. Frequent live conversations with doctors/health practitioners need to be arranged to reduce anxieties and negative psychological impacts due to the spread of COVID-19 and the lockdown in effect.

 WhatsApp accounts must be set up where pregnant and lactating women are able to share their concerns and through audio and video messages. Volunteers can be roped in with the support of civil society and community networks.

Coordinators of Self-Help Groups (SHGs) in the villages must be identified to assist ASHA workers and ANMs in-home delivery of required medicines. While this would help in reducing the burden on the latter two, it would also help expand community cohesion. For this, the SHGs can be awarded certificates of appreciation that would strengthen their credit scores for availing any further loans from banks.

The Government has identified both private and public hospitals to take in Coronavirus patients in each district. The contact numbers of these hospitals should be publicised through every available medium so that the people use these when they develop COVID-19 symptoms.

 Pregnant women, who become infected, should be treated with World Health Organisation-recommended supportive therapies in consultation with their obstetrician/gynaecologist. Pregnant women and health practitioners must be informed  about these therapies without any delay.

 It is also important to record all new cases of pregnancies due to the COVID-19 lockdown, so that Government prepares for an impending “Coronial generation” after nine months and also has a ready benchmark for future shutdowns based on the lessons learnt. The existing HMIS and ICDS data, though not very reliable, can still be low hanging fruits in this regard to utilise the Digital India architecture.

 In the lockdown scenario, the Government must ensure that the duties of AWWs are notified as essential services if it does not want the health and nutrition security of women and children to be compromised. All pending payments due to the AWWs must be transferred to the relevant bank accounts without any further delays. It must be noted that the Budget 2020-21 has allocated Rs 28,600 crore for programmes that were specific to women. It is indeed a matter of concern that the reimbursement for the purchases made for preparing Mid-Day Meals for children at AWCs has not been released for over seven months in States like Jharkhand.  With the present Budget outlay, there should be no financial excuse to withhold the payments due to the AWWs, and in fact, they must be paid a three-month advance honorarium to facilitate their work and ensure their safety.

 Expanding health insurance coverage to women and children will increase their access to necessary health services more than other groups. Along with the maternal and child health programmes, this must be added with the existing public health and community services such as prenatal care, well-child care and enabling services such as case management, transportation and home visits.

 The maternal healthcare services must include mental healthcare, contraceptive services and supplies; diagnosis and treatment of sexually transmitted diseases; prenatal, intrapartum, and postpartum care; regular breast and pelvic exams (including Pap tests), in accordance with well-recognised periodicity schedules; risk assessment; adequate education and counselling to support these interventions.

For infants and children up to five years, emphasis must be on preventive services, such as immunisation and the monitoring of physical and psychosocial growth and development, with attention to critical periods in which appropriate care is essential for sound development and progress.

 A separate, more comprehensive midwifery training programme with service level benchmarking in India must be introduced on an urgent basis. Having well-trained and capable midwives would provide a better birthing experience for the mother and would reduce the burden on obstetricians.

  Women’s SHGs should be roped in for better outcomes in ensuring the provision of take home rations. There should also be certain modifications and expansion in the type of food provided, varying regionally, to meet nutritional requirements. Planning of resources is a must to avoid misallocation and panic.

With the Coronavirus crisis expected to continue and peak in the next few months, it is imperative to urgently design and implement alternate solutions which ensure institutional deliveries, facilitate treatment to the pregnant mothers and their new-borns and address MCH needs in a timely and structured manner, simultaneously adhering to social distancing and isolation norms of the Government.

(Simi is CEO and Editorial Director while Ritika and Anshula are Research Assistants at IMPRI)

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