The report, one of the first official assessments of the fallout of the pandemic, takes a look at almost every aspect of the government's handing of the crisis.
Unexpected spending on health after being hit by Covid-19 may have pushed many families below the poverty line, a Committee of Parliament has observed. Delivery of healthcare services was severely impacted after outpatient departments (OPDs) in hospitals were shut during the lockdown, and women bore the brunt of the disruption, the panel has said in its report.
The Parliamentary Standing Committee on Health and Family Welfare assessed the response of the government to contain the novel coronavirus pandemic and mitigate its impact. The Committee has submitted its report, titled ‘The Outbreak of Pandemic COVID-19 and its management’, to Rajya Sabha Chairman M Venkaiah Naidu.
The report is among the first official assessments of the fallout of the pandemic. It takes a look at almost every aspect of the government’s handing of the crisis, including hospitals, the cost of treatment, surveillance, and testing; issues of frontline workers, school-going children, women, and mental health; and offers recommendations to the government.
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“The purpose of the report is not to criticise the government’s course of action in combating the pandemic but to identify the implementation gaps during the course of executing its contingent plan,” Prof Ram Gopal Yadav, Chairman of the Department-related Parliamentary Standing Committee on Health & Family Welfare, has said in the report.
The committee has noted that the “number of Government hospital beds… was grossly inadequate keeping in view the rising incidence” of cases. “As the numbers… were on the rise, a frantic search for vacant hospital beds became quite harrowing. Instances of patients being turned away from overburdened hospitals due to lack of vacant beds became the new normal,” it has said.
“The Committee is aggrieved at the poor state of healthcare system and therefore, recommends the Government to increase the investment in public health and take appropriate steps to decentralize the healthcare services/facilities in the country.”
The Committee has underlined that “the closure of OPD services in government hospitals… crippled the healthcare delivery system in the country” – and “non-Covid patients especially female patients and the patients with chronic and lethal diseases were the worst sufferers”.
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“The Committee notes that disruption of medical services for Non-Covid patients during lockdown paralyzed the delivery of essential healthcare services. Particularly, the diagnosis and treatment of other services did take a backseat which even led to many non-Covid deaths,” it has said.
COST OF TREATMENT
The Committee has said it “apprehends that amidst the pandemic and the uncertainty in the treatment protocol”, out-of-pocket expenditure on health “may have further driven many families to below poverty line”.
According to the Committee, “arriving at a sustainable pricing model to treat Covid patients could have averted many deaths”. The government “should have strategized a better partnership with the Private Hospitals under PPP model.”
The Committee has said that given the reports of “private hospitals charging exorbitant medical fees” that were beyond the reach of many, “free Covid treatment under PMJAY could provide a sigh of relief to the entitled beneficiaries and the economically weaker sections of the society”. It has recommended to “the Ministry to constantly make efforts to minimise the out of pocket expenditure of patients due to Covid and update the details of the beneficiaries on the scheme’s IT System”.
The Committee has noted that “poor contact tracing and slow testing in the initial phase of pandemic led to the increased number of infections”, and that it was “constrained to observe the failure of NCDC-IDSP (National Centre for Disease Control-Integrated Disease Surveillance Programme) in generating the required response…”.
“The Committee feels that NCDP-IDSP should have been utilized in a more effective manner especially when the sole objective of IDSP is to detect and respond to outbreaks in the early rising phase through trained Rapid Response Teams (RRTs),” it has said.
The Committee has said it would like the Ministry to launch IDSP in states other than the nine in which it is currently in place, and that “there is an urgent need to assess the financial requirement for NCDP-IDSP for its revitalization”.
The Committee has said while it “appreciates” measures like the janta curfew, “there have been [a] few glaring lapses… like shortage of emergency supplies, red-tapism, shortage and quality of testing kits, delay in domestic production.”
The Committee said it is “worried at the use of less reliable diagnostic tests which increase the chances of false negatives”. The government “must assess the veracity of Rapid Antigen Test vis-à-vis RT-PCR and other diagnostic tests… to bring forth the true picture of the testing capacity in the country”. It has “strongly recommended” that testing facilities are ramped up “for more accurate tests”.
Also, the Committee has noted, “testing facility is only limited to bigger districts and cities”, and “lack of testing facilities in rural areas has also resulted in underreporting of cases”. The Primary Health Centres and Community Health Centres “are still largely devoid of any testing facilities and the required technical workforce”, it has said, and “strongly recommended” that a “strong network” of Viral Research & Diagnostic Laboratories (VRDLs) be set up in the country.
The Committee has expressed anguish over instances of mistreatment of Accredited Social Health Activist (ASHA) workers engaged in contact tracing, and has said it is “pained to note that community health workers were denied wages even though they are the foot soldiers of the healthcare system”.
“It is too much to expect from the community health workers to accomplish big task without proper training, incentives and support from the health system,” it has said. “The Committee strongly advocates for strengthening the network of ASHAs, ANMs (Auxiliary Nurse Widwives), and other community health workers.”
The Committee has also highlighted “large numbers of vacancies in secondary and tertiary public hospitals which considerably increases the dependence on private providers and contractual workers”. There is “urgent need for capacity building and maintaining the pool of health resources to fight against the outbreak of the pandemic”, it has said.
The pandemic has not “only adversely affected women’s social and mental well being but also disrupted access to healthcare services especially sexual and reproductive healthcare services”, the Committee has said.
“Access to contraceptives or healthcare services became difficult which led to many unwanted pregnancies and unsafe abortions. The Committee, therefore, strongly recommends the Government to chalk out specific course of action for rescuing the women out of mental trauma by resuming the sexual and reproductive healthcare services and allocating the resources to improve women health services.”
The Committee has observed that “restrictive social norms, gender stereotypes, home quarantining and diversion of resources to respond to the Covid-19 pandemic can limit women’s ability to access health services which makes them more susceptible to health risks”.
Also, “violence against women increased during the lockdown period as the perpetrators of violence and susceptible both stayed at home”, it has said. “The Committee strongly recommends the Government to identify such women who have been the victims of sexual and domestic violence during the pandemic and rehabilitate them. The Committee would like the Ministry to create specific hotlines, telemedicine services, rape crisis centres for women.”
The Committee has expressed concern over the “confinement of the school-going children due to prolonged closure of education institutions” and, equally, at the “existing digital divide in the country which has jeopardised the future of millions of students from the weaker section of the society”. It has observed that “with the shift in education method from classroom to online medium, the education of the students residing in areas with poor connectivity has been compromised”.
It has recommended that the government should “strengthen its network for digital and online classes and once the normal classes resume, provision for extra special classes should be made especially for students from the economically and socially weaker section”.
There has been “a considerable rise in mental health issues during the lockdown”, the Committee has said. “Sudden loss of employment and social isolation aggravated the psychological burden among the masses, it has said.
“There is no denying the fact that staying in touch with friends or family is a typical mechanism for coping with stress but during the lockdown in the absence of any coping mechanism, working-age adults, students etc who live alone, were more prone to depression.”
The Committee has specifically highlighted the “increased risk of suicide during the pandemic which may be attributed to social isolation, fear of the pandemic, loss of livelihood and other economic and health fallouts”, and “strongly urged” the government to make suicide prevention and mental health a priority.
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