A successful union of public and private sectors
The COVID-19 pandemic has taught us that a country is only as strong as its healthcare infrastructure. In India, it exposed and further widened the existing fault lines in our delivery systems. Most importantly, in a country like ours, where about 70% or more of healthcare is in the private sector, we have learnt that public-private partnerships are the need of the hour in a crisis like this.
We need to strengthen our primary and public healthcare infrastructure significantly and increase both – spending as well as manpower in these areas – so that we can effectively combat the second and third wave of COVID-19, and future pandemics.
One more aspect which is absolutely important and needs to be implemented is universal healthcare for citizens. Even though the government has already taken steps to implement the Ayushman Bharat scheme and its extended programs, we need to further extend it to cover the missing middle, i.e., the middle class, especially in the self-employed and informal sectors.
That said, our experience over this year has improved our ability to deal with such similar situations should they arise in the future. We learned that the success in dealing with the pandemic was very much dependent on how well the public-private partnership between the government and the private sector was managed. The private and public health sectors have learned to work well together during this pandemic, though there were some initial hiccups. The government taking a tough stand on hospitals failing to make beds available in accordance with the rules, through consensus and dialogue rather than coercion helped the situation.
What we got right
Ever since the first few cases of COVID-19 were diagnosed in the State in March, the government took some early steps with an effective lockdown.
It set up multiple committees and a task force, and held fruitful meetings with the private sector to increase our diagnostic capacity, which is the foundation for the effective management of any pandemic. Very early in the course of the pandemic, dialogues were held with the private sector to take care of the expected rise in cases when the lockdown was phased out.
One of the very novel ideas implemented by the government was setting up of EICU and virtual consults with specialists in the private sector from Bengaluru with hospitals in all the district headquarters. We are proud that by using tele-medicine technology, there was a significant improvement in the care of these patients and an almost 50% decrease in the fatality rates in these areas.
Demand for beds
Initially, government hospital capacity and beds were upgraded and earmarked for COVID-19 cases. But when the numbers started increasing, it was found that the beds were filling up rapidly. Following this, about 50% of beds in the private sector were dedicated to COVID-19 care. For patients whose symptoms were not severe, COVID-19 Care Centres were set up by the public and private sectors. We developed a system of home care for asymptomatic patients, which started to free up beds.
Though there were some hiccups in the beginning, which was to be expected in tackling a pandemic of this scale, they were streamlined rapidly. By and large, most patients got the appropriate care, though intensive care is still a challenge. Bengaluru has around 400 high-end ICU beds and an equal number of high dependency beds, and Karnataka probably over 900.
Fortunately, there has been a significant decrease in the number of new cases by almost 70% and a significant decrease in the case fatality in Karnataka. I would imagine this is because of the right efforts and a working public-private partnership model.
Effective management of COVID-19 needs citizen participation. The decline in numbers that we are seeing would not have been possible without compliance from citizens and massive awareness campaigns. Such campaigns, along with punitive action, helped in slowing down the spread of the disease.
The hurdles that we faced were not limited to hospitals and beds, but to adjunct sectors also. One lesson learned was the need for a high concentration and flow of oxygen in the treatment of COVID-19 patients. The demand resulted in problems of oxygen supply to many of the hospitals, both in the private and government sectors. But with the efforts of all concerned, it was soon sorted out. As of now, there is no real shortage of oxygen though at times, its supply and cost have been issues that need to be resolved.
All in all, Karnataka has done well and certainly better than many other cities and States. It could be considered as a model State in the management of COVID-19. However, we have to ensure that we do not let our guard down.
Dr. H Sudarshan Ballal, Chairman, Manipal Hospitals and member of State’s COVID-19 Expert Committee