Swine Flu A Challenge to Healthcare System
First death of a 14 year old girl in Pune has sent the alarm bells ringing allover the country. In Pune, people had to plead for testing early due to long waiting time and luckily one such patient testing positive could start treatment earlier. In fact it has been a wake up call to the healthcare system which was complacent since there was no fatality so far though swine flu is more than three months old phenomenon. Suddenly the administration has woken up and there are hurried consultations and announcements. Most appalling of them has been that the treatment will be given only at government hospitals and private hospitals have been prohibited to treat swine flu cases. The private hospitals have so much investment in best of equipments, facilities and trained manpower. They are national resource and must be in the loop to tackle crisis. In the current crisis the inadequate government system is learning on the job and improvising as the situation unfolds without any plan. Today, Maharashtra government has announced opening up of 8 pretesting centers. This is at best ad hoc action. Just imagine Ganesh Festival, the most important in Pune, is round the corner and socialization is on peak at this time of the year. Is the administration having a plan to handle the situation ahead? Inadequate infrastructure: Initially, the incoming passengers from overseas were being checked for swine flu symptoms. Due to inadequate staffing it was relaxed to just declaration by passengers. Initially the source of virus was from returning travelers. Now local spread has become larger than imported source. Over last 2 months it has assumed disastrous proportion with first death in Pune. The rate, at which the new cases are coming up, shows that the problem is multiplying fast. We need a responsive system to tackle fast spreading virus. It is understandable that the virus is new and there is no previous history to guide. But can we be caught napping with a population of a billion plus? It is reported that in due course up to two billion people are expected worldwide to be affected by swine flu. India and China have highest density of population and therefore are most vulnerable. If the virus spreads uncontrolled, it will become unmanageable. The virus is not going to vanish in next 510 years as reported. State of Maharashtra has only 2 labs for testing. There are only 18 labs in the country with 37 hospitals to attend. That is inadequate by any measure. Can we learn from experience of Mexico where swine flu originated? We are just not geared to face the grim situation which may develop in next few months as the cases multiply. Learning from Experience:
In last decade we have had new biological threats with potential for global spread and large scale damages in short time. We had Anthrax threats, SARS, Avian flu and now Swine Flu. We heard dengue only in last decade. World is yet to overcome and contain HIV successfully though it is more than 25 years old. Every time it is a new learning process and different solutions. We can expect new viruses to keep showing up simply because of global warming, draughts, floods and changed ecological systems. So, how does one prepare to tackle such unpredictable menace? We need to learn from past experiences and evolve a strategic network which will spring into action when alerted. It is equivalent of “Rapid Action Force” for public health security. Public Private Partnership: As is generally known government hospitals are ill equipped and the attitude of the staff leaves much to be desired. In times of crisis like these, we need to pool together all the resources which can be marshaled for speedy service to the people needing immediate attention. Today the situation is that in Pune, people with suspected symptoms of swine flu are being told to come tomorrow! There is considerable gap between the government instructions and the ground reality. Why only government hospitals and not private for treatment of swine flu? What is special that is needed to restrict treatment to government hospitals? After all, their experience in swine flu is also limited. The private hospitals can be updated on handling and managing the situation and brought on board since there is tremendous shortage of beds in designated hospitals. Following steps may help to improve responses and create permanent strategic infrastructure to deal with exigencies of this nature in public health arena effectively: 1. The central government has just announced conversion of National Institute for Communicable Diseases to National Center for Disease Control (NCDC) with grant of Rs 500 crores for up gradation of facilities and laboratories. This is welcome move though very late. The modernization program must be properly defined and focused otherwise it will just be another black hole sucking resources. NCDC functions just as wing of health department with typical government approach. It must be made autonomous body and run by qualified professionals for effectiveness. The policy making bureaucracy and executing bodies must be separated for accountability. 2. NCDC should be nimble, quick decision making and executing body. It should be restructured to serve new mandate with teeth. NCDC has baggage of 100 years as it celebrates centenary and must change its work culture to suit the fast paced responses required to control spread of diseases. 3. The state governments can select all good hospitals including private ones in every city (at least district level), evaluate for their preparedness to handle such exigencies. Such hospitals should be designated and listed with NCDC. The government should equip the listed hospitals out of the funds received from government. Private hospitals may add additional equipments, if required, at their
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cost or out of grant from NCDC. NCDC should ensure that the state governments and private listed hospitals train the doctors and staff periodically for handling such situations. This can be refreshed when early signals come from any country about potential new virus so that experience of other countries gets disseminated among the healthcare professionals. NCDC should initiate and coordinate development of new anti viruses from time to time with various organizations and institutions engaged in such research and development work. They should be networked online with these designated hospitals and institutions for speedy communications and consultations with experts in any location. The roles of various agencies and different government departments involved in managing crisis must be well defined and understood so that there is clarity all the time. There should be standard operating procedures in a situation like this. The city hospitals should not send the public to just one or two designated hospitals in a city like Pune with 30 lakhs population. They must participate in tackling the problems in direct consultation with NCDC if required. African countries are known to have flying doctor service for reaching remote areas. There may be some lesson for us in their experience in view of large number of villages without adequate medical facilities in India. These hospitals must have same charges for testing and treatment of specified diseases both in private domain and government, so that the patients are not harassed. The healthcare professionals should address the needs and chalk out a detailed plan of action.
Effect of Globalization: In these days of globalization the overseas travel is far more easy, frequent and a sure carrier of viruses across the nations and continents. The epidemics have the potential to assume global spread quickly. While checking millions of incoming passengers becomes necessary that can not stop the spread of a virus. Businesses worldwide are immediately affected due to any threat of epidemic as global travel gets reduced significantly as was noticed during onset of SARS, and even swine flu in last few months. If there is inadequate response system in the country, the impact is much more than a normal economic slowdown. An advisory issued against travel to India would cost us dearly in terms of loss of business. Effective systems must be seen to be in place to handle such threats to public health. We must have new strategies to combat as times change. Vijay M. Deshpande Corporate Advisor, Strategic Management Initiative, Pune August 7, 2009
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