DR B C DASGUPTA MEMORIAL ORATION
Year : 2022 | Volume
: 66 | Issue : 4 | Page : 401--402
Post-COVID-19 pandemic public health: Issues and challenges in India
Professor, Centre for Public Health, School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, Maharashtra, India
Centre for Public Health, School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, Maharashtra
COVID-19 was an unexpected public health emergency. The key positive features of the Indian health system were demonstrated during the pandemic. Postpandemic is the time to introspect. Various issues and challenges facing the Indian Public Health System require due attention.
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Thakur H. Post-COVID-19 pandemic public health: Issues and challenges in India.Indian J Public Health 2022;66:401-402
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Thakur H. Post-COVID-19 pandemic public health: Issues and challenges in India. Indian J Public Health [serial online] 2022 [cited 2023 Jan 27 ];66:401-402
Available from: https://www.ijph.in/text.asp?2022/66/4/401/366565
COVID-19 was an unanticipated and unexpected public health emergency that surprised everyone. The pandemic had various social, economic, and political consequences. A series of lockdowns followed by gradual unlock-down cycles took place worldwide, including in India. Public health in India, too, underwent many changes during this period.
Since the beginning of the year 2022, slowly life is coming back to normal. Now is the time to introspect, so the intention is to present a constructive critical analysis of India's current public health, especially after the pandemic. The observations could be helpful to policymakers, program implementors, academicians, and other stakeholders. They can take necessary steps to chart the future course of action.
Key Positive Features
The 2-year pandemic demonstrated that India has a well-developed secondary and tertiary health-care infrastructure. Furthermore, the Indian health system proved it could deliver a national level well-coordinated response with short notice as per the situation. The Indian manufacturing industry also showed the capacity to increase the production of medical equipment, drugs, diagnostic/preventive kits, and others if required. The usefulness of information technology and social media in meeting the needs, especially in creating awareness among the community, was quite commendable. The health workforce and volunteers also came forward with a lot of willingness and motivation to work in the face of adversity.
Post-Pandemic Issues and Challenges
India needs to tackle many significant health issues. The entire attention was focused on COVID during the pandemic, and many other important health issues were not given due attention. In addition to COVID, there are many other communicable diseases such as tuberculosis, malaria, leprosy, and others. Moreover, India faces the threat of many emerging and re-emerging communicable diseases. In addition, the issue of noncommunicable diseases such as hypertension, diabetes, cancer, and others is increasing. Other important public health issues such as mental health, malnutrition, maternal and child health, geriatric health, and others require attention simultaneously.
Health-care infrastructure issues such as inadequate and overburdened staff are pretty significant. There are many vacancies in the government health system. Much inequity exists regarding the availability, accessibility, and affordability of health services for the ordinary person. Health services are still below par and neglected in tribal, hard-to-reach rural and urban slums. We continue to pay more attention to curative aspects rather than prevention. The private sector continues exploiting the situation to its benefit, as seen during the pandemic. In addition, a vicious cycle exists in the form of increased or forced reliance on the private sector leads to more out-of-pocket expenditure followed by poverty.
There is much discussion on the social determinants of health such as education, employment, safe drinking water, sanitation facilities, food, shelter, and others. There are various programs by the government to tackle these issues. Nevertheless, even after 75 years of independence, these issues are not entirely addressed. Nowadays, social media plays a significant role in our day-to-day life. There are both pros and cons to social media use. There is a need to be vigilant about social media's ability to spread fear and rumors, which can lead to unwarranted health issues.
There are challenges on the academic front too. There is a mushrooming of public health institutes all over India. They are also offering various public health courses in addition to medical colleges. Many students with both medical and nonmedical backgrounds are joining this public health institute. There is an urgent need for standardization of these public health courses, which will be helpful to students from various backgrounds. In addition, the proper distinction between the discipline of Public Health and Community Medicine (preventive and social medicine) is the need of the hour. Both have important roles to play in the development of the country. The interrelation between these and other courses should be made clear.
Many community medicine departments in medical colleges work as ivory towers, and many departments continue to work in isolation. It needs to change, and the community medicine departments must play an active role in the development and sustainability of public health in India, both in theory and practice. As far as health-care service delivery is concerned, the so-called community medicine/public health experts have a minimal role to play and hardly have any involvement in policy decisions.
The public health facilities all over India need strengthening and upgradation. We have heard about the dedicated public health cadre, but there is hardly any progress. The independent public health cadre will be pretty valuable for planning, implementing, evaluating, and the replanning cycle of various public health activities. The health ministry and departments cannot work in isolation and must coordinate with other ministries and departments.
Research is the most neglected part of the system. There is an urgent need to promote basic and applied research in public health. The quantity of research is increasing on one side, but on the other side, the quality is decreasing drastically. The research is done for the sake of it or to increase the number of publications. Furthermore, there is a need to integrate research by different stakeholders and convert research findings into policy formulation.
In addition, many other challenges need urgent attention. Academics, research, and health-care service delivery system mostly work independently. Integration of all these will be pretty helpful. Academicians need to play a proactive role in different spheres of public health. The involvement of existing professional networks, such as the Indian Association of Preventive and Social Medicine, the Indian Public Health Association, and the Indian Medical Association in academics, research, service delivery, and other related activities is essential for the progress of public health in India. In India, public health spending is relatively low and has decreased over the years. Increasing it is essential for a sound public health system. Organizing and conducting ongoing capacity building for everyone involved in public health is necessary. Digital technology is nowadays playing a significant role in various sectors, including public health. However, we need to remember that it is a means to achieve our public health goals, and it should not become an end by itself. Positive partnerships with various development partners, nongovernment organizations, and private institutions will be helpful. Inclusion and integration of Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy in mainstream public health will benefit from increased coverage. Proper knowledge/awareness, positive attitude, and healthy practice of basic preventive and promotive measures for better health by everyone are the keys to achieving universal health care.
India heavily depends on other countries for knowledge, supply of essentials, ratification of strategies, and health-related practices. India needs to be self-dependent (Atmanirbhar). At the same time, we should not isolate away from the world, as everything is interrelated and interdependent. A healthy give-and-take relationship of expertise with other countries and even between India's states will help us achieve challenging public health goals and objectives.
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Conflicts of interest
There are no conflicts of interest.