Need more Soldiers to shoulder the response against COVID-19

COVID-19 is a global epidemic. Today, the entire health system of the world is under strain because the health facilities, medical equipment, drugs and personal protective equipment are not sufficiently available against the rising number of COVID-19 cases. The demand for health services has risen so tremendously that gaps in preparedness of even the countries having the best health care system is exposed. If developed nations are looking helpless to counter this troublesome situation, then how the developing countries like India can sustain if this battle against COVID-19 is stretched. Compared to other countries, India so far is able to control the pace of spread of the epidemic. But in India the figures like one doctor for every 1,445 Indians is enough to get worried. The entire three tier healthcare system is under stress because of the emergency situation that emerged due to the COVID-19 outbreak. The Healthcare workers constitute the front line of response against any outbreak and they are the first one who get exposed to health risks due to virus exposure, long duty hours, mental distress, physical fatigue, occupational burnout, stigma and even at some places they are facing physical violence. The fight against COVID-19 can be weakened if the frontline of healthcare staff gets exhausted because there is evidence coming from different parts of the world where health workers are complaining about burnout due to overstress.

Major proportion of health infrastructure is constituted by primary healthcare facilities because they are the one who first of all come to interface with the community. They have the largest access to the community through community level healthcare workers. All the national programs are implemented at grass root level through the healthcare workforce engaged with primary healthcare institutes. Therefore, the critical role of primary healthcare workers cannot be sidelined during these critical hours. Currently, the primary healthcare institutes are functioning 24x7 because these healthcare providers are also working relentlessly and tirelessly for 24x7. In the pandemonium of COVID-19 pandemic the Healthcare providers are screening the patients, monitoring the quarantined population, and also referring the suspected cases. Besides that, they are also doing household surveys for identification of population which is at high risk of getting infection, or those who have come from outstation or abroad, and those who have come in contact of Covid19 positive. They are also doing IEC to create awareness in people about ways of preventing the spread of Covid-19.

This dedication and commitment towards health of the people may be part of their job but one cannot ignore that they are also equally vulnerable to the COVID-19 infection and their health is also non-negotiable. The stress is getting accumulated because of incomplete rest every day. Even covering themselves for long by personal protective equipment like gloves, face masks, air-purifying respirators, goggles, and gowns for long during duty hours are also increasing their distress. For example, the pictures are shared by medical and paramedical health care workers showing their bruised faces due to wearing PPE for long hours while treating COVID-19 patients. There is no data, but it is fact that in the emergency situation of COVID-19 the leaves and Day-off is also not allowed without strong reason due to which a big number of healthcare workers who are serving away from their families are not able to visit them at home in this testing time. This is also giving them a psychological tension. All these health challenges at the level of healthcare ‘COVID-19 warriors’ the quality and efficiency of staff in discharging their duties can also be affected. Thus, it is important to understand the issues which are leading to exhaustion of healthcare workers, including medical and paramedical staff. Therefore, there should be some alternative strategies to depreciate the fatigueness due to work and vulnerability of healthcare providers to sustain a long fight against COVID-19.

A) Roaster system can be a way out because it is already being followed in healthcare management to maintain the uninterrupted emergency service delivery at facility level. But during the COVID-19 period it is a challenge to follow with a limited number of human resource options. The rotational shifts can only be created if health facilities are having more staff as substitute. To make the roaster system more effective during COVID-19, there should be more empanelment of doctors and nurses to compensate for the gap.

B) Empanelment of retired doctors and nurses can be one of the options.

C) Another option is to empanel the unemployed nursing staff because a large number of nursing staff pass out every year is jobless. The contacts of such unemployed nursing personnel can be traced with the help of local administration and institutions from where they have completed their courses. The names can also be added by inviting medical and paramedical personnel who are voluntarily ready to serve.

D) Besides, in wake of COVID-19 lockdown, many people have returned to their native villages and towns. These returning migrants may also include some healthcare workers of varying skills. The mapping of such people at local level can be done to enlist them with local health administration and their services can be hired for a temporary period. This strategy to empanel doctors and nurses can not only strengthen the roster system but also the mobile units can be formed. As the government is converting several different buildings like hostels, hotels, railway coaches etc. as isolation ward, these mobile units developed out of empaneled healthcare workers can be deputed there to serve.

Summary: We must not forget that the situation emerging from COVID-19 is more disastrous than world war II. No war can be won without warriors. In the fight against Coronavirus the healthcare providers are the true warriors. Innovations are going on everywhere to develop vaccines, medicine and equipment. The innovative idea once succeeded; the large-scale mechanical production is possible through technology in a limited time. But the gap in human resources (healthcare workers) cannot be compensated in a short time. Adding more soldiers will create more arms to shoulder the global response against COVID-19 right up to the local level.

 Authors: 1) Rajesh Ranjan Singh, CEO WISH Foundation and 2) Dr. Ambey Kr. Srivastava , Senior Specialist- RMEL, WISH Foundation