Question

Describe 3 essential public health services that could address the COVID19 issue. Reflect on how health indicators could be used to measure the sucess of health outcomes from provision.

Answer 1

1. Patient's needing services for minor ailments would be encouraged to contact the MPW (M or F) via telephone, who would assess the situation and enable teleconsultation with a medical officer.

2. All SHC/PHCs, including HWCs particularly inaffected areas maybe linked with a telemedicine hub via telephone/videocall to facilitate consulation between the patient and the provider, which willbe guided by MoHFEE telemedicine guidelines.

3. private for profit and not for profit providers can also be engaged to provide these services particularly where a telemedicine hub in govt. facilities does not exist. In such cases the MoHFEE telemedicine guidelines on prescription generation will apply. Such providers should prescribe generic medicines.

4. Investigations and medicines prescribed (particularly from within the essential medicine list and essential diagnostic list of the state) should be provided free of cost to all the patients seeking govt. facilitated care.

* ALTERNATE MODELS FOR OUTREACH SERVICES:-

1. Services that are traditionally delivered through outreach suchas immunization, antinatal care, screening for common NCDs/communicable diseases etc. would need to be reorganized during the period of lockdown or restriction. Where feeasible, those due for any of these services, wouldbe asked to come to peripherial facilities (SHCs/PHCs/UPHCs, inculding HWCs/ urban health costs) on particular dates/ times, decided at local levels and informed telephonically or through ASHAs. This can be done by allocating fixed day services for each villege/ward area, ensuring adherence to physical distancing and other IPC protocols.

2. More number of immunization session/ VHNDs/ UHNDs/ screening session couldbe organised at the villege/ ward level after the lockdown. ASHAs much creat awareness inthe community about change in schedule and mobilize beneficiaries in small batches of 4 to 5 session to avoid crowding and ensure physical distancing norms.

3. To undertake such multiple session, retured nurses, ANMs, LHVs, couldbe engeged at local level through additional funding provided through NHM.

* HOMEVISIT

1. Homevisits by ASHAs shouldbe optimized to provide followup care to all beneficiaries in a particular household/ hamlet/ mohalla/ during 1 visit and avoid making repetitive visits tothe same house/ mohalla. This may include beneficiaries like high risk pregnant woman or new born, elderly and disabled individual etc.

2. Primary health team at SHCs, including HWCs muchbe encouraged to followup with this specific sub population groups such as pregnant woman with EDD in current month, all highrisk pregnant women , newborns, children due for immunization, children with SAM (Severe or acute malnourishment), patients on treatment for TB, leprosy, HIV and viral hepatits, patient with hypertension,diabetes,COPD,mental health,etc,patients undergoing plant procedures (Dialysis,cancer treatment & scheduled blood transfusion,etc.

3.During home visits, ASHAs should be alert to the possibility of increased gender based violence,inform the MO & support the victim to access appropriate health & social sevices.