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Subject: Health

  • Global Alliance for Vaccines and Immunization (GAVI)

    Union Health Minister has been nominated by the Global Alliance for Vaccines and Immunisation (GAVI) as a member of the GAVI Board.

    Q.The Covid-19 pandemic has exposed the limitations of global cooperation. Critically analyse.

    GAVI

    • GAVI is a public-private global health partnership with the goal of increasing access to immunization in poor countries.
    • GAVI has observer status at the World Health Assembly.
    • GAVI has been praised for being innovative, effective, and less bureaucratic than multilateral government institutions like the WHO.
    • Members: the WHO, UNICEF, the World Bank, the vaccine industry in both industrialized and developing countries, and the Bill & Melinda Gates Foundation among others.
    • GAVI programs can often produce quantified, politically appealing, easy-to-explain results within an election cycle, which is appealing to parties locked in an election cycle.

    Its function

    • It currently supports the immunization of almost half the world’s children, giving it the power to negotiate better prices for the world’s poorest countries and remove the commercial risks of manufacturers.
    • It also provides funding to strengthen health systems and train health workers across the developing world.

    Significance of India’s membership

    • The GAVI Board is responsible for the strategic direction and policymaking oversees the operations of the Vaccine Alliance and monitors program implementation.
    • With membership drawn from a range of partner organizations, as well as experts from the private sector, the Board provides a forum for balanced strategic decision making, innovation, and partner collaboration.

  • [pib] PM-JAY SEHAT

    The Prime Minister has launched Ayushman Bharat PM-JAY SEHAT to extend coverage to all residents of Jammu & Kashmir.

    Q.Discuss various challenges in ensuring Universal Healthcare in India. (150W)

    PM-JAY SEHAT

    • The full form of SEHAT is social, endeavor for health, and telemedicine. Under this scheme, the SEHAT card will be distributed to all the eligible beneficiaries.
    • All the eligible beneficiaries of Jammu and Kashmir can apply for the Scheme through common service center operators
    • Around 1 crore beneficiaries will cover under this scheme. All the eligible citizens of Jammu and Kashmir will get cashless treatment up to Rs 5 lakh under the Scheme.

  • Dominance of Private healthcare in India & Related issues

    • Lack of resources such as 1:1,700, doctor: citizen ratio, well below the minimum ratio of 1:1,000 stipulated by WHO.

    • Rural areas and smaller towns of India are the worst sufferers, where even basic health services remain inaccessible, many cases were reported where ward boys and alone found running the primary healthcare center.

    • Inadequate government spending on healthcare and lack of access to health insurance to a large section of society.

    • The quality of public health services in India continues to remain below expectations which hamper the economic growth of the country.

    • Government’s inability to build sufficient capacity and infrastructure, difficulty in reaching out to poor and vulnerable groups.

    • An undersized skilled workforce and the absence of upgraded technology is a major challenge in the health sector.

  • [pib] Vision 2035: Public Health Surveillance in India

    NITI Aayog today released a white paper: Vision 2035: Public Health Surveillance (PHS) in India.

    Q.Discuss the role of Public Health Surveillance in the success of Ayushman Bharat Abhiyan.

    Vision 2035 for PHS

    • It is a continuation of the work on health systems strengthening.
    • It contributes by suggesting mainstreaming of surveillance by making individual electronic health records the basis for surveillance.
    • Public health surveillance (PHS) is an important function that cuts across primary, secondary, and tertiary levels of care. Surveillance is ‘Information for Action’.

    Let’s have a look at the executive summary of the vision document:

    PHS in India

    • Surveillance is an important Public Health function.
    • It is an essential action for disease detection, prevention, and control. Surveillance is ‘Information for Action’.

    Why need PHS?

    • Multiple disease outbreaks have prompted India to proactively respond with prevention and control measures. These actions are based on information from public health surveillance.
    • India was able to achieve many successes in the past. Smallpox was eradicated and polio was eliminated.
    • India has been able to reduce HIV incidence and deaths and advance and accelerate TB elimination efforts.
    • These successes are a result of effective community-based, facility-based, and health system-based surveillance.
    • The COVID19 pandemic has further challenged the country. India rapidly ramped up its diagnostic capabilities and aligned its digital technology expertise.
    • This ensured that there was a comprehensive tracking of the pandemic.

    Highlights of the vision document

    • It builds on initiatives such as the Integrated Health Information Platform of the Integrated Disease Surveillance Program.
    • It aligns with the citizen-centricity highlighted in the National Health Policy 2017 and the National Digital Health Blueprint.
    • It encourages the use of mobile and digital platforms and point of care devices and diagnostics for amalgamation of data capture and analyses.
    • It highlights the importance of capitalizing on initiatives such as the Clinical Establishments Act to enhance private sector involvement in surveillance.
    • It points out the importance of a cohesive and coordinated effort of apex institutions including the National Centre for Disease Control, the ICMR, and others.

    Gap areas in India’s PHS that could be addressed

    • India can create a skilled and strong health workforce dedicated to surveillance activities.
    • Non-communicable disease, reproductive and child health, occupational and environmental health and injury could be integrated into public health surveillance.
    • Morbidity data from health information systems could be merged with mortality data from vital statistics registration.
    • An amalgamation of plant, animal, and environmental surveillance in a One-Health approach.
    • PHS could be integrated within India’s three-tiered health system.
    • Citizen-centric and community-based surveillance, and use of point of care devices and self-care diagnostics could be enhanced.
    • To establish linkages across the three-tiered health system, referral networks could be expanded for diagnoses and care.

    Moving ahead

    • Establish a governance framework that is inclusive of political, policy, technical, and managerial leadership at the national and state level.
    • Identify broad disease categories that will be included under PHS.
    • Enhance surveillance of non-communicable diseases and conditions in a step-wise manner.
    • Prioritize diseases that can be targeted for elimination as a public health problem, regularly.
    • Improve core support functions, core functions, and system attributes for surveillance at all levels; national, state, district, and block.
    • Establish mechanisms to streamline data sharing, capture, analysis, and dissemination for action.
    • Encourage innovations at every step-in surveillance activity.

  • India needs to rethink its nutrition agenda

    Poor nutritional outcomes in NFHS-5 show that a piecemeal approach does not work.

    Nutrition-related data released by NFHS-5

    • The Ministry of Health and Family Welfare has released data fact sheets for 22 States and Union Territories (UTs) based on the findings of Phase I of the National Family Health Survey-5 (NFHS-5).
    • The 22 States/ UTs don’t include some major States such as Tamil Nadu, Rajasthan, Punjab, Uttar Pradesh, Jharkhand, Odisha and Madhya Pradesh.

    Practice Question: The latest findings from the National Family Health Survey data shows a sign of worry. Suggest the policy measures required to tackle the health and nutrition-related issues in India.

    Worrying findings

    • There is an increase in the prevalence of severe acute malnutrition in 16 States/UTs (compared to NFHS-4 conducted in 2015-16). Kerala and Karnataka are the only two big states where there is some decline.
    • The percentage of children under five who are underweight has also increased in 16 out of the 22 States/UTs.
    • Anaemia levels among children as well as adult women have increased in most of the States with a decline in anaemia among children being seen only in four States/UTs.
    • There is also an increase in the prevalence of other indicators such as adult malnutrition in many States/ UTs.
    • Most States/UTs also see an increase in overweight/obesity prevalence among children and adults shows the inadequacy of diets in India both in terms of quality and quantity.
    • The data report an increase in childhood stunting (an indicator of chronic under-nutrition and considered a sensitive indicator of overall well-being) in 13 of the 22 States/UTs.
    • Poshan Abhiyaan, one of the flagship programmes of the PM, launched in 2017, aimed at achieving a 2% reduction in childhood stunting per year.

    Economic growth vs health indicators

    • There is an increase in the prevalence of childhood stunting in the country during the period 2015-16 to 2019-20.
    • This calls for serious introspection on not just the direct programmes in place to address the problem of child malnutrition but also the overall model of economic growth that the country has embarked upon.
    • The World Health Organization calls stunting “a marker of inequalities in human development”.
    • Over the last three decades, India has experienced high rates of economic growth. But this period has also seen increasing inequality, greater informalisation of the labour force, and reducing employment elasticities of growth.
    • Currently, India is witnessing a slowdown in economic growth, stagnant rural wages and highest levels of unemployment. This is reflected in the rising number of reported starvation deaths from different parts of the country.
    • The situation has become even worse due to the pandemic and lockdown-induced economic distress.
    • Field surveys such as the recent ‘Hunger Watch’ are already showing massive levels of food insecurity and decline in food consumption, especially among the poor and vulnerable households.
    • All of this calls for urgent action with commitment towards addressing the issue of malnutrition.

    Social protection schemes and their impact on nutrition indicators

    • Social protection schemes and public programmes such as the Mahatma Gandhi National Rural Employment Guarantee Scheme, the Public Distribution System, the Integrated Child Development Scheme (ICDS), and school meals have contributed to a reduction in absolute poverty as well as previous improvements in nutrition indicators.
    • However, there are continuous attempts to weaken these mechanisms through underfunding and general neglect.
    • Only about 32.5% of the funds released for Poshan Abhiyaan from 2017-18 onwards had been utilized.
    • There are some improvements seen in determinants of malnutrition such as access to sanitation, clean cooking fuels and women’s status – a reduction in spousal violence and greater access of women to bank accounts.

    A piecemeal approach

    • The overall poor nutritional outcomes show that a piecemeal approach addressing some aspects does not work.
    • Direct interventions such as supplementary nutrition (of good quality including eggs, fruits, etc.), growth monitoring, and behaviour change communication through the ICDS and school meals must be strengthened and given more resources.
    • Universal maternity entitlements and child care services to enable exclusive breastfeeding, appropriate infant and young child feeding as well as towards recognizing women’s unpaid work burdens have been on the agenda for long, but not much progress has been made on these.
    • The linkages between agriculture and nutrition both through what foods are produced and available as well as what kinds of livelihoods are generated in farming are also important.

    Conclusion

    • The basic determinants of malnutrition – household food security, access to basic health services and equitable gender relations – cannot be ignored any longer.
    • An employment-centred growth strategy which includes the universal provision of basic services for education, health, food and social security is imperative.
    • There have been many indications in our country that business as usual is not sustainable anymore.
    • It is hoped that the experience of the pandemic, as well as the results of NFHS-5, serve as a wake-up call for a serious rethinking of issues related to nutrition and accord these issues priority.

  • National Family Health Survey- 5 Part: I

    • Current times require integrated and coordinated efforts from all health institutions, academia and other partners directly or indirectly associated with the health care services to make these services accessible, affordable and acceptable to all.
    • The data in NFHS-5 gives requisite input for strengthening existing programmes and evolving new strategies for policy intervention, therefore government and authorities should take steps to further improve the condition of women in India.

    The first phase of the fifth National Family Health Survey (NFHS-5) has been released.

    Do you think that India is still the sick man of Asia?

    What is the National Family Health Survey?

    • The NFHS is a large-scale, multi-round survey conducted in a representative sample of households throughout India.
    • Three rounds of the survey have been conducted since the first survey in 1992-93.
    • The survey provides state and national information for India on fertility, infant and child mortality, the practice of family planning, maternal and child health, reproductive health, nutrition, etc.
    • The Ministry of Health has designated the International Institute for Population Sciences (IIPS) Mumbai, as the nodal agency, responsible for providing coordination and technical guidance for the survey.

    Part I of the Survey

    • The latest data pertains to 17 states — including Maharashtra, Bihar, and West Bengal — and five UTs (including J&K) and, crucially, captures the state of health in these states before the Covid pandemic.
    • Phase 2 of the survey, which will cover other states such as Uttar Pradesh, Punjab and Madhya Pradesh, was delayed due to the pandemic and its results are expected to be made available in May 2021.

    Highlights of the NHFS-5

    • The NFHS-5 contains detailed information on population, health, and nutrition for India and its States and Union Territories.
    • This is a globally important data source as it is comparable to Demographic Health Surveys (DHS) Programme of 90 other countries on several key indicators.
    • It can be used for cross country comparisons and development indices.

    Good news

    • Several of the 22 states and UTs, for which findings have been released, showed an increase in childhood immunisation.
    • There has been a drop in neonatal mortality in 15 states, a decline in infant mortality rates in 18 states and an increase in the female population (per 1,000 males) in 17 states.
    • Fertility rate decline and increase in contraceptive use were registered in almost all the states surveyed showing trends of population stabilization.

    Some bad news

    • There has been an increase in stunting and wasting among children in several states, a rise in obesity in women and children, and an increase in spousal violence.
    • In several other development indicators, the needle has hardly moved since the last NFHS-4.

    (1) Hunger Alarm

    • The proportion of stunted children has risen in several of the 17 states and five UTs surveyed, putting India at risk of reversing previous gains in child nutrition made over previous decades.
    • Worryingly, that includes richer states like Kerala, Gujarat, Maharashtra, Goa and Himachal Pradesh.
    • The share of underweight and wasted children has also gone up in the majority of the states.

    (2) Fertility Rate

    The total fertility rate (TFR) is defined as the average number of children that would be born to a woman by the time she ends childbearing.

    • The TFR across most Indian states declined in the past half-a-decade, more so among urban women, according to the latest NFHS-5.
    • Sikkim recorded the lowest TFR, with one woman bearing 1.1 children on average; Bihar recorded the highest TFR of three children per woman.
    • In 19 of the 22 surveyed states, TFRs were found to be ‘below-replacement’ — a woman bore less than two children on average through her reproductive life.
    • India’s population is stabilizing, as the total fertility rate (TFR) has decreased across majority of the states.

    (3) Under-5 and infant mortality rate (IMR)

    • The Under 5 and infant mortality rate (IMR) has come down but in parallel recorded an increase in underweight and severely wasted under 5 children among 22 states that were surveyed.
    • These states are Goa, Gujarat, Himachal Pradesh, Kerala, Maharashtra, Meghalaya, Mizoram, Nagaland, Telangana, Tripura, West Bengal, Lakshadweep and Dadra & Nagar Haveli and Daman and Diu.

    For the first time: Gaps in internet use

    • In 2019, for the first time, the NFHS-5, which collects data on key indicators on population health, family planning and nutrition, sought details on two specific indicators: Percentage of women and men who have ever used the Internet.
    • On average, less than 3 out of 10 women in rural India and 4 out of 10 women in urban India ever used the Internet, according to the survey.
    1. First, only an average of 42.6 per cent of women ever used the Internet as against an average of 62.16 per cent among the men.
    2. Second, in urban India, average 56.81 per cent women ever used the Internet compared to an average of 73.76 per cent among the men.
    3. Third, dismal 33.94 per cent women in rural India ever used the Internet as against 55.6 per cent among men.
    • In urban India, 10 states and three union territories reported more than 50 per cent women who had ever used the Internet: Goa (78.1%), Himachal Pradesh (78.9%), Kerala (64.9%), and Maharashtra (54.3%).
    • The five states reporting the lowest percentage of women, whoever used the Internet in urban India were Andhra Pradesh (33.9%), Bihar (38.4%), Tripura (36.6%), Telangana (43.9%) and Gujarat (48.9%).

  • Matru Sahyogini Samitis Scheme

    The MP government has issued an order for the appointment of committees led by mothers to ensure better monitoring of services delivered at Anganwadi or day-care centres across the State.

    Try this PYQ:

    Q.Which of the following are the objectives of ‘National Nutrition Mission’?

    1. To create awareness relating to malnutrition among pregnant women and lactating mothers.
    2. To reduce the incidence of anaemia among young children, adolescent girls and women.
    3. To promote the consumption of millets, coarse cereals and unpolished rice.
    4. To promote the consumption of poultry eggs.

    Select the correct answer using the code given below:

    (a) 1 and 2 only

    (b) 1, 2 and 3 only

    (c) 1, 2 and 4 only

    (d) 3 and 4 only

    Matru Sahyogini Samitis

    • Called ‘Matru Sahyogini Samiti’ or Mothers’ Cooperation Committees, these will comprise 10 mothers at each Anganwadi centres.
    • They would be representing the concerns of different sets of beneficiaries under the Integrated Child Development Services, or National Nutrition Mission.
    • Beneficiaries’ would include children between six months to three years, children between three years and six years, adolescent girls and pregnant women and lactating mothers.
    • These mothers will keep a watch on weekly ration distribution to them as well as suggest nutritious and tasteful recipes for meals served to children at the centres.
    • The move is being taken as per the mandate of the National Food Security Act, 2013 (NFSA).

    Its’ functioning

    • The committees will include mothers of beneficiary children as well as be represented by pregnant women and lactating mothers who are enrolled under the scheme.
    • The Anganwadi scheme includes a package of six services delivered at the centres, including supplementary nutrition, health services including vaccination, early education, among others.
    • The Committees will also include a woman panch, women active in the community and eager to volunteer their support to the scheme, teachers from the local school, and women heads of self-help groups (SHG).

    Why such a move?

    • This is in a move that is aimed at strengthening community response to the problem of hunger and malnutrition in the State.
    • With the help of mothers, we will be able to turn anganwadis into a community health system, a nutrition management centre, and spread awareness against social evils.
    • These will turn into a model for local governance as well as allow for greater engagement between communities and the State government.

    Back2Basics: Integrated Child Development Services (ICDS)

    • The ICDS aims to provide food, preschool education, primary healthcare, immunization, health check-up and referral services to children under 6 years of age and their mothers.
    • The scheme was launched in 1975, discontinued in 1978 by the government of Morarji Desai, and then relaunched by the Tenth Five Year Plan.
    • The tenth FYP also linked ICDS to Anganwadi centres established mainly in rural areas and staffed with frontline workers.
    • The ICDS provide for anganwadis or day-care centres which deliver a package of six services including:
    1. Immunization
    2. Supplementary nutrition
    3. Health checkup
    4. Referral services
    5. Pre-school education (Non-Formal)
    6. Nutrition and Health information

    Implementation

    • For nutritional purposes, ICDS provides 500 kilocalories (with 12-15 grams of protein) every day to every child below 6 years of age.
    • For adolescent girls, it is up to 500-kilo calories with up to 25 grams of protein every day.
    • The services of Immunisation, Health Check-up and Referral Services delivered through Public Health Infrastructure under the Ministry of Health and Family Welfare.

  • Threat of malnutrition to promise of India

    POSHAN Abhiyan has completed 1000 days. The article analyses the challenges country face on the nutrition front which has been exacerbated by the Covid-19 induced disruptions.

    Severity and impact of malnutrition

    • Malnourished children tend to fall short of their real potential — physically as well as mentally.
    • That is because malnutrition leaves their bodies weaker and more susceptible to illnesses.
    • In 2017, a staggering 68% of 1.04 million deaths of children under five years in India was attributable to malnutrition, reckoned a Lancet study in 2019.
    • Without necessary nutrients, their brains do not develop to the fullest.
    • Malnutrition places a burden heavy enough for India, to make it a top national priority.
    • About half of all children under five years in the country were found to be stunted (too short) or wasted (too thin) for their height, estimated the Comprehensive National Nutrition Survey, carried out by the Ministry of Health and Family Welfare with support of UNICEF three years ago.

    POSHAN Abhiyan against the background Covid-19 disruption

    • The Prime Minister’s Overarching Scheme for Holistic Nutrition (POSHAN) Abhiyaan in 2018, led to a holistic approach to tackle malnutrition.
    • Under it, the government strengthened the delivery of essential nutrition interventions.
    • COVID-19 is pushing millions into poverty making them vulnerable to malnutrition and food insecurities.
    • Pandemic-prompted lockdowns disrupted essential services — such as supplementary feeding under anganwadi centres, mid-day meals, immunisation, and micro-nutrient supplementation which can exacerbate malnutrition.
    •  Leaders from academia, civil society, development partners, community advocates and the private sector have come together as part of ‘commitment to action’.
    • The ‘commitment to action’ includes commitments around sustained leadership, dedicated finances, multi-sectoral approach and increased uninterrupted coverage of a vulnerable population under programmes enhancing nutrition.

    Financial commitments

    • India already has some of the world’s biggest early childhood public intervention schemes such as the Integrated Child Development Scheme, the mid-day meal programme, and Public Distribution System.
    • India needs to ensure coverage of every single child and mother.
    • To ensure this, the country needs to retain its financial commitments for nutrition schemes.
    • Economic insecurities often force girls into early marriage, early motherhood, discontinue their schooling, and reduce institutional deliveries, cut access to micronutrient supplements, and nutritious food.
    •  Accelerating efforts to address these will be needed to stop the regression into the deeper recesses of malnutrition.

    Conclusion

    It takes time for nutrition interventions to yield dividends, but once those accrue, they can bring transformative generational shifts. Filling in the nutrition gaps will guarantee a level-playing field for all children and strengthen the foundations for the making of a future super-power.

  • Anganwadi centres

    The article highlights the role of Anganwadi’s in the effective implementation and service delivery under the ICDS.

    Gaps in the utilisation of services by ICDS

    • The economic fallout of COVID-19 makes the necessity of quality public welfare services more pressing than ever.
    • The Integrated Child Development Services (ICDS) programme is one such scheme.
    • ICDS caters to the nutrition, health and pre-education needs of children till six years of age as well as the health and nutrition of women and adolescent girls.  
    • However, recent reports have shown gaps in the utilisation of services.

    Recasting the Anganwadi centres

    • Anganwadi centres (AWCs) could become agents of improved delivery of ICDS’s services.
    • According to government data, the country has 13.77 lakh Anganwadi centres (AWCs).
    • These centres have expanded their reach, but they need to play a much larger role in anchoring community development.
    • Nearly a fourth of the operational AWCs lack drinking water facilities and 36 per cent do not have toilets.
    • In 2015, the NITI Aayog recommended better sanitation and drinking water facilities, improved power supply and basic medicines for the AWCs.
    • NITI Aayog also suggested that these centres be provided with the required number of workers, whose skills should be upgraded through regular training.
    •  It has acknowledged the need to improve anganwadi centres.
    • The Central government’s Saksham Anganwadi Scheme aims to upgrade 2.5 lakh such centres across the country. It is up to the state governments to take up the baton
    • Only a limited number of AWCs have facilities like creche, and good quality recreational and learning facilities for pre-school education.
    • An approach that combines an effective supplementary nutrition programme with pedagogic processes that make learning interesting is the need of the hour.

    Steps taken for effective implementation of ICDS

    • Effective implementation of the ICDS programme rests heavily on the combined efforts of the anganwadi workers (AWWs), ASHAs and ANMs.
    • The Centre’s POSHAN Abhiyaan has taken important steps towards building capacities of AWWs.
    • Technology can also be used for augmenting the programme’s quality.
    • AWWs have been provided with smartphones and their supervisors with tablets, under the government schemes.
    • Apps on these devices track the distribution of take-home rations and supplementary nutrition services.
    • The data generated should inform decisions to improve the programme.
    • In Andhra Pradesh and Telangana, anganwadi centres have been geotagged to improve service delivery.
    • Gujarat has digitised the supply chain of take-home rations and real-time data is being used to minimise stockouts at the anganwadi centres.

    Conclusion

    Government must act on the three imperatives. First, while infrastructure development and capacity building of the anganwadi remains the key to improving the programme, the standards of all its services need to be upscaled. Second, states have much to learn from each other’s experiences. Third, anganwadi centres must cater to the needs of the community and the programme’s workers.

  • Healthcare in India & Pandemic

    Pandemic has been ravaging the world in a way few could have imagined. It highlighted the flaws in our healthcare system. However, it also offers several important lessons for tackling future pandemics and healthcare emergencies.

    Where we stand after 1 year of pandemic

    • About a year after the first cases were reported, we are in a different position than at the start.
    • Doctors, public health specialists and policymakers have a better sense of the interventions that are required.
    • Many treatments initially proposed, based on expert experience, have been tested and removed from management strategies even as modified protocols have improved survival rates.
    • Vaccines have moved even faster than drugs with  nearly 40 of them undergoing clinical trials, a dozen of which are at the phase three stage, and at least one has been licensed post-phase three trials under conditional emergency use authorisation (EUA).
    • This highlights the importance of science, technology, multilateral partnerships such as the Coalition for Epidemic Preparedness Innovations and the WHO.
    • This highlights the importance of science, technology, multilateral partnerships such as the Coalition for Epidemic Preparedness Innovations and the WHO.

    Takeaways from our response to pandemic

    1) Increase investment on health services

    • The countries which handled the pandemic best (Thailand and Vietnam) have well-functioning health systems designed to deliver primary healthcare services.
    • These countries also have strong preventive and promotive health services as well as a dedicated public health workforce.
    • Their governments had made sustained investments in health over decades.
    • In contrast, countries which focused mainly on hospital centric medical systems struggled.

    2) Important role played by health workers

    • The role of community health workers in recognising, referring and motivating individuals for therapy was remarkable.
    • Healthcare workers, particularly those at the frontline, such as the accredited social health activists (ASHA) who visited hundreds of households repeatedly during the pandemic.
    •  If we are to build back better, we need to give them better recognition, salaries and career progression.

    3) Increase community participation

    • Third, community trust and participation is essential for implementation of non-pharmacological interventions.
    • Dharavi in Mumbai is an example of the difference community participation can make.

    4) Importance of data

    • Outside of the immediate response, the need for timely and quality data in a health information system was recognised again during the pandemic.
    • Without real time data on testing, disease surveillance and other outcomes, tailored responses are near impossible.
    • The solutions that have brought us hope have come from long-term private or public investments in scientific research and developments.

    Conclusion

    Future readiness needs to start now, and we have the resources and knowledge to do this — all we need is commitment and that is outlined in the recent National Health Policy 2017 and reiterated in the report of the Fifteenth Finance Commission, which for the first time has a dedicated chapter on health.