The Lancet Citizens’ Commission on Reimagining India’s Health System on Tuesday suggested eight urgent measures for the Centre and state governments as a response to the Covid-19 surge in the country.

The commission was launched in December 2020 with the agenda of establishing universal health coverage in India over a span of the next decade. It undertakes work through a participatory and consultative process with citizens and stakeholders in India’s healthcare system.

The commission called for the decentralisation of the organisation of essential healthcare services.

“A one-size-fits-all approach is untenable since the numbers of COVID-19 cases and health services differ substantially from district to district,” it said. “District-level working groups that have the autonomy to respond to rapidly changing local situations must be empowered to receive funds and resources to coordinate efforts across all sectors of the health system, from front-line workers to tertiary care.”

The commission said a transparent national pricing policy was required for all essential services involved in healthcare, including ambulances and medical oxygen. “Hospital care should not require any out-of-pocket expenditure and costs should be covered by existing health insurance schemes for all people, as has been done in some states,” it said.

Evidence-based and clear information on the management of Covid-19 must be “more widely disseminated and implemented”. This should include information on home care and treatment, primary care and district hospital care “in local languages that incorporate local circumstances and clinical practice”. The information should also include what should not be done.

“...All available human resources across all sectors of the health system, including the private sector, must be marshalled for the COVID-19 response and adequately resourced, particularly with sufficient personal protective equipment, guidance on the use of clinical interventions, insurance, and mental health support,” the commission’s statement read.

Central systems should procure and distribute Covid-19 vaccines for free, the commission suggested, “a departure from the current policy of decentralised procurement through state governments”.

The commission also called for community engagement and participation of the public, transparency in government data collection and “community-based tracking of the effectiveness of COVID-19 treatment protocols and long-term outcomes”.

It also said that the impact of the pandemic should be alleviated through money transfers to those who lost their means to earn a living. “Finally, the profound suffering and risk to health caused by loss of livelihoods should be minimised by making provisions for cash transfers by the state to workers in India’s vast informal economy who have lost their jobs, as is being done by some state governments,” the commission said.

The writers of the suggestions were 21 experts, including virologist Gagandeep Kang, Chairman of Narayana Hrudayalaya Limited in Bengaluru Devi Shetty, and Professor at Harvard’s TH Chan School of Public Health Vikram Patel.

The suggestions came as India reels under the second wave of the Covid-19 crisis. The country on Wednesday reported 2.08 lakh new cases in the last 24 hours, taking the overall tally past 2.71 crore since the pandemic first broke out in December 2019. The toll rose by 4,157 to 3,11,388, while the active caseload declined by over 91,000 to 24,95,591.

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