Zika in India

Communication is key during a public health threat like Zika and India has fallen short

Even if an isolated case is detected, the government needs to tell the public so as to prepare for the possibility of an outbreak.

In 2016, the National Center for Disease Control in India published a National Risk Communication Plan. The key guidelines prescribed disseminating information about uncertain health risks, including Zika, to the public before actual cases were diagnosed, in a timely and transparent manner that would engender public trust, through multiple media channels including social media, and constant sharing updates with journalists. These risk communication principles seem to have been rendered largely irrelevant when the government informed the World Health Organisation about three cases of Zika in Gujarat months after they were confirmed. More importantly, we do not know why the public was kept in the dark.

A union health ministry official’s statements that the situation is under control with no further cases reported seems to be due to three related reasons:

  1. The cases were isolated as opposed to an outbreak in which cases are linked to one another.
  2. Consequently, the level of Zika transmission was categorized as “low”.
  3. Given this, the government refrained from triggering public panic disproportionate to the level of threat.

To see how these arguments fare in a global context, however, it is worthwhile considering the case of Singapore.

Singapore’s smart strategy

In May 2016, an isolated, imported case of Zika was confirmed in Singapore. An imported case refers to a patient who gets infected outside of the country where it is diagnosed, as opposed to a locally transmitted case, which is usually considered a more urgent threat. Almost immediately Singapore’s health ministry and National Environmental Agency, institutions charged with the task of managing Zika, informed the public through traditional and social media channels.

Singapore’s first Zika case was soon cured. Nearly three months later, the country experienced a large Zika outbreak that swelled to nearly 380 cases within weeks. The agencies resumed their efforts with greater vigor using social media channels to connect with citizens one-on-one, allay fears and anxieties, and make them aware of specific strategies by which to protect themselves. The most compelling story was that of a Member of Parliament, who, while being pregnant herself, assuaged her constituents’ fears on Facebook, and visited them to hand out insect repellants and posters.

Not surprisingly, Singapore received a WHO commendation for efficiently tracking and containing the outbreak and demonstrating high levels of transparency in the process. Their story demonstrated the value of an efficient, transparent integrated public communication strategy during a Zika outbreak.

The communications from their Indian counterparts, in comparison ranged from non-existent to passive. For a government famed for its public relations machinery, it was indeed baffling to note that they issued no official press releases to the news media since the cases were confirmed.

Similarly, none among Prime Minister Narendra Modi who actively campaigns for Swachch Bharat, Union Health Minister JP Nadda, or the Ministry of Health and Family Welfare have provided any statement related to Zika on Twitter since news about the cases were released on the WHO website.

Gujarat’s Health Minister Shankar Chaudhary retweeted two tweets from his interview to a wire service.

As such, officials have only shared information when approached by the news media instead of reaching out to them as part of the government’s communication plan. Health Commissioner JP Gupta’s assertion that the situation has not yet reached crisis levels is reassuring, but it should also worry us if his words imply that the public only need to be informed if the situation worsens. It is also unclear if any concrete communication or outreach measures have yet been undertaken to address public concern and questioning triggered by the May 28 media reports.

Publicly available maps from the Integrated Disease Surveillance Programme website for the first three weeks in January 2017, when the Zika cases were confirmed, raise further questions about the motivations behind cases not being made public. These maps provide measles alerts in Jamnagar, Surat and Junagadh, and hepatitis B alerts in Vadodara, but make no mention of Zika. As documented by the United States National Research Council, governments sometimes choose to withhold disease information for various reasons including potential threats to tourism, economic costs to the private sector, and possible exposure to questioning by critics. Not surprisingly, public health scientists are now trying to use mobile and social media to directly crowdsource disease-related reports from the public globally.

Why tell the public?

These analyses beg the question: why is it important for the government to inform the public when the threat of disease appears to not be grave enough? The answer is that it is a necessary component of preparedness efforts that can influence efficient response to and swifter recovery from an outbreak if one does happen.

As seen in Singapore, an isolated case or cases does not negate the possibility of a bigger outbreak. To prepare the public for a future threat, the government should make its people aware of the level and nature of threat, and specific strategies they can use to protect themselves. In doing so, the authorities would do well to be ready to counter short-term public panic, given that outreach is bound to bear longer term benefits. Moreover, WHO experts and public health scientists have said that a Zika outbreak is inevitable in India, given that both dengue and chikungunya are endemic in the country and that all three infections are caused by the Aedes mosquito. Lastly, globally accepted risk communication practices suggest that greater transparency and a constant flow of information from the government to its people are vital to strengthen trust and reassure people during outbreaks like Zika. These factors might facilitate people’s adherence to health-related directives from the government if and when such a situation arises.

If the government’s responses listed in the WHO report are to be believed, “risk communication materials are being finalized by the Central Health Education Bureau, in consultation with UNICEF”. This tells us that the government has yet to finalise risk communication materials about Zika more than 16 months after it was declared a Public Health Emergency of International Concern and despite its imminent threat to the Indian public.

The government can claim to have not violated International Health Regulation requirements to report Zika cases to the WHO within 24 hours by arguing that an outbreak had not yet occurred. But when the municipal commissioner and mayor of the city where the cases reside have been left uninformed, and the public is caught off-guard, it is clear they have fallen short on grounds of public responsibility and transparency.

The writer is a senior research fellow in digital living at the Faculty of Health & Life Sciences, Northumbria University, UK and former journalist with The Indian Express. He specialises in health communication research with a focus on the role of digital technologies in preventing and managing infectious disease outbreaks like Zika.

Aravind Sesagiri Raamkumar, research associate at Nanyang Technological University, Singapore provided analytics assistance for this article.

We welcome your comments at letters@scroll.in.
Sponsored Content BY 

Putting the patient first - insights for hospitals to meet customer service expectations

These emerging solutions are a fine balance between technology and the human touch.

As customers become more vocal and assertive of their needs, their expectations are changing across industries. Consequently, customer service has gone from being a hygiene factor to actively influencing the customer’s choice of product or service. This trend is also being seen in the healthcare segment. Today good healthcare service is no longer defined by just qualified doctors and the quality of medical treatment offered. The overall ambience, convenience, hospitality and the warmth and friendliness of staff is becoming a crucial way for hospitals to differentiate themselves.

A study by the Deloitte Centre for Health Solutions in fact indicates that good patient experience is also excellent from a profitability point of view. The study, conducted in the US, analyzed the impact of hospital ratings by patients on overall margins and return on assets. It revealed that hospitals with high patient-reported experience scores have higher profitability. For instance, hospitals with ‘excellent’ consumer assessment scores between 2008 and 2014 had a net margin of 4.7 percent, on average, as compared to just 1.8 percent for hospitals with ‘low’ scores.

This clearly indicates that good customer service in hospitals boosts loyalty and goodwill as well as financial performance. Many healthcare service providers are thus putting their efforts behind: understanding constantly evolving customer expectations, solving long-standing problems in hospital management (such as long check-out times) and proactively offering a better experience by leveraging technology and human interface.

The evolving patient

Healthcare service customers, who comprise both the patient and his or her family and friends, are more exposed today to high standards of service across industries. As a result, hospitals are putting patient care right on top of their priorities. An example of this in action can be seen in the Sir Ganga Ram Hospital. In July 2015, the hospital launched a ‘Smart OPD’ system — an integrated mobile health system under which the entire medical ecosystem of the hospital was brought together on a digital app. Patients could use the app to book/reschedule doctor’s appointments and doctors could use it to access a patient’s medical history, write prescriptions and schedule appointments. To further aid the process, IT assistants were provided to help those uncomfortable with technology.

The need for such initiatives and the evolving nature of patient care were among the central themes of the recently concluded Abbott Hospital Leadership Summit. The speakers included pundits from marketing and customer relations along with leaders in the healthcare space.

Among them was the illustrious speaker Larry Hochman, a globally recognised name in customer service. According to Mr. Hochman, who has worked with British Airways and Air Miles, patients are rapidly evolving from passive recipients of treatment to active consumers who are evaluating their overall experience with a hospital on social media and creating a ‘word-of-mouth’ economy. He talks about this in the video below.

Play

As the video says, with social media and other public platforms being available today to share experiences, hospitals need to ensure that every customer walks away with a good experience.

The promise gap

In his address, Mr. Hochman also spoke at length about the ‘promise gap’ — the difference between what a company promises to deliver and what it actually delivers. In the video given below, he explains the concept in detail. As the gap grows wider, the potential for customer dissatisfaction increases.

Play

So how do hospitals differentiate themselves with this evolved set of customers? How do they ensure that the promise gap remains small? “You can create a unique value only through relationships, because that is something that is not manufactured. It is about people, it’s a human thing,” says Mr. Hochman in the video below.

Play

As Mr. Hochman and others in the discussion panel point out, the key to delivering a good customer experience is to instil a culture of empathy and hospitality across the organisation. Whether it is small things like smiling at patients, educating them at every step about their illness or listening to them to understand their fears, every action needs to be geared towards making the customer feel that they made the correct decision by getting treated at that hospital. This is also why, Dr. Nandkumar Jairam, Chairman and Group Medical Director, Columbia Asia, talked about the need for hospitals to train and hire people with soft skills and qualities such as empathy and the ability to listen.

Striking the balance

Bridging the promise gap also involves a balance between technology and the human touch. Dr. Robert Pearl, Executive Director and CEO of The Permanente Medical Group, who also spoke at the event, wrote about the example of Dr. Devi Shetty’s Narayana Health Hospitals. He writes that their team of surgeons typically performs about 900 procedures a month which is equivalent to what most U.S. university hospitals do in a year. The hospitals employ cutting edge technology and other simple innovations to improve efficiency and patient care.

The insights gained from Narayana’s model show that while technology increases efficiency of processes, what really makes a difference to customers are the human touch-points. As Mr. Hochman says, “Human touch points matter more because there are less and less of them today and are therefore crucial to the whole customer experience.”

Play

By putting customers at the core of their thinking, many hospitals have been able to apply innovative solutions to solve age old problems. For example, Max Healthcare, introduced paramedics on motorcycles to circumvent heavy traffic and respond faster to critical emergencies. While ambulances reach 30 minutes after a call, the motorcycles reach in just 17 minutes. In the first three months, two lives were saved because of this customer-centric innovation.

Hospitals are also looking at data and consumer research to identify consumer pain points. Rajit Mehta, the MD and CEO of Max Healthcare Institute, who was a panelist at the summit, spoke of the importance of data to understand patient needs. His organisation used consumer research to identify three critical areas that needed work - discharge and admission processes for IPD patients and wait-time for OPD patients. To improve wait-time, they incentivised people to book appointments online. They also installed digital kiosks where customers could punch in their details to get an appointment quickly.

These were just some of the insights on healthcare management gleaned from the Hospital Leadership Summit hosted by Abbott. In over 150 countries, Abbott is working with hospitals and healthcare professionals to improve the quality of health services.

To read more content on best practices for hospital leaders, visit Abbott’s Bringing Health to Life portal here.

This article was produced on behalf of Abbott by the Scroll.in marketing team and not by the Scroll.in editorial staff.