India's Covid fight needs transparency on data: 21 experts in Lancet

Kiran Mazumdar Shaw, Dr Devi Shetty other authors say 'one-size-fits-all approach' will not help in tackling another wave of infections.

A commentary on the website of medical journal 'Lancet' has recommended eight measures India needs to take to prevent a resurgence of Covid-19 infections. The commentary, authored by 21 experts, includes Biocon's Kiran Mazumdar Shaw, cardiac surgeon Dr Devi Shetty and microbiologist Gagandeep Kang.

The measures they suggested include decentralisation of essential health services, a transparent pricing policy and wider dissemination of clear and evidence-based information on the management of Covid-19, among others.

The eight points recommended by the experts:

1. The organisation of essential health services must be decentralised. A one-size-fits-all approach is untenable since the numbers of COVID-19 cases and health services differ substantially from district to district.

2. There must be a transparent national pricing policy and caps on the prices of all essential health services—eg, ambulances, oxygen, essential medicines, and hospital care. 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. All local governments must be allocated their grants as recommended by the Fifteenth Finance Commission8 to ensure they have the resources to augment COVID-19-related health services in their jurisdictions.

3. Clear, evidence-based information on the management of COVID-19 must be more widely disseminated and implemented. This information should include suitably adapted international guidelines9 for home care and treatment, primary care, and district hospital care in local languages that incorporate local circumstances and clinical practice. The guidance must also emphasise what not to do,10 and ensure that only evidence-based therapeutics are used.

4. 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.

5. Central systems to procure and distribute Covid-19 vaccines free of cost should be established in a departure from the current policy of decentralised procurement through state governments.15 Such an approach would optimise prices and minimise cross-state inequities that may result from differential fiscal and capacity contexts.

6. Community engagement and public participation must lie at the heart of India's COVID-19 response. Grassroots civil society has historically had a crucial role in people's participation in health care and other development activities, such as in strengthening the Covid-19 response in Mumbai.

7. There must be transparency in government data collection and modelling to enable districts to proactively prepare for the likely caseloads in the coming weeks. Health system personnel require data on age and sex disaggregated COVID-19 cases, hospitalisations, and mortality rates; community-level coverage of vaccination; and community-based tracking of the effectiveness of Covid-19 treatment protocols and long-term outcomes.

8. 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. Formal sector employers must be required to retain all workers, irrespective of the status of contracts, through a government commitment to offer compensation to these companies when the economy revives.