Shortage of infrastructure has posed a major problem for healthcare in India in the face of corona virus pandemic. It has disrupted the normal health services delivery system forcing hospitals and doctors to improvise emergency plans daily, even as they remain uncertain how bad the crisis will get.The challenge is medical and financial — but also political.So far, India looks pretty mild compared to the rest of the world. However, the strain on healthcare providers is clearly visible. How long overworked medical staff- doctors, nurses, and other paramedical- will be able to perform?
Despite acute shortage of doctors and nurses India is tackling Coronavirus epidemic better than many advanced countries. An analysis of medical infrastructure and other data show that country has an estimated 0.7 hospital beds per 1,000 people – a ratio that is one of the lowest in Asia. India has 1.7 nurses per 1,000 population, 43% less than the World Health Organisation norm (3 per 1,000). India has fewer hospital beds and doctors per 1,000 people than prescribed norms.
This shortage is acute in states like Bihar, Orissa, Madhya Pradesh and Rajasthan due to uneven rural-urban distribution. To fight the expanding outbreak, the country is relying on a medical system that is overburdened even in normal times.
The arrival of a pandemic: Though India has experience of tackling epidemic like smallpox, SARS virus, Dengu fever, Malaria but this one is different. All the previous ones were confined to certain geographical areas and the cure was known.
Certain steps do not solve problems. Invoking Essential Services Management Act (ESMA) against nurses for complaining about inadequate supply of masks and personal protective equipment(PPE) is not a solution. Doctors and health workers testing positive of Covid 19 and patients misbehaving with nurses, female doctors and medical staff and above all violent attacks on health workers during field survey as witnessed in Indore (Madhya Pradesh) are concerns. These incidents call for an efficient HR management for safety and well-being of healthcare providers.
The healthcare providers need answers how to face the problems. During crisis the HR teams are called upon to redeploy employees, either temporarily or permanently, set expectations for communication and response times, and define clear roles for each member of these teams. Any outbreak strikes directly at the most valuable asset — employees — and could last for months, so at the very least, an impact analysis becomes essential. It needs pinpoint functions impacted directly by “surge” activities that increase during an outbreak. For this building operational resilience by bolstering bench strength in critical areas is crucial.
Impact on the health-care system: Nurses and doctors may be able to work extended shifts for a week or two, but prolonged duties can reduce their performance. Some ICU patients may be moved to other units, and some medical or surgical procedures could be postponed. But most cases that require ICU care, such as strokes and heart attacks, would not wait. A practical protocol offering a real solution to the problems of providing care to all to face a pandemic has to be planned. The health-care system will experience critical shortages of pharmaceuticals of all types to treat secondary infections and complications. The workers have to be told to choose the priorities as per exigencies. As the number of cases rise and healthcare system staggers, healthcare service providers are worried about short supply of PPE or safety against misbehaving patients. They are worried about the potential work disruptions to their own work more than their physical safety. Periodic training workshops should be held to keep them prepared for using personal protective equipment and availability of prophylactic medications. Health-care workers want to be heard before they are in the midst of a crisis.
Appropriate communication: Communication is essential when preparing for avirus pandemic and any other public health disaster.The HR department needs to roll out appropriate communication about the Dos and Don’ts of Coronavirus. During a pandemic, actions taken willingly by the hospital staff in response to accurate, scientific information will reduce contagion and suffering. They should be also facilitated to communicate with their family members.
Emotional support: During epidemic, hospital staff is tensed. Quoting rules and instilling fearing will not yield desired results. The HR need to empower the staff rather than criticise, judge and deplete them further. They have to be motivated to adapt. The top priority for HRin healthcare during a pandemic is to put ‘employees’ first and care about their needs. The support staff in hospitals such as house-keeping, ward attendants, paramedical may not be able to provide advanced treatment support, but their role in identification of cases, contact tracing, quarantine and isolation monitoring, and referrals would prove significant. Their preparedness would depend on their training. India’s healthcare system is inadequate to provide quality infrastructure and manpower to millions of its citizens is well known. What the COVID-19 pandemic has done is to bring a sense of urgency to fix it.What we need is true reform of our healthcareservices. This is a long-term project that extends wellbeyond the lifetime of the present Corona pandemic.
(The author is a Senior H.R. Executive, with Narayana Health Group India, Bengaluru. Email: akshayw@hotmail.com)
Akshay Gathia