India

Ensuring essential health services during COVID-19 in the State of Chhattisgarh, India

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Frontline health workers in Bijapur testing for Malaria by door-to-door house visits during the third phase of the Malaria Mukt Bastar Campaign. © WHO/Dr Varun Kakde

In the Mangalnar village in Bijapur district, Rajeshwari and Gopi conceived a child after ten years of waiting. In early April, during a strict lockdown to combat COVID-19, Rajeshwari went into premature labour at 24 weeks pregnant.

Thanks to the district’s referral network, she was promptly moved to the nearest community health centre and delivered her baby safely. However, with a birth weight of a meagre 510 grams, the tiny baby’s fight for survival had just begun. After nearly three months of care in a sick newborn care unit at a district hospital and tele-mentoring from experts at the Apex health care institute of the All India Institute of Medical Sciences in Raipur, she became the youngest preterm baby to survive in the region.

“Because of our bitter past we had almost given up hope, but thanks to the tireless efforts of the doctors and nurses, our daughter has miraculously survived,” said Rajeshwari.

Maintaining essential services during COVID-19

Bastar region, located in the southern part of Chhattisgarh in central India, is one of the most difficult to reach areas in the country. The region has some of the poorest health indicators in India, lagging behind national averages.

As part of its support to the state government of Chhattisgarh, WHO is providing technical expertise to three districts in the Bastar region to support and reinforce the Health and Wellness Centre programme. This is part of WHO’s assistance, through the UHC Partnership, which works in 115 countries and areas to help governments accelerate progress towards UHC through funding provided by the European Union (EU), the Grand Duchy of Luxembourg, Irish Aid, the Government of Japan, the French Ministry for Europe and Foreign Affairs, the United Kingdom – Foreign, Commonwealth & Development Office and Belgium.

In these districts up to 70% of women age 15-49 and children under five are anemic. The burden of noncommunicable diseases (NCDs) is steadily rising with up to 8% of men and 7% of women age 15-49 years showing early symptoms of hypertension and diabetes.

Health and Wellness Centres at the primary health care (PHC) level provide a good platform for the expansion of services to prevent and manage these conditions. Since early 2019, with technical support from WHO India, about 50% of existing sub health centres in all three districts have been upgraded to Health and Wellness Centres. This network of recently strengthened facilities are pivotal in providing uninterrupted essential health services during the COVID-19 pandemic.

Collaborative efforts, coupled with the urgency created by the COVID-19 pandemic, helped make primary health care available in the most far-flung areas and to the most vulnerable communities. Service delivery at many sub health centres have been revived and strengthened after remaining non-functional for nearly two decades.

Reorganization of services in response to COVID-19

The recent expansion of services in the form of Health and Wellness Centres and mentoring support from WHO has enabled a much-needed reorganization of health services. Armed with training on active surveillance and infection prevention and control protocols from WHO, auxiliary nurse midwives, with help from community health volunteers, increased the frequency of home visits for surveillance of COVID-19 and other health needs.

With support from WHO, a health call centre was established in Dantewada to ensure essential health services, and separate fever clinics were established at all secondary and tertiary levels of health facilities in three districts. This helped safeguard health workers from exposure to COVID-19. As a result of efforts to minimize the impact of the pandemic on essential health services, the number of antenatal care registrations in Bijapur, Dantewada and Sukma substantially increased from 1,496 in March 2020 to 2,238 in May 2020.

Reaching the most marginalized with essential health services

While COVID-19 has inevitably presented new challenges to the people and the health system of Chhattisgarh State, it has galvanized solid local action to reinstate and strengthen primary health care services, building the foundation for UHC. The Government, with technical support and training from WHO, has worked hard to ensure that the whole population, even those in the hardest to reach places, are not left behind.