After facing waves of delta and omicron variants, the healthcare system in Tamil Nadu is slowly limping back to normalcy. But experts say without meaningful intervention immediately, it may take years for the state to undo the damage caused by the pandemic.
While the state is now seeing just a small number of fresh Covid-19 cases every day, doctors say Tamil Nadu is more likely to face systemic challenges with much more complex and chronic diseases. “Over the last two years, there were retractions in preventive checks, elective surgeries, and in several instances even emergency care leading to increased morbidity and mortality,” said director of public health Dr TS Selvavinayagam. A Lancet study, which he co-authored, showed how excess deaths in Chennai city dragged down life expectancy by nearly four years through the pandemic years. While there is no data on the effect of excess deaths on life expectancy in all the districts, the situation, according to Dr Selvavinayagam, is likely to be similar.
Experts say the state’s healthcare system will not collapse, but delayed diagnosis and treatment may become routine. This can result in increased complications, higher medical costs, and weak outcomes, principally for people with chronic ailments and the elderly – one of the key challenges the DMK government identified in the first few months of its governance.
Hence, it launched the ‘makkalai thedi maruthuvam’ and relaunched the ‘Varammun Kappom’, said health minister Ma Subramanian. The ‘Varammun Kappom’ scheme will take preventive screening to people through mobile camps in cities, semi-urban, hilly, and rural areas. The ‘makkalai thedi maruthuvam’ program will offer services, including delivery of medicines, dialysis, physiotherapy, and palliative care, at people’s doorsteps. “The aim is to reduce complications and deaths due to noncommunicable diseases at minimum out-of-pocket expenditure to people. We don’t want them to skip a day’s wage to reach hospitals and seek treatment or postpone treatment,” Subramanian said.
More than 60,000 people have received treatment at doorsteps and more than 1,000 medical camps have been held in less than a year. “It’s a good start but policymakers should not assume they are anywhere closer to the finish line,” said public health expert and National Health Systems Resource Center former director T Sundararaman. The state needs to focus and invest more in preventive primary health care if it wants to improve health indices, he said.
“But sadly, we see a cut in allocation for healthcare this year,” he added. H Allocations for the health department in the state budget for 2022-23 at Rs 17,901. 73 crore are lower by Rs1,000 crore compared to the revised budget for 202122. The finance department gave two reasons for the cut, including a steady fall in Covid-19 cases. It said the funds it allotted for establishing 11 new medical colleges in 2021 need not be put back in 2022. But the 6% cut in allocations worries many healthcare experts, who want more funds for primary healthcare centres.
During recent discussions on the healthcare needs of the state, members of the state planning commission recommended 70% of allocation towards primary and preventive care for communicable, non-communicable and reproductive health. Senior vascular surgeon Dr J Amalorpavanathan, who is one of the members of the planning commission, said the commission has recommended an extension of services at the primary care centres, where there are nearly 25,000 beds. “Besides maternal and child care, we should extend services for preventing and managing diseases such as diabetes and hypertension,” he said.
Giving muscle to primary health care is likely to improve health outcomes, besides keeping crowds out of tertiary care facilities. “If just needy people come to bigger centres, the quality of care and services will improve. Covid has taught us how to reserve beds in bigger hospitals for people who need that kind of care,” said director of medical education Dr R Narayanababu.
The health department has identified fixes for several weak joints in tertiary care – setting up a multi-specialty hospital in Guindy as there are no government hospitals in South Chennai, building a massive cancer hospital in Kancheepuram, and expanding the institute of mental health into an institute of mental health and neurosciences.
The wait, however, continues for the state’s healthcare policy. “It is important because it helps establish guidelines that benefit patients, healthcare organizations, and our healthcare system. Having protocols in place can help prevent human error and poor communication around medical decisions,” said Dr Sundararaman.
The state has started the process, said health secretary J Radhakrishnan. A group of experts are working to write a policy that will not just help healthcare providers and administrators but also deliver the best care to patients and gather evidence to inform future policies. On a broader level, it will help patients understand benefits and rights.
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