Shift Focus From Hospitals To Primary Care

Depending on tertiary hospitals to manage a pandemic burdens the public health system. Primary care network must be improved

- Pavitra Mohan/Nachiket Mor

The detection, isolation and management of coronavirus-infected people in India has so far been largely dependent on hospitals. This must change, given the evidence that is coming across.

Bergamo is a small town in Italy. which became the epicentre of the epidemic. Based on their own experience, doctors in Bergamo caution against the hospital-based approach to fight the epidemic. There is fear that hospitals may be the main COVID-19 carriers, as they are rapidly populated by infected patients, facilitating transmission to others.

Western healthcare systems have been built around the concept of patient-centred care, but an epidemic requires a change of perspective toward a concept of community-focused care. There is an urgent need for India to heed and act on this advice coming from Italy.

Risk of infection

In India, to test for the coronavirus, people either come to laboratories located in tertiary hospitals or they visit district hospitals, where samples are collected and transported to the laboratory. In both cases, the person has to travel large distances, and risks exposure to infection during transit and in the hospital. If infected, there is a high chance of the person contributing to the risk of transmission among lay public and healthcare providers. The only exceptions are some accredited private hospitals, who for a fee, offer to collect the samples at households. Even for isolation, many States rely on specially designated areas or wards within tertiary hospitals, or create new large hospitals or isolation centres.