Managing the next pandemic: Lessons for policy makers from COVID-19.

Managing a pandemic offers lessons for preparing for similar episodes in future. The importance of surveillance in One World-One Health mode and the need to share information expeditiously to mobilize national and international resources has been evident. Pandemics cause disruption to normal social and economic activity, which would be tolerated better if there is trust in authorities. Governments need to guard against over centralization in a health crisis as it discourages community involvement and willing compliance with pandemic-related restrictions. Health emergencies can be managed effectively if health systems have been strengthened during normal times. Financial flexibility needs to be built into the public financial management systems to fund the unanticipated expenditure. The pandemic has underscored the global interdependence and the need to have systems for a global response to health emergencies. Health systems have to be reengineered to better deal with future pandemics.

Field-testing of primary health-care indicators, India.

OBJECTIVE: To develop a primary health-care monitoring framework and health outcome indicator list, and field-test and triangulate indicators designed to assess health reforms in Kerala, India, 2018-2019. METHODS: We used a modified Delphi technique to develop a 23-item indicator list to monitor primary health care. We used a multistage cluster random sampling technique to select one district from each of four district clusters, and then select both a family and a primary health centre from each of the four districts. We field-tested and triangulated the indicators using facility data and a population-based household survey. FINDINGS: Our data revealed similarities between facility and survey data for some indicators (e.g. low birth weight and pre-check services), but differences for others (e.g. acute diarrhoeal diseases in children younger than 5 years and blood pressure screening). We made four critical observations: (i) data are available at the facility level but in varying formats; (ii) established global indicators may not always be useful in local monitoring; (iii) operational definitions must be refined; and (iv) triangulation and feedback from the field is vital. CONCLUSION: We observe that, while data can be used to develop indices of progress, interpretation of these indicators requires great care. In the attainment of universal health coverage, we consider that our observations of the utility of certain health indicators will provide valuable insights for practitioners and supervisors in the development of a primary health-care monitoring mechanism.

Kerala's response to COVID-19.

The response of Kerala state to COVID-19, led by the health department, was nested in larger social mobilization. Kerala has developed a strong government health system. Learning from managing the Nipah outbreaks, Kerala took effective prevention measures early. Local governments, actively involved in public health in Kerala, played an active role in controlling the epidemic and in cushioning the impact on the poor. Transparency in information and willingness of the government to take the people into confidence has contributed to enhancing trust in the government. These strengths will stand Kerala in good stead as it prepares to manage the next wave of COVID-19 infections.