After launching Himalayan Watch, a digital forum for researching and communicating ecological affairs of the mountain state, SDC Foundation organized the inaugural edition of SDC Dialogs. It is an in-house initiative to mainstream the social and environmental affairs of the Indian Himalayan Region.

SDC dialogs is a series of webinar organized with domain experts and citizens on issues specific to mountain states.  The first edition was organized on 13 August 2020. The topic of discussion was “Discussing the State of Public Health Systems in Mountains”.

Dr. Ajit Gairola, Former Director, National Health Mission – Uttarakhand; Dr. Garima Pant, Senior Medical Officer, Sub-District Hospital, Mussoorie; and Anand Sankar, Kalap Trust joined in as panelists. The discussion was moderated by Rishabh Shrivastava, Lead – Public Policy and Communications, SDC Foundation.

Uttarakhand’s health performance has been in an abysmal state. Niti Aayog’s Health Index for 2018 reported Uttarakhand to be at 15th place but in 2019’s index it dropped to 17th place. The report also commented on the Himalayan state’s poor performance on critical health indicators like infant mortality rate, neonatal mortality rate and sex ratio. The report also mentioned that state lacked specialists in district hospitals and there are no doctors in primary health centers.

With COVID-19 pandemic claiming more than 48000 lives nationally, Jammu & Kashmir remains the most infected Himalayan state (close to 27000 cases) followed by Uttarakhand ( 11302 cases). Himachal Pradesh (3816 cases) continues to be witness a gradual growth in cases and fares better then J&K and Uttarakhand. Meghalaya, Sikkim and Mizoram continue to be three least infected states in India.

(Webinar was hosted by SDC Foundation on 13 August 2020. Design by: Radhika Sinha)

Having set all of this as background, panelists were asked to give their opening remarks and engage in the discussion.

“COVID-19 came as a novel public health crisis and we had no answer to it. We failed to do early testing and quarantining of people who started returning to state after the lockdown, which increased the number of total cases in the hill state. To move ahead, implementing a robust containment strategy is the only way forward”, said Dr. Ajit Gairola. He also added, ” National Health Mission has been a success but it still needs to work on a few fronts. Manpower remains a critical issue for the Himalayan states, which still needs to be addressed and that is something on which we are working,” said Dr. Gairola.

Dr. Garima Pant, being a frontline health worker shared, “I would like to appreciate the way state government responded to the COVID-19 crisis. The initial guidelines formulated by the central and state governments helped in streamlining the testing and treatment protocols for us at the district hospitals. Though these guidelines have kept on changing but it has helped many frontline staff in attending COVID-19 cases”.

Dr. Garima also commented on the state of public health in the mountains and said, “resources and infrastructure in Uttarakhand have surely been upgraded by the state government. District hospitals are better equipped today, they have been renovated and made modernized. Things are improving gradually”. She also added, “But we should not promote privatization in the Himalayan state. It has been a complete failure for Uttarakhand. PPP model is not workable”.

She also said that we need to start adequately incentivizing the medical personnel posted in rural areas or promoting young medical professionals to take up some services in the upper and rural reaches of the mountains. This will ensure adequate availability of skilled and trained manpower.

Dr. Gairola said, ” we should not be promoting PPP model in Uttarakhand. It is simply not workable and viable. We should build our own capacities and infrastructure. We should train our own people in managing and operating these resources. Private players are coming here, using our resources and we are the only ones paying them.”

Anand founded Kalap Trust in 2014 and has been working in the Mori block in the upper reaches of Uttarakhand with around 40 villages. Kalap Trust has been providing free of cost health services to locals. He said, “Uttarakhand and other Himalayan regions have been facing problems with regard to implementation of even the basic services like roads, electricity and water. We have tried to make people volunteer for medical camps but the unavailability of basic services like the internet and electricity is a major barrier. Connectivity can play a major role in public health for the Himalayan regions”.

Anand also said, “COVID-19 has been handled with a policing approach. There’s no handling of it as an epidemic or pubic health crisis. That makes a big difference”. He further added, “we need to have a manual on how to respond during the crisis which is different from policing approach”.

On making local communities equal stakeholders in the public health process he said that lack of awareness and communication has kept local communities out of the entire process. We need to ramp up our awareness and communication techniques to make local communities as equal stakeholders in the public health systems.

The webinar was facilitated by Anoop Nautiuyal, Gautam Kumar, Aadarsh Anand and Vidush Pandey.

(By: SDC Team)

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