Intersectoral Collaboration and Health Services during COVID19: A multi-stage, multi-level mixed-methods study in Ahmedabad, India
Final Report Abstract
Background: Public health emergencies affect the supply and demand of health services. The imbalance between demand and supply can be due to reduced access, increased need for emergency care, changes in the health workforce and interruptions in essential health product supply chains. Recent public health emergencies also highlighted a significant impact on the quality of health services during crises. The previous experiences during the SARS and NIPAH outbreaks indicate that effective intersectoral collaboration, both between the human and animal and the public and private health sector, is essential to deal with zoonotic disease outbreaks. Multi-sectoral action could help in the uninterrupted supply of essential services during the crisis. The Covid-19 pandemic continued to pose severe challenges to global health beyond the impact of the disease itself. Countries allover the world experienced disruptions in all health-care settings, especially access at the primary care and community care levels. Especially the prevention of maternal and newborn deaths, known to be one of the most sensitive indicators for the overall function of health care services, was affected. Objectives: The CoV intersect project aimed to document and analyse how multi-sectoral collaborations played a role in maintaining routine health services during the Covid-19 pandemic in the local health system in a Western city of India, Ahmedabad, taking maternal and newborn health care as an example. Methods: The embedded mixed-method study involved both qualitative and quantitative designs. The study explored all three levels of the health system i.e. community, clinical and administrative settings. About 278 women were surveyed to document their access to health care before, during and after delivery during the pandemic; 150 community health workers (CHW) were also surveyed for the health service delivery parameters. In-depth interviews were carried out among administrative officials of the health department and other departments, medical officers of primary health centres of Ahmedabad, private practitioners of Ahmedabad, veterinary doctors, mothers, and community health workers. Results: There is a significant difference between pregnant women who tested positive for SARS-CoV-2 and those who did not during their pregnancy regarding access to Ante-Natal Care (ANC), Intra-Natal Care (INC), Post-Natal Care (PNC) and child care services. CHW reported a complete disruption of services during the first wave, which was reduced in the consequent waves. Medical officers and administrative staff noticed different levels of intersectoral collaborations between departments like the education department, fire safety department, police department, estate department and many others. On a larger scale, various convenience and need-based measures were undertaken by the Ahmedabad Municipal Corporation (AMC) in collaboration with other departments to manage the pandemic. There was a shortage of beds, oxygen and essential medications. The private hospitals managed the crisis with the help of their acquittances and Non-Government Organizations (NGOs). Some private hospitals signed a Memorandum of Understanding (MoU) with the AMC to function as Covid care centres and got support in procuring oxygen and necessary medicines. Animal health was not much of a focus during the pandemic. Pet parents faced fear of disese for and from their pe animals and difficulties in accessing veterinary clinics during the lockdowns. Conclusion and recommendation: Some interruptions in health care could be more effectively reduced through a robust and dedicated collaboration, between levels and sectors, especially the public and the private health sector and between different public sectors during emergencies.
