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Metropolitan areas drive economies, yet the same elements that contribute to economic growth, such as industrialization accompanied by migrant influx, result in overcrowding and poor housing and sanitation. These factors, coupled with intensive international connectivity, make cities extremely vulnerable to pandemics. Experiences from New York and Sno Paulo show that complex administrative structures; conflicting messages from federal, state, and city governments; human resource shortages; supply chain mismanagement; weak coordination between hospitals and public health systems; and poor linkages with the private sector are all limiting factors of a comprehensive pandemic response. COVID-19 has seriously impacted the delivery of essential health services, especially in cities, where the private sector and public hospitals deliver a significant share of primary care. COVID-19 also presents a major public mental health challenge both for health professionals and the public.
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The COVID-19 pandemic has ravaged the global economy, either reversing or slowing ongoing efforts to eliminate extreme poverty in many countries. Despite recent progress, including increased recoveries and lower death rates, India is ranked third globally in absolute numbers of COVID-19 reported cases. India's chronic underinvestment in health, coupled with a hard-hit economic sector, has further entrenched segments of India's population in vulnerability and poverty. The exodus of millions of migrants from the cities has contributed to the spread of infection from urban to rural areas, where health systems are weaker. As economic activities are revived following a period of lockdowns, policy makers must make smart choices that prevent and rein in the spread of COVID-19. In the absence of effective treatment and a vaccine, preventive measures combined with testing and tracing, followed by quarantine and isolation and supportive treatment, are critical to minimize the spread of COVID-19 and rejuvenate livelihoods to restore India's economy. In this paper, authors bring together promising testing and tracing lessons and approaches from India and globally, based on a desk review of various initiatives and analyses of secondary data. Key lessons and findings are that: (i) testing and tracing is central to an effective COVID-19 response; (ii) a robust response to an unprecedented pandemic requires creative approaches, such as active case finding, pooled testing, testing environmental samples, triangulation of microdata, effective contact tracing, and partnering with the private sector; (iii) optimizing COVID-19 testing capacity should not negatively impact ongoing disease control programs; (iv) containment of COVID-19 should go hand-in-hand with preparation for future pandemics. We also summarize innovations and bottlenecks to rapidly scale up testing capacities at the state level, including strategies for optimizing the role of the private sector and introducing new technologies to enhance access to testing in rural populations. This paper offers options especially relevant to Indian policy makers, with a focus on sustained health systems strengthening.
Coronavirus --- COVID-19 --- Disease Control and Prevention --- Health Monitoring and Evaluation --- Health, Nutrition and Population --- Public Health Promotion
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