Published : 3. June 2020 13:52:19
Written by Vryshali Shekhar and Puja Chaldea
India is in a sanitary mine waiting for an explosion, and this crisis has nothing to do with KOVID-19. Factors such as a national blockade and the diversion of resources to reduce VIDOC-19 have led to significant disruption in the provision of essential non-VIDOC-19 related health services, which are essential for sustainable progress on health indicators in India.
In March alone, there was an alarming decline in maternal health care: There were decreases of 16.2 percent and 7.7 percent in home and institutional deliveries, respectively; decreases of 7.5 percent and 34.3 percent in childhood vaccinations with BCG and DIC; and decreases of 64 percent and 51.8 percent in outpatient treatment of major non-communicable diseases such as cancer and cardiovascular disease. If they are not controlled, they will inevitably have long-term consequences for the mortality and morbidity of people who are not VIDOC carriers.
While supply-side constraints, such as inadequate health services, overstretched human resources for health and insufficient funding, weigh on the overstretched health system, we cannot ignore the behavioural patterns of individuals and communities that influence their demand for health. Perceptions of fear and threat, social norms, choice and cognitive overload, and lack of resources are some of the heuristics that play a key role in a public health emergency, such as COVID-19.
Behavioral sciences perspectives
One of the central emotional reactions during a pandemic is fear. The negative emotions generated by a threat can be contagious, and fear can make threats even more direct. Negative emotions are amplified by misinformation and rumors in social networks, which make the number of deaths scandalous rather than the speed of recovery. Fear of physical contact also replaces the traditional handshake in Namaste as a new social norm in Western countries. Adapting the herd’s behaviour to the barn for fear of transmission can also overshadow individual needs and the demand for medical care, such as postponing vaccinations.
It is estimated that 5 million children have not been vaccinated since the pandemic in India. This trend is worrying in India, where the two main causes of infant mortality are linked to preventable diseases such as pneumonia and diarrhoea, underlining the need to prevent and manage children’s health.
The problem of the overwhelming diversity of choices is becoming an urgent one today as people are forced to use their limited cognitive resources to process information about the pandemic. Pregnant and breastfeeding women are psychologically burdened by the practice of multiple births and trainings. Blurring intellectual space with information on COVID-19 could be a barrier in the short term, disguising the limited focus on emergency management rather than on preventive medical practices. The study estimates that in low and middle-income countries maternal health coverage declined by 10 percent during VIDOC-19, resulting in an alarming additional 28,000 maternal deaths and 168,000 newborns. MRI, which is performed in India with 122 per 100,000 live births, should focus on ensuring continued demand for prevention services for mothers.
Poverty is another common cause of cognitive overload. The blockade has led to the loss of livelihoods of India’s disproportionately large informal labour force. People facing economic hardship and scarcity find that the struggle for survival demands their attention and often leads to unhealthy behaviour and exacerbates health inequalities. For example, the health crisis is likely to exacerbate the malnutrition of the most vulnerable groups, i.e. women and children. The disruption of the food supply chain and inadequate food safety measures explain the supply side of the food crisis.
However, the struggle to survive with limited resources has an income and substitution effect on cheap calories rather than nutritious food. Moreover, in these times of economic desperation, the consumption of food supplements for women and fortified foods with micronutrients for children can be forgotten. In addition, mothers may be concerned about the transmission of the coronavirus to their babies through breast milk, which is an essential element in the fight against malnutrition. This is important in India, where 69 percent of children under five die of malnutrition and one in two women suffers from anaemia.
Border guards can be trained to give advice using digital media
Putting theory into practice
Policy makers should focus on developing solutions that help people achieve their long-term health and well-being goals.
Policies should aim to minimise efforts and barriers while making healthy behavioural choices. During pandemics, when people are less inclined to make active health choices, it is important to make their standard version simple and healthy. Attention should focus on the use of a choice architecture that takes advantage of people’s tendency to cling to a decision they have already made, especially a trusted resource such as a therapist. For example, supporting a strategy to inform the physician when immunisation is proposed as standard and structuring the discussion on immunisation as a refusal to participate rather than a consent to participate can help to minimise parents’ autonomy over the child’s health.
It is also essential to reduce the administrative burden and facilitate access to health services. On the other hand, the pandemic has led to an alarming upward trend in mental ill health and suicides. Creating frictional costs by making it difficult to obtain large quantities of over-the-counter drugs can effectively reduce overdose and suicide rates.
Following the coronavirus outbreak, the Ministry of Health and Family Welfare and NITI Aayog published a guide to promote non-contact telemedicine in India. Odisha was the first company to offer free teleconsultation to reduce healthcare congestion, break down barriers of low availability and minimize the impact of virus transmission. For example, the practice of social remoteness can be difficult for pregnant women, as most weekly and monthly prenatal visits during pregnancy are necessary and severe coronavirus symptoms may be experienced due to a state of relative immunosuppression compared to their non-pregnant counterparts. The use of telemedicine is a good way to reduce the impact of telemedicine in prenatal care.
In addition, qualified staff can be trained to give advice using digital media. One example of this is distributing WhatsApp videos about critical health behaviors that they can share or show to members of the community.
Finally, among the noise caused by COVID, we have to find some voices in other critical health situations. We need to look at how we can increase the risk of other diseases (for example, by pointing out that the chance of a child dying of measles without an MMR vaccine is much higher than with VIDC-19). We also need to think about how to take advantage of the risks and behaviours revealed by the current pandemic, such as germ cell theory, wearing masks and washing hands, and how to use them to improve behaviour and results for other diseases.
The need of the hour is to ensure that an episodic pandemic does not prevent the goal of health for all from being achieved. Future painful options for action should focus on integrating behavioural perceptions into the mainstream of healthcare and policy, while addressing the VIDOC pandemic.
Shekhar advises the World Bank on social protection, health and nutrition. Voia Chaldeya, Senior Advisor, Centre for Social and Behavioral Change, Ashoka University. The ideas expressed there are their own.
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