Public Health Emergency Response Strategies to Covid-19 are Yielding Results in Uttar Pradesh
NewDelhi: With the sudden covid-19 spike experienced in Uttar Pradesh and India at large, the immediacy for all involved was to stabilise the situation as quickly as possible and stop it from getting worse. Uttar Pradesh adopted multi-pronged strategy to effectively fight the pandemic, and bring relief to the people. The steps included streamlining oxygen distribution, active case finding in rural areas, and health systems strengthening.
Oxygen, being one of the most critical elements for clinical treatment, had to be managed at a war footing. For this, the focus was on the most important metric – location of assets and managing the movement of assets to carry as much oxygen as possible, with an underlying focus on optimisation.
The State Government activated the teams all over UP and other sourcing states like Jharkhand, West Bengal & Odisha to intercept the trucks carrying oxygen cylinders, deployed an Application that was downloaded on smart phones- which were then placed in each of the trucks plying, without disturbing their ongoing route. Simple SOP was to be followed- to track their live location. This was called the stealth approach – speed and scale beats optimal and perfect anytime, in a war-like situation. Key macro-decisions undertaken were to deploy the rail network to bring oxygen supplies from the eastern states to UP and airlift the empty cylinders with the help of the Air Force, using airports like Agra, Hindon & Lucknow back for re-filling.
The information from App was fed into a live dashboard, which was able to display all the trucks carrying Oxygen & helped the decision makers to address the allocation gap smartly and swiftly and stabilise the oxygen supply. Real time information on tankers and their movement, being the most critical element of the O2 supply chain, was displayed using the dashboard to decision makers. The dashboard called “OxyTracker” was used to visually flag the efficiency of the entire fleet with one sweep of the eye. Key elements displayed about tankers
include: “running”, “idle”, “transit empty or full”, “ETA to destination”, “driver name” and “number” and “quantity” being carried, “tankers travelling by plane, train or road”.5 major hubs were created in UP – Modinagar, Agra, Kanpur, Lucknow and Varanasi as the primary and then Bareilly and Gorakhpur as the secondary hubs for optimising the entire supply chain. These hubs fed the regions around them, within the cycle time limit of 10 hr max. It ensured that all the tankers arriving within these hubs have to be shipped within these regional centres and distribute the oxygen at designated places and reach the airports – within 10 hrs. Each of these hubs have the airports & these airports were used to bring the tankers back to shipping points –places where UP has been allocated the gas quota – Jamnagar, Jamshedpur, Bokaro, Durgapur, Haldia and few other centres in West Bengal. All the shipping centres are within the earshot of the airports too. The airlifts saved 40% in cycle team.
Once the empty tankers are back in batch of two, get them filled as soon as possible, put them quickly on rail yard for loading and hopping, in a batch of 4. Ship the train with rakes with 4 tankers on it. Each train to carry at least 80 MT to dedicated hub point. Once the train leaves, based on from where, one will start receiving trains at one of the hubs within 16-22 hrs range, based on shipping point and the hub. Once the hub receives the tankers, run them on set routes within the zone to keep the cycle time within 10 hrs to provide ample time for the Airforce to manage the queue. Airforce needed to operate 16 flights per day between hubs and shipping centre’s details.
The approach helped the UP Government to lift almost 1000MT in about 10 days from the time. Earlier, UP was lifting and distributing
250MT. Other factors that contributed heavily towards the outcomes included Responsive leadership; Speed of decision making; Cross functional teams collaborating with nimbleness and agility; SOPs being developed and deployed very quickly in the field; Operationalizing – people, process and technology triad; and Decoding “Massive Supply Chain” complexity metrics.
In order to build Oxygen Generation Capacity, Government of India has sanctioned 14 PSA plants for 14 institutions, of which 5 plants have already been installed and remaining 9 are under implementation. State Government has issued Purchase Orders for 4 PSA plants. These are in addition to the existing working oxygen generation plants in 13 districts. Further, the State Government is constantly engaging with the Government of India for identification of sites for establishment of additional PSA plants under PM CARE, and a list of 167 additional sites has been shared with Government of India. UP used this exercise to develop a blueprint for public health emergency plans that can be used for effective, efficient & timely delivery of oxygen & life-saving drugs or supplies, in the face of future COVID-19 waves or a public health crisis.
ACTIVE CASE FINDING IN RURAL AREAS
The World Health Organization has lauded the efforts of the Uttar Pradesh government, for “going to the last mile” during the current Covid-19 crisis. It tweeted “The Uttar Pradesh state government has initiated house-to-house active case finding of COVID-19 in rural areas to contain transmission by testing people with symptoms for rapid isolation, disease management and contact tracing.”
In Uttar Pradesh, Government teams have been moving across thousands of villages over several days. Each monitoring team has two members, who visit homes in villages and remote hamlets to test everyone with symptoms of COVID-19 using Rapid Antigen Tests (RAT) kits. Those who test positive are quickly isolated and given a medicine kit, with advice on disease management. All the contacts of those who test positive are quarantined and tested using an RT-PCR at home by a rapid response team. Two mobile vans have been allocated to each Block within a District in the state to test people with symptoms, even as routine sample collection and testing continues in Community Health Centres. The state government has deployed 141,610 teams and 21,242 supervisors from the state health department for this activity to ensure all rural areas are covered.
Those with symptoms are tested and given medicine kits and information on quarantining and isolation, both at home and in hospitals. People without signs of COVID-19 are urged to get vaccinated and follow COVID-appropriate behaviours to prevent transmission in rural areas of India’s most populated state. Micro planning, house visits, concurrent monitoring and follow ups were core to India’s polio eradication strategy to ensure no one misses access to vaccination and health care services.
HEALTH SYSTEMS STRENGTHENING
At present there are around 65 thousand Isolation beds available in various Covid hospitals in the state. There are over 15 thousand beds with ventilators /HFNC/ BiPAP, available in various Covid hospitals in state. Around 80 thousand beds have been made available for the treatment of Covid-19 patients in all L1,L2 and L3 hospitals. There are total 209 level 2 and level 3 hospitals available for treating Covid patients in the state. 307 private hospitals are also treating Covid patients in the state. In every district, 2 CHCs have been converted into 50 bedded Covid L1 plus hospitals. 7,500 Beds have been added in rural areas by opening these Covid treatment centres. A 500-bed Covid Hospital has been opened at Lucknow with the support of DRDO. Another 700 bedded hospital has been started in Varanasi through DRDO.
Almost 1.5 Crore persons in the state have been administered Covid vaccine, three-fourth of which have got one dose while over 30 lakh have taken both doses of the vaccine. The State has decided to vaccinate the beneficiaries free of cost. CVCs have been identified and State has started procuring vaccines for the above-said group as per GoI guidelines. In addition, the private CVCs who have procured vaccines from other than the GoI channel, have also been registered on the Cowin portal as per guidelines and are conducting vaccination. Special vaccination drive was started for those between 18-44 age group from 1st May, 2021 in seven districts, which has now been expanded to cover 18 districts from 10th May, 2021.