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NEW DELHI : Social distancing norms to curb the spread of covid-19 could affect essential healthcare services in rural India, with the government re-organising the services traditionally delivered through outreach programmes.

While some maternal, newborn and child healthcare services and prevention and management of communicable diseases will see changes, non-covid services, such as health promotion, Information Education Communication (IEC) campaigns, community-based screening for chronic conditions and other screening programmes, will be undertaken only after the lockdown is lifted on 3 May.

The public health facilities and workforce are currently flooded with activities to check the pandemic, the health ministry told states.

“In doing so, there is a risk that essential health services which communities expect from the health system, would be compromised," it added.

The government has, however, said that if feasible, patients can be asked to come to peripheral facilities on particular dates and times, decided at local levels and informed telephonically or through accredited social health workers (ASHAs).

For now, the government has recommended suspending or lessening the immunization and screening sessions. The Centre has also suspended services under Pradhan Mantri Surakshit Matritva Abhiyan which ensures free check-up for pregnant women in their first trimester. “Home visits by ASHAs should be optimized to provide follow up care to all beneficiaries in a particular household/hamlet/mohalla during one visit and avoid making repetitive visits to the same mohalla. This may include beneficiaries like high-risk pregnant women or newborns, elderly and the disabled."

Public health experts said the covid-19 pandemic may have a major impact on primary health services.

“Covid-19 may cause enormous collateral damage to the overall health systems. In rural India, access to quality healthcare facilities, especially for maternal and child care, has been a challenge even in the best of times," said Suryaprabha Sadasivan, vice-president and healthcare policy practice lead, Chase India, a research and public policy consultancy.

She added that suspension or limitation of maternal and child care schemes during covid-19 coupled with diversion of all public healthcare resources including the 1.4 million Anganwadi workers and 1.3 million ASHAs to manage covid-19, could impact maternal and child health in the long term.

Echoing the same sentiment, Amir Ullah Khan, Senior Research Fellow a Rajiv Gandhi Institute for Contemporary Studies (RGICS), a social think tank, said that neglect of rural health is apparent. “There can be consequences like decreased maternal health and higher mortality, infant mortality, lower baby weights and anemia among mothers as all of this will be unchecked during antenatal checkups," said Khan. Public health experts have said that the emergency response towards covid-19 at the expense of other priorities can have serious and long-term repercussions on other aspects of health.

Poonam Muttreja, executive director at Population Foundation of India (PFI), a public health, policy and development strategies firm, argued that maternal and reproductive health services are at risk of being severely compromised. “Limited movement of ASHAs, limited access and restricted availability of reproductive, maternal and child health services will contribute to a rise in increased unmet need for contraception, and increased number of unsafe abortions and maternal and new born mortality," said Muttreja.

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