Public health strategies for building resilience in India's health system are outlined. Key strategies include developing strong social capital and community engagement, identifying vulnerable communities, building surge capacity, and promoting domestic production of medical technologies. Recent examples that have worked include leveraging existing infrastructure like TB programs to respond to COVID-19. Moving forward, the focus should be on strengthening primary care through health centers, adopting digital tools, and empowering patients. Developing partnerships and creating lasting change are also emphasized.

1. Public Health Strategies for
Resilient Health System in India
Dr. Animesh Jain
Professor of Community Medicine
Kasturba Medical College, Mangalore
Manipal Academy of Higher Education, India

2. Outline
• What is Public health? What is resilience?
• Some examples from recent pandemic
• Strategies
• Way forward
• Conclusion
Public health strategies for resilient health system - Dr Animesh Jain 2

3. What is Public Health?
• the science of protecting the safety and improving the health of
communities through education, policy making and research for disease
and injury prevention. (Univ of Pittsburgh Graduate School of Public
Health)
• Public Health is a growing field that aims to prevent disease and promote
good health amongst communities. (PHFI)
• Overall, public health is concerned with protecting the health of entire
populations – as small as a local neighborhood, or as big as an entire
country or region of the world.
Public health strategies for resilient health system - Dr Animesh Jain 3

4. Source: https://www.cdc.gov/nphpsp/images/phs-figure1.gif
Public health strategies for resilient health system - Dr Animesh Jain 4

5. What does Resilience mean?
• Latin verb resilire, meaning "to jump back" or "to recoil."
• the capability of a strained body to recover its size and shape
after deformation caused especially by compressive stress
• an ability to recover from or adjust easily to misfortune or change
Public health strategies for resilient health system - Dr Animesh Jain 5

6. Resilience…contd
• Community resilience - fundamental to pandemic response; health
emergencies; disaster preparedness, response, and recovery.
• Resilient communities are composed of “healthy individuals, families,
and communities with access to health care and the knowledge and
resources to know what to do and care for others in both routine and
emergency situations.” (National Health Security Strategy, USA)
Public health strategies for resilient health system - Dr Animesh Jain 6

7. Some examples from past & recent pandemic
• Wi-Fi networks in shelters and disaster recovery centers
• Preparedness apps such as the bReddi Facebook App16 (created from
the US Department of Health and Human Services Lifeline Challenge
Award) and the American Red Cross Hurricane App
• Services that help survivors access psychological support (e.g., crisis
counseling, Disaster Distress Helpline)
Public health strategies for resilient health system - Dr Animesh Jain 7

8. Some examples from recent pandemic - India
• R&D
• Scaling up production
• NGOs involvement
• Telemedicine
• Psychological counselling
• Public engagement
Public health strategies for resilient health system - Dr Animesh Jain 8

9. Strategies to build resilience
• Strong social capital, both among people and among individuals and
organizations
• Development of social capital
• Community engagement skills of health department staff,
• building sustainable community engagement processes,
• developing metrics for resilience-promoting interventions, and
• launching a social media campaign.
• Aldrich DP. Building Resilience: Social Capital in Post-Disaster Recovery. Chicago, IL: University of Chicago Press; 2012.
• Plough A, Fielding JE, Chandra A, et al. Building community disaster resilience: perspectives from a large urban county department of public
health. Am J Public Health. 2013; Epub ahead of print May 16, 2013.
Public health strategies for resilient health system - Dr Animesh Jain 9

10. Strategies to build resilience
• Community engagement skills of emergency responders
• Capacity building - increasing the preparedness knowledge of public
health workers, using mapping tools to identify potential areas of
vulnerability in community resilience
• Identifying and mentoring community resilience leaders,
• Developing a training module and toolkit (currently being piloted in
select communities)
• Establishing such day-to- day systems is critical
Public health strategies for resilient health system - Dr Animesh Jain 10

11. Strategies to build resilience
• Geographic Information System technology based social
vulnerability maps
• identify communities most vulnerable to disasters  policymakers
can then prioritize for resilience and social capital growth initiatives.
• Adequately designed primary health care
• Surge capacity
• Disease surveillance and health management information systems
Public health strategies for resilient health system - Dr Animesh Jain 11

12. Strategies to build resilience
• Promote domestic capacity for medical technology
• Governance
• Human resource capacity as a precondition of resilience
• Funding and financing mechanism as a precondition of resilience
Public health strategies for resilient health system - Dr Animesh Jain 12

13. Building on what works
• PATH
• COVID-19 response control rooms in Bihar and Karnataka
• Virtual call center in Mumbai
• Helping to guide the planning and implementation of response
activities and connect them to existing work to improve health
services in India.
https://www.path.org/articles/strengthening-health-systems-india-covid-19/
Public health strategies for resilient health system - Dr Animesh Jain 13

14. Building on what works
• Supply chain
• Building on logistics of fortified rice distribution to schools & cold chain
system, understand the demand of essential drugs & equipment
• PATH is working with the postal department to facilitate the collection of
drug samples for COVID-19.
• Tuberculosis
• engaging the private sector in TB control and treatment – Existing.
• As TB patients have additional medical vulnerability to COVID-19, PATH is
leveraging its existing project to call 10,000 patients every week to provide
them with information on protecting themselves from COVID-19 and
identify problems with accessing TB medication.
Public health strategies for resilient health system - Dr Animesh Jain 14

15. Building on what works
• Community engagement
• health education and information
• volunteers at a virtual call center to answer questions, provide
community counselling, consult with travelers, and facilitate data
entry on COVID-19 patients and their potential contacts.
• India’s Centre for Cellular and Molecular Platforms launched the
COVID-19 Innovations Deployment Accelerator, or CCIDA, on March,
26, 2020, to rapidly deploy COVID-19 innovations with the highest
potential for impact
Public health strategies for resilient health system - Dr Animesh Jain 15

16. • PATH staff are
supporting a virtual
call center to
provide information
to communities.
Photo: PATH.
Public health strategies for resilient health system - Dr Animesh Jain 16

17. Way forward – Some pointers
• Primary health care - Ayushman Bharat’s Health and Wellness Centres
• Go phygital
• Build a digital-savvy health workforce
• AI powered tools; future ready
• Empower patients as equal participants in health management
• Acceptance for Software as a Medical Device / Diagnostic / Clinical
decision aide
• Readying the health workforce of the future - Health-tech in
curriculum
• Ranganathan S. Mission resilience – a clarion call for India. https://www.orfonline.org/expert-speak/mission-resilience-a-clarion-call-for-indias-
future-of-health-65506/
Public health strategies for resilient health system - Dr Animesh Jain 17

18. Way forward – Strategies & tips
• Developing partnerships prior to emergencies
• resources, limitations, and operational realities.
• familiarity with the culture and management styles of each organization.
• Creating long lasting change
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19. To conclude
• Time and again, local organizations and networks have proven far
more adaptable and responsive than outside agencies in responding
to disasters
• Mission Resilience should aim to remodel the system into a
trustworthy, hardy, all-weather one
• American Journal of Public Health | July 2013, Vol 103, No. 7
• Ranganathan S. Mission resilience – a clarion call for India. https://www.orfonline.org/expert-speak/mission-
resilience-a-clarion-call-for-indias-future-of-health-65506/
Public health strategies for resilient health system - Dr Animesh Jain 19

20. References
• Aldrich DP. Building Resilience: Social Capital in Post-Disaster Recovery. Chicago, IL:
University of Chicago Press; 2012.
• Plough A, Fielding JE, Chandra A, et al. Building community disaster resilience:
perspectives from a large urban county department of public health. Am J Public Health.
2013; Epub ahead of print May 16, 2013.
• Sundararman T, Muraleedharan VR, Ranjan A. Pandemic resilience and health systems
preparedness:lessons from COVID-19 for the twenty-first century. Journal of Social and Economic
Development. Journal of Social and Economic Development. https://doi.org/10.1007/s40847-020-
00133-x
• Morton MJ, Lurie N. Community resilience and Public Health Practice. American Journal
of Public Health | July 2013, Vol 103, No. 7 https://doi:10.2105/AJPH.2013.301354
• Ranganathan S. Mission resilience – a clarion call for India.
https://www.orfonline.org/expert-speak/mission-resilience-a-clarion-call-for-indias-
future-of-health-65506/
• https://www.path.org/articles/strengthening-health-systems-india-covid-19/
Public health strategies for resilient health system - Dr Animesh Jain 20

21. Thank you
You may reach me via
animesh.jain@manipal.edu AND/OR 98450 32334
Acknowledgement: Dr Sushma Katkuri & Org team of CME.
This presentation was a part of my talk in CME on “Emergence of Resilient
Healthcare System in India: Time to unlearn” on 13th March 2021 organized
by Dept of Community Medicine, ESIC Medical College, Hyderabad, India