The COVID-19 pandemic has laid bare the vulnerabilities of healthcare systems globally, exposing the need for innovative and resilient solutions, particularly in rural areas. In India, the response to the crisis has prompted the creation of COVID Care Centres (CCCs) to alleviate pressure on urban healthcare systems. However, logistics and technical implementation challenges have led to the reevaluation of strategies. This article explores the concept of the Integrated COVID Campus, using the Mahasamund district as a case study to showcase how an integrated approach can significantly enhance health resilience at the grassroot level.
Background
In response to the pandemic's challenges, governments worldwide established COVID Care Centres (CCCs), including India. These centres aimed to reduce the burden on hospitals by providing isolation facilities for asymptomatic or mildly symptomatic patients. However, implementing CCCs posed logistical and technical difficulties, hindering effective patient isolation and management, especially in rural and remote areas.
Mahasamund's proactive integrated approach
Mahasamund, a district in Chhattisgarh, India, responded proactively to the challenges posed by the pandemic by establishing an Integrated COVID Campus. This model aimed to streamline the management of COVID-19 cases by combining three types of centres within a single facility: a COVID Care Isolation Centre for asymptomatic patients, a dedicated COVID hospital for symptomatic patients, and a residential-cum-quarantine hostel for healthcare personnel.
The selection of the District Hospital (DH) as the site for the Integrated COVID Campus was a crucial decision. The DH, located on the outskirts of the main town, offered sufficient space away from densely populated residential areas. It had existing staff hostels that could be repurposed, and resources could be shared with non-COVID facilities, making it an ideal location. However, this decision posed challenges, particularly in ensuring the seamless continuation of non-COVID services provided by the DH.
The selection of the District Hospital (DH) as the site for the Integrated COVID Campus was a crucial decision.
The DH campus, previously serving as a secondary care community hospital, had been responsible for handling regular non-COVID cases and emergency hospital services. Disrupting these vital services was not an option, necessitating careful planning to accommodate COVID and non-COVID facilities within the same campus. Challenges included maintaining services like maternity and neonatal care units while establishing the necessary infrastructure for COVID-19 patients and designing separate entry points to prevent cross-contamination.
Mahasamund successfully transformed its healthcare infrastructure by adopting an integrated approach. The DH campus was divided into two zones: the designated COVID-19 campus and the non-COVID essential services area. This strategic division created an independent entry/exit road connecting the highway to the COVID-19 campus, ensuring the smooth functioning of essential non-COVID services. Existing facilities within the DH premises were repurposed, such as two hostels converted into a COVID isolation centre and a residential-cum-quarantine hostel for healthcare personnel.
Optimising resource utilisation and facilities management
One of the key advantages of the integrated approach was the optimisation of available resources. Mahasamund's administration developed Standard Operating Procedures (SOPs) and a comprehensive checklist to utilise existing resources judiciously. By leveraging existing facilities and resources within the campus, the DH administration maximised its capacity to provide quality care to patients.
Existing facilities within the DH premises were repurposed, such as two hostels converted into a COVID isolation centre and a residential-cum-quarantine hostel for healthcare personnel.
The locally developed COVID-19 Facilities Management System was crucial in streamlining campus patient care and facility management. This software facilitated real-time updates on bed availability and maintained digital records of patients, ensuring efficient monitoring and management. The system also generated default prescriptions for patients based on age, gender, and clinical history, following the COVID-19 management protocols set by the Indian government.
Ensuring the safety and well-being of healthcare workers
The well-being and safety of healthcare workers (HCWs) were given paramount importance in the transformed DH campus. A dedicated COVID-19 team was formed to manage HCWs working in the COVID-19 facilities. Duties were allocated centrally, ensuring equitable distribution of workload, and HCWs were rotated among different COVID-19 facilities to prevent burnout and enhance experience in various areas of COVID care.
To ensure the safety of HCWs, training sessions were conducted on the proper usage of personal protective equipment (PPE) and adherence to strict hygiene practices. The DH administration provided comprehensive training modules addressing the donning and doffing of PPE kits, hand hygiene, respiratory hygiene, and disposal of biomedical waste. These training sessions gave HCWs the necessary knowledge and skills to protect themselves and effectively manage COVID-19 cases.
Results
Establishing the Integrated COVID Campus in the Mahasamund district has led to efficient management and care of COVID-19 patients. The Integrated COVID Campus demonstrated its effectiveness in handling COVID-19 cases with a high recovery rate of 83.18 percent. The management approach implemented in the COVID Campus has resulted in streamlined care and a high recovery rate. Only a small percentage of patients (5.36 percent) admitted to the COVID Isolation centre required a transfer to the dedicated COVID hospital for oxygen support, indicating the effectiveness of the integrated approach in providing appropriate care based on the severity of the patient's conditions.
The management approach implemented in the COVID Campus has resulted in streamlined care and a high recovery rate.
Lessons learnt and model for effective healthcare preparedness
Mahasamund's experience provides valuable lessons for building health resilience and effective healthcare preparedness. Key strategies include investing in robust healthcare infrastructure in rural and remote areas, effective coordination between public administration teams and healthcare professionals, continuous training and capacity building for healthcare workers, and developing a COVID-19 Facilities Management System.
Continuous training and capacity building for healthcare workers are crucial components of effective disaster management. Preparedness plans should be in place to address future outbreaks and mitigate their impact on the healthcare system. The commitment to providing training sessions on the proper usage of personal protective equipment (PPE) and adherence to strict hygiene practices showcases the importance of equipping healthcare workers with the necessary knowledge and skills to protect themselves and effectively manage COVID-19 cases.
Real-time updates on bed availability, digital records of patients, and an in-built alert system for patient transfers ensured efficient monitoring and management.
Moreover, the development and implementation of the COVID-19 Facilities Management System played a pivotal role in streamlining patient care and facility management within the campus. This digital management system improved the overall coordination and communication among healthcare teams and enhanced patient care quality. Real-time updates on bed availability, digital records of patients, and an in-built alert system for patient transfers ensured efficient monitoring and management.
Conclusion
In conclusion, Mahasamund's experience setting up the Integrated COVID Campus serves as a beacon for building health resilience in the face of a global pandemic. The district's integrated approach effectively managed COVID-19 cases and ensured the continuity of essential non-COVID services. By learning from Mahasamund's experience and replicating these strategies, other districts can enhance their preparedness and response to future health crises, ultimately providing quality healthcare services to their communities.
Health resilience, as demonstrated, is a cornerstone in building a robust healthcare system capable of withstanding the present challenges and future uncertainties. The success of the Integrated COVID Campus in Mahasamund underscores the importance of a dedicated and integrated approach to efficiently managing and providing care to COVID-19 patients. The lessons learnt can serve as a valuable example for other regions facing similar challenges, emphasising the significance of coordinated efforts and comprehensive care in combating any healthcare emergency. Building health resilience is not just a response to a crisis; it is an ongoing commitment to creating a healthcare system that can adapt, innovate, and effectively address the evolving health needs of communities. Mahasamund's journey provides a roadmap for achieving this resilience and is a model for effective healthcare preparedness.
Ravi Mittal is an Indian Administrative Services (IAS) officer currently posted as the District Collector of the District Jashpur, Chhattisgarh.
Surbhi Jain is a DM Resident in Neurology at the National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bangalore.
Kartikeya Goel is an IAS officer who currently serves as the District Collector of Raigarh District in Chhattisgarh.
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