A decentralized approach for effective COVID management

COVID COUNSELING CENTRE

Rationale of introducing decentralized management of COVID-19 cases: With the surge in overall cases in the State and mainly at Guwahati city (the heart of Assam), where many cases are coming without known travel history and not known history of coming to high risk contacts, it is felt necessary to have community centric strategy so that community acceptability of testing goes up. With that backdrop, Health Department, Assam with active community participation decided to further decentralize the COVID care management by taking COVID care services at the door step of community and thus to ensure that maximum people get facility of testing and awareness on COVID so that situation does not go beyond control.

Under decentralization process, it is decided that in all the 31 wards of Guwahati city, a suitable venue to be found out, which will be named as "COVID Counseling Centre (CCC)". Accordingly, for all the 31 wards, CCCs have been identified either at existing Urban State Dispensary or a suitable school has been identified, which is named as CCC. If it is school, then the head teacher of the school is asked to coordinate with the medical team of that school for smooth functioning of CCC. The head teacher is also asked to propagate the information of functioning of CCC among all students of the school so that family members of students can take benefits of the services. The CCC, where Medical Team (led by Medical Officer, GNM, ANM, Lab tech, Pharmacist, DEO and identified Urban ASHA) sits, there any citizen of the ward (irrespective of the medical condition) can visit the CCC to give swab to know the COVID status. On giving swab, citizens are asked to stay at home till the report comes out. The CCC data entry operator (DEO) maintains proper data base of the persons, who give swab and samples are sent to designated testing centre. The CCC wise report of samples is sent to the respective CCC in-charge, who in turn informs the family member, who is found positive using the data base, she/he has. If any member is found positive, then the rest of the members are asked to visit the CCC next morning and to give swab. If any member of the concerned family is too ill or aged, then the lab tech from the CCC visits the household to take swab of the ill or aged person. The person, who is found positive is sent to the COVID hospital based on the condition of the patient by an ambulance, attached to the CCC.

Earlier, when cases were handled centrally from district Hq then issues were faced in identifying the address of the positive cases, informing and shifting them to designated COVID hospital, but now with the functioning of CCC at each ward, the identification of the person, who is found positive and in locating his/her household has become much easier. The community acceptance has also gone up in giving swab, earlier because of distance and thinking that one has to be in "Q" for long and also with the fear that one might get COVID just by visiting the COVID hospital, many opted out not to visit the COVID hospital to give swab. Because of better accessibility of the CCC, people are visiting the designated CCC and giving swab.

These CCC works from morning 8 am to afternoon daily. Since, the medical team is led by a Medical Officer, so before giving swab, Medical Officer and his team members do necessary counseling and based on the complaints, the Medical Officer gives supportive symptomatic medicines. Each of the CCC are given 2 (two) ambulances, which are used for smoothly managing the activities, including shifting of positive cases to COVID Hospitals. Once, a patient is dropped at hospital then it the duty of the Medical Officer of the CCC to ensure sanitization the ambulance and to make it ready for next use. The Medical Officer with the support of school teacher arranges swab collection corner, which needs to be protected, and Lab Tech stands inside with full PPE so that he is not exposed to any case. Wide media publicity is given by Health Department so that people know and can avail the services.

Undoubtedly, this is an innovative initiative of Health Department and it will help in better management, mainly in getting community acceptability, encouraging testing, follow up of positive cases and in enhancing community knowledge.

-- Dr. Dipjyoti Deka, SPM, NHM, Assam

Dr. Biraj Shome, Consultant, WHO

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