Primary care for the urban poor in India during the pandemic: Uninterrupted management of non-communicable diseases and home-based care of patients with COVID-19 infection (2024)

Abraham, S., John, S. M., Gupta, A., Biswas, S., Khare, M. M., Mukherjee, P., & Frankline, A. C. (2023). Primary care for the urban poor in India during the pandemic: Uninterrupted management of non-communicable diseases and home-based care of patients with COVID-19 infection. Frontiers in Public Health, 10, Article 1043597. https://doi.org/10.3389/fpubh.2022.1043597

Abraham, Sunil ; John, Sushil Mathew ; Gupta, Archna et al. / Primary care for the urban poor in India during the pandemic : Uninterrupted management of non-communicable diseases and home-based care of patients with COVID-19 infection. In: Frontiers in Public Health. 2023 ; Vol. 10.

@article{1148d811729c4fce93e06c4d86ecc258,

title = "Primary care for the urban poor in India during the pandemic: Uninterrupted management of non-communicable diseases and home-based care of patients with COVID-19 infection",

abstract = "Problem: The two waves of COVID-19 severely affected the healthcare system in India. The government responded to the first wave with a strict nationwide lockdown which disrupted primary care, including the management of non-communicable diseases (NCDs). The second wave overwhelmed healthcare facilities leading to inadequate access to hospital services. Collectively, these issues required urgent responses, including the adaptation of primary care. Approach: The Low-Cost Effective Care Unit (LCECU) of Christian Medical College, Vellore (CMC) has a network of community volunteers, community health workers, an outreach nurse, social workers and doctors who operate clinics in six poorer areas of Vellore. The network adapted quickly, responding to the lockdown during the first wave and ensuring ongoing primary care for patients with non-communicable diseases. During the second wave, the team developed a system in collaboration with other CMC departments to provide home-based care for patients with COVID-19. Local setting: The LCECU is a 48-bed unit of the Department of Family Medicine, part of the 3,000-bed CMC. It originated in 1982, aiming to care for the poor populations of Vellore town. It has been actively working among urban communities since 2002, with a focus on delivering Community Oriented Primary Care (COPC), for six poor urban communities since 2016. Relevant changes: During the first wave of COVID the LCECU team ensured patients with NCDs had uninterrupted primary care and medications by visiting them in their homes. The team also addressed food insecurity by organizing a daily lunch service for 600 people for over 2 months. In the second wave, the team responded to community needs by organizing and delivering home-based care to monitor patients affected by COVID-19. Lessons learned: The COVID-19 pandemic raises many questions about the preparedness of health systems for disasters that disproportionately affect marginalized populations globally. COVID-19 is only one of the many potential disasters, including non-communicable diseases, mental health problems, pollution, climate change, and lifestyle illness. There is an urgent need to study models of care that support vulnerable communities in an accessible, cost-effective, and patient-oriented way, particularly in low- and middle-income countries. This paper outlines lessons on how the LCECU team addressed disaster management: 1. The COVID-19 pandemic has highlighted the importance of primary care-based rapid response interventions in disaster management. 2. The LCECU model demonstrated the effectiveness of a primary care intervention based on pre-existing networks and familiarity between primary care teams and the community. 3. Establishing community-based health care via interdisciplinary teams, including community health workers, community volunteers, outreach nurses, and doctors, is key. 4. Addressing other social determinants of health, such as food insecurity, is an important component of care delivery.",

keywords = "disaster response, India, pandemic (COVID-19), primary care, urban poor communities",

author = "Sunil Abraham and John, {Sushil Mathew} and Archna Gupta and Seema Biswas and Khare, {Manorama M.} and Pavan Mukherjee and Frankline, {Augustine C.}",

note = "Publisher Copyright: Copyright {\textcopyright} 2023 Abraham, John, Gupta, Biswas, Khare, Mukherjee and Frankline.",

year = "2023",

month = jan,

day = "9",

doi = "10.3389/fpubh.2022.1043597",

language = "English",

volume = "10",

journal = "Frontiers in Public Health",

issn = "2296-2565",

publisher = "Frontiers Media S.A.",

}

Abraham, S, John, SM, Gupta, A, Biswas, S, Khare, MM, Mukherjee, P & Frankline, AC 2023, 'Primary care for the urban poor in India during the pandemic: Uninterrupted management of non-communicable diseases and home-based care of patients with COVID-19 infection', Frontiers in Public Health, vol. 10, 1043597. https://doi.org/10.3389/fpubh.2022.1043597

Primary care for the urban poor in India during the pandemic: Uninterrupted management of non-communicable diseases and home-based care of patients with COVID-19 infection. / Abraham, Sunil; John, Sushil Mathew; Gupta, Archna et al.
In: Frontiers in Public Health, Vol. 10, 1043597, 09.01.2023.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Primary care for the urban poor in India during the pandemic

T2 - Uninterrupted management of non-communicable diseases and home-based care of patients with COVID-19 infection

AU - Abraham, Sunil

AU - John, Sushil Mathew

AU - Gupta, Archna

AU - Biswas, Seema

AU - Khare, Manorama M.

AU - Mukherjee, Pavan

AU - Frankline, Augustine C.

N1 - Publisher Copyright:Copyright © 2023 Abraham, John, Gupta, Biswas, Khare, Mukherjee and Frankline.

PY - 2023/1/9

Y1 - 2023/1/9

N2 - Problem: The two waves of COVID-19 severely affected the healthcare system in India. The government responded to the first wave with a strict nationwide lockdown which disrupted primary care, including the management of non-communicable diseases (NCDs). The second wave overwhelmed healthcare facilities leading to inadequate access to hospital services. Collectively, these issues required urgent responses, including the adaptation of primary care. Approach: The Low-Cost Effective Care Unit (LCECU) of Christian Medical College, Vellore (CMC) has a network of community volunteers, community health workers, an outreach nurse, social workers and doctors who operate clinics in six poorer areas of Vellore. The network adapted quickly, responding to the lockdown during the first wave and ensuring ongoing primary care for patients with non-communicable diseases. During the second wave, the team developed a system in collaboration with other CMC departments to provide home-based care for patients with COVID-19. Local setting: The LCECU is a 48-bed unit of the Department of Family Medicine, part of the 3,000-bed CMC. It originated in 1982, aiming to care for the poor populations of Vellore town. It has been actively working among urban communities since 2002, with a focus on delivering Community Oriented Primary Care (COPC), for six poor urban communities since 2016. Relevant changes: During the first wave of COVID the LCECU team ensured patients with NCDs had uninterrupted primary care and medications by visiting them in their homes. The team also addressed food insecurity by organizing a daily lunch service for 600 people for over 2 months. In the second wave, the team responded to community needs by organizing and delivering home-based care to monitor patients affected by COVID-19. Lessons learned: The COVID-19 pandemic raises many questions about the preparedness of health systems for disasters that disproportionately affect marginalized populations globally. COVID-19 is only one of the many potential disasters, including non-communicable diseases, mental health problems, pollution, climate change, and lifestyle illness. There is an urgent need to study models of care that support vulnerable communities in an accessible, cost-effective, and patient-oriented way, particularly in low- and middle-income countries. This paper outlines lessons on how the LCECU team addressed disaster management: 1. The COVID-19 pandemic has highlighted the importance of primary care-based rapid response interventions in disaster management. 2. The LCECU model demonstrated the effectiveness of a primary care intervention based on pre-existing networks and familiarity between primary care teams and the community. 3. Establishing community-based health care via interdisciplinary teams, including community health workers, community volunteers, outreach nurses, and doctors, is key. 4. Addressing other social determinants of health, such as food insecurity, is an important component of care delivery.

AB - Problem: The two waves of COVID-19 severely affected the healthcare system in India. The government responded to the first wave with a strict nationwide lockdown which disrupted primary care, including the management of non-communicable diseases (NCDs). The second wave overwhelmed healthcare facilities leading to inadequate access to hospital services. Collectively, these issues required urgent responses, including the adaptation of primary care. Approach: The Low-Cost Effective Care Unit (LCECU) of Christian Medical College, Vellore (CMC) has a network of community volunteers, community health workers, an outreach nurse, social workers and doctors who operate clinics in six poorer areas of Vellore. The network adapted quickly, responding to the lockdown during the first wave and ensuring ongoing primary care for patients with non-communicable diseases. During the second wave, the team developed a system in collaboration with other CMC departments to provide home-based care for patients with COVID-19. Local setting: The LCECU is a 48-bed unit of the Department of Family Medicine, part of the 3,000-bed CMC. It originated in 1982, aiming to care for the poor populations of Vellore town. It has been actively working among urban communities since 2002, with a focus on delivering Community Oriented Primary Care (COPC), for six poor urban communities since 2016. Relevant changes: During the first wave of COVID the LCECU team ensured patients with NCDs had uninterrupted primary care and medications by visiting them in their homes. The team also addressed food insecurity by organizing a daily lunch service for 600 people for over 2 months. In the second wave, the team responded to community needs by organizing and delivering home-based care to monitor patients affected by COVID-19. Lessons learned: The COVID-19 pandemic raises many questions about the preparedness of health systems for disasters that disproportionately affect marginalized populations globally. COVID-19 is only one of the many potential disasters, including non-communicable diseases, mental health problems, pollution, climate change, and lifestyle illness. There is an urgent need to study models of care that support vulnerable communities in an accessible, cost-effective, and patient-oriented way, particularly in low- and middle-income countries. This paper outlines lessons on how the LCECU team addressed disaster management: 1. The COVID-19 pandemic has highlighted the importance of primary care-based rapid response interventions in disaster management. 2. The LCECU model demonstrated the effectiveness of a primary care intervention based on pre-existing networks and familiarity between primary care teams and the community. 3. Establishing community-based health care via interdisciplinary teams, including community health workers, community volunteers, outreach nurses, and doctors, is key. 4. Addressing other social determinants of health, such as food insecurity, is an important component of care delivery.

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KW - India

KW - pandemic (COVID-19)

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KW - urban poor communities

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Abraham S, John SM, Gupta A, Biswas S, Khare MM, Mukherjee P et al. Primary care for the urban poor in India during the pandemic: Uninterrupted management of non-communicable diseases and home-based care of patients with COVID-19 infection. Frontiers in Public Health. 2023 Jan 9;10:1043597. doi: 10.3389/fpubh.2022.1043597