Language
Undefined

With COVID-19, our lives are no longer the same. The pandemic has overshadowed other health issues and reversed the progress made over decades in our fight against other diseases, including tuberculosis (TB). In India, despite sustained and aggressive nation-wide interventions, this deadly disease continues to haunt the population with one of the world’s highest TB infection rates. 

Under the National TB Elimination Program, the country has successfully treated over 20 million patients since 1997. Efforts have been afoot to further reduce the TB burden, but the COVID-19 pandemic has created serious obstacles.

However, rather than being an obstacle, the pandemic should be seen as an opportunity to simultaneously combat COVID-19 and TB, in order to avert millions of deaths.

The respiratory route is the primary mode of transmission for both infections. Interrupting it will stop the spread of both.  In addition, global strategies to control COVID-19 and TB have common key elements: early detection, diagnosis, contact tracing, and case management. Both ailments also require a whole-of-society approach and active community engagement for implementing simple, doable, evidence-based and affordable non-pharmaceutical interventions.  

The National TB Elimination Program is a good place to start this process in India. It has demonstrated the strong involvement of civil society and community leadership in prevention and management of TB. This can be used to curb the spread of COVID-19 through community outreach that seeks to reduce close contact and promote use of non-pharmaceutical interventions (e.g. respiratory hygiene) in communities, public transport and overcrowded houses.

The program has also been instrumental in finding active TB cases. This can be expanded to include COVID-19 by strengthening the surveillance for influenza-like illness. The unification of surveillance activity for communicable diseases with similar modes of transmission is prudent, efficient, productive, and cost-effective.

This success can also be attributed to the involvement/engagement of the private sector, including use of the TB notification and patient management system ‘NIKSHAY.’ This IT-based platform can be strengthened to integrating notifications and responses to COVID-19. The strategies for COVID-19 can be synchronized with TB’s four strategic pillars of “Detect – Treat – Prevent – Build.”

India has scaled up diagnostic facilities by making highly effective tests available throughout the country. This has helped to make sure more people are diagnosed, receive proper medical treatment and thus reduce transmission of infection.

One of these tests, the cartridge-based nucleic acid amplification test, is rapid, highly sensitive, specific, and also detects resistance against recommended antituberculosis drugs. This system has also been extensively used during the COVID-19 pandemic, demonstrating the possibility of cross-use and integration of this system for diagnosis of other infectious diseases. With minor modifications it has the potential to become an affordable and reliable diagnostic aid across the spectrum of infectious diseases.

The pandemic should be seen as an opportunity to simultaneously combat COVID-19 and TB, in order to avert millions of deaths.

The other, TrueNat®, is a chip-based, portable reverse transcription polymerase chain reaction (RT-PCR) machine that is the fastest available test for COVID-19. It also has the potential to become an important diagnostic tool for multiple infectious diseases.

These tests can be made more effective by strengthening diagnostic outreach in the community with well-defined referral mechanisms. 

Using the same facilities for testing TB and COVID-19, with possible expansion and strengthening, can help in successful reductions of both diseases.  India has, in a remarkably short period of 6 months, scaled testing capacity for COVID-19 from the initial 15 testing laboratories to more than 1750 labs across the country. TB detection services can benefit immensely from this feasible, affordable and quality service network-based delivery model.

Prime Minister Narendra Modi has launched the Tuberculosis Free India Campaign (TB Mukt Bharat), presenting his vision to eliminate TB from India by 2025. Similar leadership has been shown in managing the pandemic. India even allocated about $10 million to the COVID-19 Emergency Fund for fighting the pandemic in the neighboring countries in South Asia. The pandemic response can benefit from adopting best practices in India’s TB program, including telemedicine, doorstep delivery of drugs, insurance coverage, improved logistics, private sector partnerships and other benefits to community and frontline health workers.

The COVID-19 response has put the focus on public health interventions like social distancing, use of masks, cough etiquette, and hand hygiene. Continuing these steps will help in preventing new infections of TB as well. In the long term, strengthening efforts on providing properly ventilated houses to the poor contributes to the prevention of all respiratory infections. Initiatives such as the 30-second coronavirus mobile phone ring tone produced in India can be also be used to promote control of TB and other infectious diseases.

Managing the COVID-19 outbreak can help end tuberculosis in India in other ways as well. A major challenge in TB elimination continues to be “missing cases”. Sustained awareness amongst communities on various facets of TB – including the lethal consequences of late diagnosis and incomplete treatment of TB, will encourage people to seek health services more quickly. A strong network of diagnostic laboratories – on the pattern of COVID-19 labs, is needed to confirm the diagnosis and provide appropriate treatment.

Lessons learnt from pandemic should also include integrated training on related ailments. The disease dynamics and management of TB and COVID–19 can be communicated simultaneously to medical professionals and the public to ensure uniformity and better compliance. Other diseases can also be easily integrated into these training modules or platforms for broader upgrading of skills and efficient use of training resources.

Across the world, enormous technical and financial resources are being invested into fighting the COVID-19 pandemic. Most of these are fortifying existing public health services and skills in managing cases and implementing effective measures for infection prevention and control. It will be prudent to sustain these achievements and use them to provide a swift response to future epidemics or pandemics as well as improved health services, especially those pertaining to respiratory infections.

covid, covid-19, coronavirus, novel coronavirus, corona virus, covid-19 response, communicable diseases, infectious diseases, emergency response, health response, outbreak, pandemic, covid-19 prevention, India, tuberculosis, TB, respiratory illnessSonalini KhetrapalSungsup RaPatrick L. OseweCountries: IndiaArticle

Original Source: blogs.adb.org

Language
English

The “informal economy” is often seen as primarily daily-wage laborers, such as in the construction sector or housekeepers, but it also encompasses vast numbers of workers in short- term, usually contract jobs in the formal service sector such as hospitality, retail, and transport. It also includes those working in the new gig economy.

Their work is often characterized by uncertainty, instability and insecurity. As opposed to those in business or government employment, they bear the risks of their work and receive limited social benefits and entitlements.

The Asia-Pacific region accounts for around 60% of the non-farm global workforce, higher than in Latin America and Eastern Europe, ranging from about 20% in Japan to over 80% in Myanmar and Cambodia. They are twice as likely as formal workers to belong to low-income households and often live hand-to-mouth. If they cannot work for extended periods, their family’s income is at risk.

The informal economy is not a relic of the past or a sign of backwardness. It is also not a consequence of the failure of modernization strategies. Today’s informal economy is an essential feature of global production networks. It operates in an environment marked by complex formal and informal economic links, global economic cycles, and domestic economic concerns.

For many in the informal economy, savings are either nonexistent or extremely limited. Typically, they lack employment security, healthcare benefits, sick leave, pensions, and severance packages. Only some of these low-income households are beneficiaries of social transfer programs or other formal insurance arrangements. And here also coverage and adequacy of benefits remain an issue. In short, informal workers earn their living without a safety net.

Without these protections, informal economy workers, especially the poor, face a wide range of occupational, safety, and health risks. They are disproportionally affected by natural hazards and human-made disasters. When affected, the poor tend to lose a larger fraction of their wealth, given their lower ability to cope and recover from disaster impacts. 

Even those whose employment is technically on the books, such as Uber drivers, face a raft of disadvantages. Being classified as independent contractors, many struggle to win unemployment benefits because their employers fail to pay insurance premiums or report wage data to state agencies.

Today, many at-risk informal workers are classified as “essential” to keep the economy going during the pandemic even though they lack basic labor protections.

The private insurance sector should see this as an opportunity to contribute to societal development by designing and offering fit-for-purpose healthcare provision, pensions, and insurance solutions for the missing middle. 

The extension of social protection or insurance to workers in the informal economy often concerns households already relying on informal support and risk-sharing. Insurers should gain insights from the interactions between pre-existing informal risk-sharing networks, social protection schemes, and formal insurance markets while designing new solutions. The design elements must reinforce rather than undermine the positive aspects of informal support mechanisms in risk management. 

Often the potential to build on community-based insurance like cooperatives and mutuals is overlooked. A thorough understanding of these mechanisms can help create positive synergies to manage the idiosyncratic risks. For covariate risks, financing the extension of risk protection needs to be done via risk transfer. 

Microinsurance provides a credible option to balance equity and sustainability. Post-disaster, microinsurance products can cover the cost of health care, deaths, and burials, loss of livestock or crops, or business assets. They can also support the business or income-generating enterprises while the overall system recovers. 

However, limited access to a range of risk management mechanisms and data prevents insurers from offering access to affordable insurance. A case in point is the challenge of developing business interruption products post-pandemic due to a lack of legal documents, proof of inventory and income, and insurance providers’ misperceptions about the client group. 

Today, many at-risk informal workers are classified as “essential” to keep the economy going during the pandemic even though they lack basic labor protections.

The COVID-19 outbreak and accompanying disasters due to natural hazards have exposed the challenges in protecting informal workers and vulnerable households in Asia.

In the new normal:

Mutuals and community-based insurance need strengthening through regulatory and supervisory oversight as they play a critical role in insuring the missing middle. In doing so, the women’s position as the households’ risk manager can be reinforced further and recognized at the community level. 
Governments should consider linking social protection programs with insurance to provide a safety net response. The use of digital technologies to target social protection programs towards households most at risk and targeting the female heads of families would be necessary. 
Subsidies do not automatically lead to high take-up, although evidence suggests that they expand coverage in different contexts. The role of smart subsidies needs to be further explored. And the same goes for smart technology.
The viability of insurance is a direct function of an insurer’s solvency of following a large-scale catastrophe or sequential disaster events. Well capitalized and regulated insurers can diversify their portfolios via reinsurance and help in growing this nascent market.
The design elements of new insurance products need to address the informal sector’s risks and the gig economy workers. They must also consider access to existing risk-pooling arrangements to offer optimal protection.
There is little awareness or understanding of the merits of insurance for managing large-scale disasters. More awareness-building is needed to instill trust and to involve women as change agents. Home is the best school, and the mother is the best teacher. In this manner, one can instill the value of insurance in an entire generation. At the same time, stringent action should be taken against those who are mis selling. 

To address the future of work, a shift in thinking is needed about private partnerships and putting the elderly, women, and youth at the center of loss prevention and building resilience for the households. This will be the most effective way forward for developing future protection solutions.

covid, covid-19, coronavirus, novel coronavirus, corona virus, covid-19 response, communicable diseases, infectious diseases, emergency response, health response, outbreak, pandemic, covid-19 prevention, insurance, informal workers, informal labor, social protections, health insurance, vendors, day laborers, contract workersArup Kumar ChatterjeeArticle

Original Source: blogs.adb.org