With the larger spread of Covid-19 cases in peri-urban, rural and tribal areas, the government on Sunday released guidelines to ensure that community-based services and primary level health infrastructure in these areas are equipped to manage the infections.
The Health Ministry called for active surveillance of influenza-like illness/ severe acute respiratory infections (ILI/SARI) in every village periodically by ASHA with help of village health sanitation and nutrition committee (VHSNC).
“Symptomatic cases can be triaged at village level by teleconsultation with Community Health Officer (CHO), and cases with comorbidity/low oxygen saturation should be sent to higher centres. Every subcentre should run an ILI/SARI OPD for dedicated time slots/days,” it said.
Identified suspected COVID cases should link for testing to the health facilities either through Covid-19 rapid antigen testing or by referral of samples to nearest Covid-19 testing Laboratory. CHOs and nurses should be trained in performing Rapid Antigen Testing (RAT) and provision of RAT kits should be made at all public health facilities including sub-centres, Health and Wellness Centres (HWCs) and Primary Health Centres (PHCs). These patients should also be counselled to isolate themselves till test results are available, as per the guidelines.
Meanwhile, the guidelines emphasized on monitoring of oxygen saturation levels of COVID patients. For this it said each village should have an adequate number of pulse oximeters and thermometers.
The VHSNC through local administration should mobilize resources to make provisions for this equipment.
“A system of providing the pulse oximeters and thermometers on loan to families with a confirmed case of COVID should be developed through ASHA/ Anganwadi workers and village-level volunteers. The pulse oximeters and thermometers should be sanitized after each use with cotton/cloth soaked in alcohol-based sanitizer”, the guidelines added.
The government said that a home isolation kit should be provided to all such cases which should include required medicines such as Paracetamol 500 mg, Tab. Ivermectin, cough syrup, multivitamins as prescribed by the treating doctor besides a detailed pamphlet indicating the precautions to be taken, medication details, monitoring proforma for patient condition during the home isolation, contact details in case of any major symptoms or deterioration of health condition and the discharge criteria.
Rural Level Health Infrastructure
The three-tier structure for covid management – COVID Care Centre (CCC) to manage mild / asymptomatic cases, dedicated COVID Health Centre (DCHC) to manage moderate cases, dedicated COVID Hospital (DCH) to manage severe cases should be aligned to the health infrastructure so planned for peri–urban, rural and tribal areas.
Tribal Covid-19 care
Strengthening community-based management through Gram Sabha should be taken and they should be involved at every stage of planning and executing COVID-care activities, the guidelines said.
Mobile Medical Unit (MMU) under national health mission or NHM should be used to facilitate access to public health care in tribal areas. MMUs have an existing medical team – medical officers, pharmacist, staff nurse and lab technician. This team may be utilised to create awareness regarding COVID-appropriate behaviour, carry out RAT, take samples for RT-PCR, provide treatment for mild illness, and help establish referral linkage with DCHC and DCH.