Thread by @prashanthns

1/ Thread on High Level Expert Committee for Prevention & Management of COVID 3rd wave chaired by #DeviShetty & nearly #allmale & clinician led committee with hardly any diverse expertise needed (covered in my earlier thread which fell on deaf ears @BSYBJP @mla_sudhakar);

2/ My view based on my training in medicine & #PublicHealth & what I have learned through several years of #CommunityEngagement & #PrimaryHealthCare in rural Karnataka #Chamarajanagar;

3/ While the original notification was all men, 2 women seem to have been added; the summary of the report is about 30 pages while the "detailed recommendations" are 60 pages; rather poor attempt at summarising IMO

4/ preface says various "disciplines of medicine" were included which is overly narrow for a social & community crisis that we saw; the ToC of topics covered shows total lack of a coherent framework in defining the technical inputs; clearly public policy expertise lacking

5/ Given that report has private-sector & corporate membership (Chair himself!), one would have expected an articulartion of "principles"/values/assertions that underly choice of recommendations; NONE listed; did you expect disclosures? NONE

6/ report is a list of bullet points; under PH infrastructure, committee makes "list for procuring drugs including consumables"; an operational detail which does not normally need a committee of experts; @DHFWKA already has/ought to have such capacity;

7/ Total lack of ANY structural reform; a huge missed opportunity; be it the Public health cadre need that's been suggested for 2 decades now & having good qualaity evidence for; instituting a hospital manager cadre for eg lacking; a good quality HR management system...none!

8/ A1. Public health infrastructure & HR: no structural reform, usual stuff on expansion of infra & filling up of vacancies (none of these need expert committees to tell us); complete lack of understanding of what is Governance on which more below

9/ The recommendations under Governance demonstrate lack of expertise in the Chair to be able to guide/conceptualise Public health; this is not surprising; furthermore for a corporate head to make recommendations on Governance w/o consultations or including experts is wrong

10/ Under recommendations for upgrading medical colleges, more vacancy filling; NOTHING on the poor technical & clinical leadership from medical colleges and how to improve that, limited convening function of current Community Medicine depts at district level decision-making?

11/ Not a MENTION of the Chamarajnagar oxygen tragedy where at least 28 died at a medical college hospital; what did we learn? How do we prevent this in the coming days? Did nobody bring this up?

12/ Section 2 on Vaccination strategy is entirely focused on urban middle class Bangalore save for "Whole of community" should be involved (how does this work?); only meaningful recommendation here is on micro-planning Bravo!

13/ Under vaccination sites, here is an interesting suggestion to NGOs: "Encourage NGOs to provide refreshment at the vaccination sites." (🙄 ) and some plain common-sense offered; any data-driven stuff on this? any analysis of measles/polio at GP level? NOTHING

14/ On vaccine hesitancy, I have read good quality high school essays that are more meaningful; again NGOs thrown in as some entity that magically can "mobilise rural populations" (what do they think rural populations are? sheep waiting to be "mobilised" by NGOs?)

15/ More common sense under under cold-chain management & clinical management & adherence. Did we need an expert committee for this? Is it possible that the job was done by unmentoried/unsupervised juniors?

16/ Such deep-seated ignorance and stereotype of "rural communities"; this heterogenous term has been stereotyped basically to indicate one thing: they need help for "slot booking" on COWIN! (Was the Chair unaware of the current walk-in strategy widely deployed?)

17/ Under a theme titled "Software" 2 bullet points belie a lack of understanding of both software or its social realities; and by the way, for them COWIN is the ONLY software;

18/ An eg of the lack of deeper engagement with details/lack of expertise in the M&E section: here was an opportunity for the expert committee to go into details of how district & taluka reviews can be made more effective; instead more common-sense assertions "Strengthen";

19/ In oxygen section, some focus on piped oxygen supplies in govt & private hospitals (low interest COVID package loans suggested for private hospitals); some good bullet point recommendations on oxygen concentrators but so few details?

20/ Why have an expert committee if it can't come up with some templates/guidance and clear "new way of doing things" or a different way of doing things or lessons learned?

21/ Such a narrow view of fundamental public health concepts; see below for eg. 2 recommendations under "Patient safety"

22/ 2 pages on public awareness & messaging appears mainly targeting urban middle class communities with limited opportunities for actually "engaging" & involving people; instead just passive information offloads; also these are rather generic IEC/campaign mode stuff;

23/ 3 pages of psycho-social support is rather well written & important; but short on implementation detail on how to roll out in health & WCD departments across state; which are the specific staff at district & taluka who will receive this training?

24/ How will these integrate into care-seeking processes at PHCs & taluka hospitals? That's why the need for wide spectrum of public health & community medicine expertise needed

25/ The only section that addresses "lessons learned" is the 3-page section on PH preparedness; heavily biomedical with limited engagement with particular vulnerable populations;

26/ section on sentinel surveillance is particularly useful; willing districts struggling to set up & looking for models; in this section there is some attempt at a template of surveillance that could be established at district levels & could be an early-warning system

27/ As someone who's at a village/district level, the 5 bullets under Public health and social measures are quite entertaining; again, did we need an expert committee to put together these brilliant "social measures"?

28/ "Additional Preparedness for COVID 3rd Wave (Pediatric)", extensive calculations projecting population beds, HR & pediatric patient load; careful calculations done in tables have not been synthesised into district-wise actions which could be sent to DCs, Deans DHOs;

29/ On the nutrition recommendations, focus on milk; but NOT one mention of egg/meat; given huge protein-energy malnutrition, AT LEAST eggs will be vital to overcome the limited protein quality in staple cereals; also bizarre to list cherry-picked NGOs (unclear why these)

30/ Yay for COVID registry; hope this comes through and with good ownership by the participating medical colleges this will yield important insights if well done;

31/ section on PPP shows lack of Public policy expertise; so many PPPs either have limited effectiveness evidence or even plain negative evidence against their use esp for contracting out services; one of the PPP modality is to partner with "public at large" (sic!)

See for eg.

32/ the limited understanding of typology and diversity within "NGO" which are all bunched together thus and arbitrarily 3 out of 3225 have been named specifically to give the reader an "example" (as if readers may not understand what is an NGO)

33/ Partnership with IAP receives extensive mention; where they are working, probably useful & must be better documented; indeed allowing for better engagement of doctor, nurse & other professional bodies in public engagement on key topics is important and lacking till date;

34/ section on re-opening of schools leans on IAP guidance but paradoxically, DS had made non-evidence based assertions in media about huger wave in children; current preparedness for measures in govt schools still lacking & needs decentralised attention at district level;'

35/ Yes, I know it's easy to critique from "outside", & perhaps there are several individual members who worked hard on this; but for public health trained people to NOT engage critically with this would be a pity; also those of us involved at GP & taluka/district level have…

36/ …seen that listening & praxis are vital in co-creating a response; with limited consultation & participation, the report & recommendations are only as good as what went (& what did not) go into them

37/ Ultimately, a more participatory & decentralised consultative approach that privileges equity, empathy and caring will be most vital; and that can only happen through broadbased alliances, coalitions and committees at the lower levels

38/ the DS led committee does mention (in passing) district level committees; this is welcome and hopefully will be more broad-based; perhaps just strengthening & empowering GPTFs too needed </theEnd>