Article Type : Research Article
Authors : Sharma B , Verma R and Muqtadir M
Keywords : Covid 19; Health care workers; Himachal Pradesh; World health organisation
The
professional life of the doctors and other health-care workers is laborious due
to the nature of their occupation. The primary and inherent peril of their
occupation is risk of various infections. Their jobs may become
life-threatening while treating patients having contagious diseases. They also
have to deal with the physical and mental fatigue, the torment of difficult
decisions, the agony of deaths of their patients and colleagues. The present
situation in the world of Covid-19 has raised the challenges for them as the
vast number of health-care workers got affected with it across the world. The
state of Himachal Pradesh had slow emergence of the Covid cases and the present
paper looks at how the government has implemented the rights of the health-care
workers.
As per Guidelines of
W.H.O., there are numerous rights of the health-care workers during the current
pandemic. Some of important rights include to receive all necessary preventive
and protective measures to minimize occupational safety and health risks; to
receive adequate IPC and PPE supplies (masks, gloves, goggles, gowns, hand
sanitizer, soap and water, cleaning supplies) in adequate quantity to
healthcare and other staff engaged in caring for suspected or confirmed
Covid-19 patients. They must be acquainted with technical updates relating to
Covid-19 and provided appropriate tools to assess, test and treat patients.
They should be able to disseminate infection prevention and control information
with patients and the public. Their rights extend to obtain information,
training as well as instruction regarding occupational safety and health such
as refresher training on infection prevention and control (IPC). They also have
to know the correct manner of use as well as disposal of personal protective
equipment (PPE). The right to receive proper working hours with breaks; to
respect the right to compensation, rehabilitation and curative services if
infected with Covid-19 after exposure in the workplace are included in the list
of the rights. The right receive access to mental health and counselling
resources is also primary. Due to a lack of personal protective equipment’s,
healthcare workers are being infected in hospitals. Others are also being
infected outside hospitals, in their homes or communities. More than 3,000
healthcare workers from 79 countries around the world have died due to the
novel coronavirus infection [1]. Almost 1,302 doctors have found positive for
the virus. In terms of infections, private consultants and resident doctors
count for the highest number of cases. Out of the total infected healthcare
workers, resident doctors were 566, private consultants were 586 and house
surgeons were 150. Till April 30, more than 5% accounted for healthcare
workers. The above figure is expected to be a major undervalue due to a lack of
reporting. They have also experienced reprimanding including arrests and
dismissals from the authorities and their employers for voicing safety
concerns. In some cases, they have been exposed to violence and stigma from
members of the public. On 30th July, 2020 six months passed since a global
health emergency was declared under the International Health Regulations by the
World Health Organisation. The research objectives of the present study are to
discuss the rights of the health-care workers during Covid-19; to enumerate the
measures taken by the Govt. of India and Govt. of H.P. for protecting the
rights of health care workers and to study the enforcement of the rights of
various health care workers in the state of H.P [2].
Inspirational series on
Healthcare Service Personnel has been launched by the MoHFW. The series include
musical tribute to the health-care workers; break the stigma-do and don’ts;
gratitude towards them; felicitation of the nurses etc. The series is made
available in Hindi and English. Insurance Scheme for Health Workers Fighting
Covid-19 under Pradhan Mantri Garib Kalyan Package was approved in the end of March
2020. It will provide an insurance cover of rupees fifty lakhs for ninety days
[3]. It aims to cover around 22.12 lakh public healthcare providers, along with
community health workers, approaching Covid-19 patients in direct contact and
care. It will also embrace accidental loss of life due contracting Covid-19.
Due to the extraordinary situation, private hospital staff, retired, volunteer,
local urban bodies, contract, daily wage, ad-hoc, outsourced staff employed by
States, Central hospitals, autonomous hospitals of Central or States or UTs,
AIIMS & INIs or hospitals of Central Ministries can also be included. An
advisory dated 18th June 2020 requires detailed instructions; activation of
Hospital Infection Control Committee (HICC), stipulates Standard Operating
Procedure for health work force deployment during COVID-19 , different
procedure to be adopted in case a health care worker reports symptoms
suggestive of COVID-19 and mandates regular quarantine of healthcare workers
after performing duty in COVID-19 areas. Country-wide Toll free helpline
numbers have started under the aegis of the Ministry and under Indian Medical
Association for pscyho-social support for the various health professionals
[4-8].
On 28th March, Himachal
Pradesh State Government formed a ‘HP Covid-19 Solidarity Response Fund’ to
offer personal protection equipment to the health workers and other related
officials. It would ensure even supply of essential commodities such as food
items and medicines. A new bank account with HDFC Bank, Chotta Shimla has been
opened to allow donors for generous donating to help the persons suffering
during the COVID-19 pandemic. A number of Guidelines and Advisories have been
issued by the Government of Himachal Pradesh dealing with Covid-19. List of
Training resource material for the purpose of capacity building of health care
professionals for Covid 19 containment was released in April, 2020. Committee
for giving advisory for managing Health Care Work was constituted on 26th May,
2020. Covid Clinical Committees have been established in the six Government
Medical colleges in State to monitor cases on day to day basis on 4th June,
2020. Additional incentive of Rs.1000 to all ASHA workers from March, 2020 to
June, 2020 was announced on 26th June, 2020. HP SDMA Covid-19 State Disaster
Response Fund is a secure way to contribute to the state of Himachal Pradesh
efforts to respond to Corona pandemic. Essential supplies such as PPEs to various
health workers and food, medicines etc. may be provided to communities with the
assistance from this fund [9,10].
The doctrinal and
non-doctrinal methods of study have been adopted by the researchers. The health-care
workers were interviewed through digital means. Around 25 questions were asked
including the nature of job, district of posting, and the knowledge about the
rights of the health-care workers. As on 30th July, 2020, the total number of
cases in H.P. are 2403; active cases are 1057. Total 14 deaths have taken place
so far in the State [11].
The researchers have
adopted convenience sampling. The universe of the study is state of Himachal
Pradesh. Himachal Pradesh is located in the Western Himalayas and is one of the
eleven mountain states and is characterized by an extreme landscape featuring
several peaks and extensive river systems. It has a total population of
6,864,602. The state covers an area of 55,673 square kilometres (21495 sq mi)
[12,13].
108 respondents were
included, from various categories of health care workers. Doctors, nurses,
final year students, interns etc. constituted the respondents (Table 1) (Figure
1-5).
· Around 58% did not made any complaint
regarding violation of their rights during Covid-19. Almost 20% of the
respondents made violation of their rights whereas almost 22% made no
complaint.
· Out of the respondents who made complaints,
only 35% respondents found improvements after making the complaints. Whereas,
for 65%, situation remained the same.
· 32.4 % respondents replied that they have not been provided any training on infection prevention and control; and use/ disposal of Personal Protective Equipment. Whereas 67.6% respondents were provided the training.
Figure 1: District of posting of
respondents.
Figure 2: Nature of employment of
respondents.
Figure 3: Profession of
respondents.
Figure 4:
Specialization of doctors.
Figure 5: Complaints made by respondents during Covid.
Table 1:
Respondents from different parts of H.P.
S.No. |
District |
Percentage of Respondents |
1. |
Bilaspur |
3.4% |
2. |
Hamirpur |
4.6% |
3. |
Kangra |
18.4% |
4. |
Mandi |
5.7% |
5. |
Shimla |
39.1% |
6 |
Solan |
21.8% |
7. |
Una |
1.1% |
8. |
Sirmaur |
5.7% |
· 58.3 % respondents answered that mental
health and counselling services exist in your workplace, if required by a
health-care worker. 41.7 % answered the absence of such services for the health
care workers.
· 62.6% respondents were not aware of the
toll-free helpline – “08046110007” for psycho-social support for health care
workers in India. Only 37.4 % of the respondents had knowledge of this
Toll-Free Helpline.
· 76.5% respondents found adequate availability
of equipment’s like pulse ox meter, temperature measuring devices etc. in their
hospital or college. 23.5% answered negatively.
· Regarding regular sanitization of the
hospital or the medical college, 64% respondents believed that their workplaces
were sanitized whereas more than 20% of the respondents had no knowledge of
sanitization. 16% believed that the hospital or college were not sanitized.
Health care workers have played a significant role in the global
comeback to the Covid-19 pandemic. Across countries, they have put their health
and wellbeing at peril. They continue to work in very difficult circumstances
and with very little support, to ensure that people are able to access the
essential services they need. It must be accepted that the health-care workers
are a dominant resource and their lives are precious for everyone. Recognizing
and accepting that every health system is vulnerable would help to trace any
existing gaps and would enable the protection of both health workers and the
public at large.
· The
national and state governments must take measures such as provision of food,
rest and care for Health care workers and their families.
· The
psychological support for Health Care Workers also needs to be focused.
· Adoption
of proper security and sanitization measure by the hospitals and its
supervision by the dedicated department of the Government.
· Enhanced
incentive scheme for work over-time and extra shifts.
· Organized
training and emergency drill sessions for the health workers.
· States
should ensure that employers provide all health and essential workers with
adequate PPE to protect themselves during the Covid-19 pandemic, in accordance
with international standards, as set by W.H.O.
· States
should place Covid-19 under the category of an occupational disease. The
workers who contract Covid-19 as a result of work-related activities should be
allowed to claim compensation and medical and other necessary care. This should
comprise all health and essential workers regardless of the nature of their
contract.
· Health
and essential workers safety concerns must be attended to and addressed in a
suitable manner. There must be no adverse action against workers for raising
concerns or lodging a complaint related to health and safety.
· Prompt
investigation in an independent and fair manner of any by attacks or acts of
violence against health and essential workers must be done by authorities.
Perpetrators must be brought to explanation.
· The
States should acknowledge that health care workers are at a higher risk on
account of their work.
· Effective,
comprehensive and independent reviews should be undertaken regarding
preparedness for and responses to the pandemic.
· Data
on the basis of occupation, who have been infected by COVID-19, and how many
have died as a result should be collected and published by States.