By Shubha Nagesh, Preethi John, Deepika Saluja
Image courtesy: Wikicommons
The last few months of 2020 made us feel like 2021 would be the end of the Pandemic- lockdowns would end, vaccines would be available, herd immunity would build to adequate levels, etc. However, the virus has unleashed a plethora of fresh concerns with the new variants, lapses in vaccine delivery, and so much more; making it seem like 2021 will be no different. While all of us will continue to be affected adversely, the stakes are very high for health care systems and healthcare workers, who continue to work to their limits, braving the risk, summoning the courage and inspiring us all. This article seeks to spotlight one such critical cadre, the Allied and Healthcare Professionals (AHP), who have truly demonstrated their huge role in service delivery, alongside the doctors and nurses, and enable patients towards health, well-being and independence during the COVID times and beyond.
Allied Health Professionals constitute a significant proportion of the healthcare workforce and contribute to high quality care and better outcomes for patients they support and heal. The global community of AHPs, defined as the associates, technicians, or technologists trained to support the diagnosis and treatment of any illness, disease, injury, or impairment) have emerged as another critical (and often missed out) cadre of Frontline Health Workers (FLWs), shouldering key responsibilities in keeping the health systems functional during the pandemic. 2020 has shown them as a committed, driven and indispensable part of the workforce and 2021 should be the best time to invest in them.
In India, a notable milestone in the recognition of these AHPs was the National Commission for Allied and Healthcare Professions Bill in the Indian Parliament on September 15, 2020, that seeks to regulate and standardize the education and practice of AHPs. The bill recommends setting up of ten professional Councils, inclusive of 55 separate professional groups, covering laboratory sciences, occupational therapy, trauma care, behavioral sciences, physiotherapy, diagnostic imaging, nutritional sciences, ophthalmic sciences, and health informatics.
Women in Global Health India (WGHI) through its Dialogue Series on Engagement of Frontline Health Workers (FLWs) in India’s COVID-19 response, brought the long due spotlight on the role and critical contributions of AHPs in October’s Dialogues 10 (Oct 27) & 11 (Oct 30). In this piece, we share reflections from the engaging conversations initiated with different AHPs and policy level stakeholders during those two dialogues, in an attempt to also appreciate their efforts and bring this cadre into the mainstream policy discussions. The challenges reported by the AHPs during the dialogues, were in line with critical concerns already raised by the other FLW cadres in WGHI previous dialogues, including access and fit of PPE kits, work overload and accompanying stress due to stigma etc. But they also raised some less apparent practical concerns around working on patient-facing roles and balancing them with the rapidly changing and rather fragmented guidelines.
These challenges were repeatedly highlighted to often compound with lack of training, inadequate resources, deficiency of essential physical and mental healthcare services, and difficult work environments, like that of working with children with special needs or those at high risk of trafficking (as shared by a panelist, a social worker based in Goa), thereby making it a struggle for the AHPs (social workers, counsellors etc.) to cater to the needs of vulnerable population groups when they need it the most.
The lab technologists brought out the initial struggle they faced from not being allowed to meet their families for extended periods as well as being ostracised from several parts of society as they were wrongly ascribed to be COVID carriers rather than COVID warriors. Also, with rapidly changing protocols, routines, use of different gear and need for technology adaptation, training was paramount but time was less due to the high workload on hand.
Based on the community level and policy level discussions through these dialogue series, the following three recommendations emerged strongly to bring the spotlight to these AHPs and support them in effectively carrying out their responsibilities:
1) Recognition of AHPs as an important cadre of FLWs: Despite being the backbone of the healthcare system, representing almost 55 different cadres of health workers, the AHPs are valuable, indispensable and need to be duly credited- investment in their services and in them is essential. The other cadres in the health system need to engage with the AHPs as peers and be able to deliver patient centric care exhibiting good team work in a multidisciplinary environment is very critical. A positive work culture that recognises and acknowledges all levels of healthcare professionals as one without succumbing to traditional hierarchical structures will enable a unified and mutually supportive workforce.
2) Professionalism Standards Establishment: The National Commission on AHPs Bill, 2020 needs to be passed so that the standards for skills and competencies can be enforced, quality in services can be ensured and standardized education, training and certification could be established in institutions across the country. This includes establishing a pyramid that allowed task shifting and specialisation at every level. Safety and Quality standards and accreditation mechanisms are vital to streamline the work of AHPs, as for any other cadre of health professionals, and need to be affirmed by policies and practices. The system has to be inclusive of this cadre of professionals and now is the time.
3) Support for physical and mental wellbeing: As personnel who are key to innumerable functions in a health care system, the toll falls heavy on the shoulders of AHPs. It is the duty and the responsibility of health facilities and organizations to provide adequate protection for physical and particularly mental well-being, including services to prevent burnout and ensure a healthy and happy workforce on the premises. A well, healthy and resilient workforce can deliver healthy and safe services. Online reach for continuity of patient care has seen a big leap and irrespective of the nature of work, whether it is tele-physiotherapy, tele-counselling, tele-optometry, tele-nutrition, etc., AHPs must have access to appropriate technology to ensure accessibility of services and continuity of care as well as for their needs to be taken care of.
The health system are its people, particularly those that work in resource-constrained settings, serving the marginalized populations. The allied health workforce like other cadres contribute their might through diagnostic, rehabilitative, restorative and supportive services to improve access, utilization and effectiveness of health services. If they are missing from the health system, a critical portion will be missing from the cohesive unit of health care professionals that need to work together to deliver healthcare services. Their contributions are vital and this diverse workforce constitute the veins of the health systems, delivering a coordinated network of services in a well-orchestrated pattern. It is time the system supports them with training, resources, adequate pay and protection, for them to be able to effectively carry out their responsibilities, during the pandemic and beyond. They are true healthcare heroes and the WHO is spot-on when they decided to name 2021 as the international year of Health and Care Workers -the AHPs are the icing on the cake!
Let's recognise them, celebrate them, and support them!
Shubha Nagesh is a medical doctor and a global health consultant who strives to make childhood disability a global health priority. She works for the Latika Roy Foundation. Preethi John is the Dean of Chitkara School of Health Sciences, Chitkara University Punjab and co-founder of WGH India. Deepika Saluja is a public health research consultant, and is the co-founder of WGH India. The views are personal to the authors