Originally published in: Times of India

Authors: Nikhil Srivastav and Payal Hathi


At the end of the PM’s announcement of India’s countrywide lockdown last month, he reminded us of the importance of health workers as we cope with the rapid spread of Covid-19, and announced a Rs 15,000 crore allocation for health system strengthening. The critical question is, how should this allocation be prioritised to minimise the cost to society of this current crisis and to best support health workers?

Based on the experiences of other countries, we know that slowing down the spread of the virus is crucial. Other than caring for sick patients, what role do health workers have? As researchers we have spent time studying infection control practices in north Indian public hospitals. Through 2016/17 we visited 2 medical colleges, 10 district hospitals and 10 community health centres.

One morning we met a middle-aged microbiologist in a health centre, as he tested tuberculosis slides. To our surprise he was not wearing gloves. He later threw the previous day’s slides out of the window. When asked if he feared getting infected himself he confidently replied, “Agar aap bindaas raho to kuch nahi hoga, agar aap bahut chinta karoge to kuch ho jayega” (If you are carefree nothing will happen to you, if you worry a lot something will happen).

Our microbiologist is not an outlier. A pediatrician during his OPD told us that he does not worry about infections because he can tell what illness someone has when they walk through the door. He takes precautions such as washing his hands only if the patient is contagious. Again and again we met health workers who understood the germ theory of disease but did not practise it.

Although we expected to find strict infection control measures in hospitals the health providers we met rarely wore gloves and when they did, they often did not change them between patients. Most health workers did not wash their hands or disinfect equipment between patients either. These practices are risky during normal times and even more dangerous right now, when they can easily spread infection from patient to patient.

We do not intend to blame health care workers for not putting the germ theory into practice. They serve hundreds of patients each day, while facing severe supply shortages. Many have worked in resource constrained settings for their entire careers. As a result many practitioners justify these aberrations in their behaviour as simply being practical.

During the current pandemic, however, not following infection control rules based on the germ theory of disease would have even more serious consequences. It increases the chances of health providers catching Covid-19 themselves and turning into super spreaders among their patients and communities. The experiences of Italy, China and the United States where thousands of health workers have tested positive for Covid-19, show what may soon happen in India. We cannot afford for health workers to become sick at this critical time.

Most patients who may spread the virus will seek care at neighbourhood clinics and nursing homes before ever going to a hospital or needing ICU care, thus infection control in these health facilities will play an important role in slowing down the virus spread. Much attention has been spent on potential shortages of ICU beds and ventilators in hospitals. But as the WHO recommends and as the PM mentioned in his speech, we must invest in refreshing health workers’ training on infection prevention and control, and protect health workers at all levels of the system.

Although each individual has a responsibility in slowing the spread of the virus, the practices of health workers will have a major impact on the trajectory of this pandemic in India. The government should be as focussed on providing supplies and training to small-scale providers as to major hospitals. We are in this together, but we must train and protect our health workers so that they can care for us.

Nikhil Srivastav is cofounder of Research And Action for Health in India (RAAHI) and Payal Hathi is a graduate student at the University of California, Berkeley