Assessing the impact of COVID-19 management on the workload of human resources working in India's National Tuberculosis Elimination Program.
COVID-19
Human resources for health
Tuberculosis
Journal
BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677
Informations de publication
Date de publication:
07 Aug 2024
07 Aug 2024
Historique:
received:
27
03
2023
accepted:
21
05
2024
medline:
8
8
2024
pubmed:
8
8
2024
entrez:
7
8
2024
Statut:
epublish
Résumé
In 1993, WHO declared tuberculosis (TB) as a global health emergency considering 10 million people are battling TB, of which 30% are undiagnosed annually. In 2020 the COVID-19 pandemic took an unprecedented toll on health systems in every country. Public health staff already engaged in TB control and numerous other departments were additionally tasked with managing COVID-19, stretching human resource (HR) capacity beyond its limits. As part of an assessment of HR involved in TB control in India, The World Bank Group and partners conducted an analysis of the impact of COVID-19 on TB human resources for health (HRH) workloads, with the objective of describing the extent to which TB-related activities could be fulfilled and hypothesizing on future HR requirements to meet those needs. The study team conducted a Workload Indicators and Staffing Needs (WISN) analysis according to standard WHO methodology to classify the workloads of priority cadres directly or indirectly involved in TB control activities as over-, adequately or under-worked, in 18 districts across seven states in India. Data collection was done via telephone interviews, and questions were added regarding the proportion of time dedicated to COVID-19 related tasks. We carried out quantitative analysis to describe the time allocated to COVID-19 which otherwise would have been spent on TB activities. We also conducted key informant interviews (KII) with key TB program staff about HRH planning and task-shifting from TB to COVID-19. Workload data were collected from 377 respondents working in or together with India's Central TB Division (CTD). 73% of all respondents (n = 270) reported carrying out COVID-19 tasks. The average time spent on COVID-19 tasks was 4 h / day (n = 72 respondents). Multiple cadres highly instrumental in TB screening and diagnosis, in particular community outreach (ASHA) workers and CBNAAT/TrueNAAT laboratory technicians working at peripheral, block and district levels, were overworked, and spending more than 50% of their time on COVID-19 tasks, reducing time for TB case-finding. Qualitative interviews with laboratory technicians revealed that PCR machines previously used for TB testing were repurposed for COVID-19 testing. The devastating impact of COVID-19 on HR capacity to conduct TB case-finding in India, as in other settings, cannot be overstated. Our findings provide clear evidence that NTEP human resources did not have time or essential material resources to carry out TB tasks during the COVID pandemic without doing substantial overtime and/or compromising on TB service delivery. To minimize disruptions to routine health services such as TB amidst future emerging infectious diseases, we would do well, during periods of relative calm and stability, to strategically map out how HRH lab staff, public health resources, such as India's Health and Wellness Centers and public health cadre, and public-private sector collaboration can most optimally absorb shocks to the health system.
Sections du résumé
BACKGROUND
BACKGROUND
In 1993, WHO declared tuberculosis (TB) as a global health emergency considering 10 million people are battling TB, of which 30% are undiagnosed annually. In 2020 the COVID-19 pandemic took an unprecedented toll on health systems in every country. Public health staff already engaged in TB control and numerous other departments were additionally tasked with managing COVID-19, stretching human resource (HR) capacity beyond its limits. As part of an assessment of HR involved in TB control in India, The World Bank Group and partners conducted an analysis of the impact of COVID-19 on TB human resources for health (HRH) workloads, with the objective of describing the extent to which TB-related activities could be fulfilled and hypothesizing on future HR requirements to meet those needs.
METHODS
METHODS
The study team conducted a Workload Indicators and Staffing Needs (WISN) analysis according to standard WHO methodology to classify the workloads of priority cadres directly or indirectly involved in TB control activities as over-, adequately or under-worked, in 18 districts across seven states in India. Data collection was done via telephone interviews, and questions were added regarding the proportion of time dedicated to COVID-19 related tasks. We carried out quantitative analysis to describe the time allocated to COVID-19 which otherwise would have been spent on TB activities. We also conducted key informant interviews (KII) with key TB program staff about HRH planning and task-shifting from TB to COVID-19.
RESULTS
RESULTS
Workload data were collected from 377 respondents working in or together with India's Central TB Division (CTD). 73% of all respondents (n = 270) reported carrying out COVID-19 tasks. The average time spent on COVID-19 tasks was 4 h / day (n = 72 respondents). Multiple cadres highly instrumental in TB screening and diagnosis, in particular community outreach (ASHA) workers and CBNAAT/TrueNAAT laboratory technicians working at peripheral, block and district levels, were overworked, and spending more than 50% of their time on COVID-19 tasks, reducing time for TB case-finding. Qualitative interviews with laboratory technicians revealed that PCR machines previously used for TB testing were repurposed for COVID-19 testing.
CONCLUSIONS
CONCLUSIONS
The devastating impact of COVID-19 on HR capacity to conduct TB case-finding in India, as in other settings, cannot be overstated. Our findings provide clear evidence that NTEP human resources did not have time or essential material resources to carry out TB tasks during the COVID pandemic without doing substantial overtime and/or compromising on TB service delivery. To minimize disruptions to routine health services such as TB amidst future emerging infectious diseases, we would do well, during periods of relative calm and stability, to strategically map out how HRH lab staff, public health resources, such as India's Health and Wellness Centers and public health cadre, and public-private sector collaboration can most optimally absorb shocks to the health system.
Identifiants
pubmed: 39113002
doi: 10.1186/s12913-024-11131-8
pii: 10.1186/s12913-024-11131-8
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
907Informations de copyright
© 2024. The Author(s).
Références
Behera D, Tuberculosis. COVID-19, and the end tuberculosis strategy in India. Lung India off Organ Indian Chest Soc. 2020;37(6):467–72.
doi: 10.4103/lungindia.lungindia_544_20
Prasad R, Singh A, Gupta N, Tuberculosis. COVID-19 in India: challenges and opportunities. Lung India off Organ Indian Chest Soc. 2020;37(4):292–4.
doi: 10.4103/lungindia.lungindia_260_20
Behera D. TB control in India in the COVID era. Indian J Tuberc. 2021;68(1):128–33.
doi: 10.1016/j.ijtb.2020.08.019
pubmed: 33641833
Cilloni L, Fu H, Vesga JF, Dowdy D, Pretorius C, Ahmedov S, et al. The potential impact of the COVID-19 pandemic on the tuberculosis epidemic a modelling analysis. EClinicalMedicine. 2020;28:100603.
doi: 10.1016/j.eclinm.2020.100603
pubmed: 33134905
pmcid: 7584493
Duarte R, Aguiar A, Pinto M, Furtado I, Tiberi S, Lönnroth K, et al. Different disease, same challenges: social determinants of tuberculosis and COVID-19. Pulmonology. 2021;27(4):338–44.
doi: 10.1016/j.pulmoe.2021.02.002
pubmed: 33648891
pmcid: 7894090
Malik AA, Safdar N, Chandir S, Khan U, Khowaja S, Riaz N, et al. Tuberculosis control and care in the era of COVID-19. Health Policy Plan. 2020;35(8):1130–2.
doi: 10.1093/heapol/czaa109
pubmed: 32832996
Bardhan M, Hasan MM, Ray I, Sarkar A, Chahal P, Rackimuthu S, et al. Tuberculosis amidst COVID-19 pandemic in India: unspoken challenges and the way forward. Trop Med Health. 2021;49(1):84.
doi: 10.1186/s41182-021-00377-1
pubmed: 34674772
pmcid: 8528656
Chopra KK, Arora VK, Singh S. COVID 19 and tuberculosis. Indian J Tuberc. 2020;67(2):149–51.
doi: 10.1016/j.ijtb.2020.06.001
pubmed: 32553303
pmcid: 7294290
Dara M, Sotgiu G, Reichler MR, Chiang CY, Chee CBE, Migliori GB. New diseases and old threats: lessons from tuberculosis for the COVID-19 response.:5.
Reid MJA, Silva S, Arinaminpathy N, Goosby E. Building a tuberculosis-free world while responding to the COVID-19 pandemic. Lancet. 2020;396(10259):1312–3.
doi: 10.1016/S0140-6736(20)32138-3
pubmed: 34338198
pmcid: 7581348
Fatima R, Akhtar N, Yaqoob A, Harries AD, Khan MS. Building better tuberculosis control systems in a post-COVID world: learning from Pakistan during the COVID-19 pandemic. Int J Infect Dis. 2021;113:S88–90.
doi: 10.1016/j.ijid.2021.03.026
pubmed: 33744479
pmcid: 7968149
Dhawan M, Angural S, Parmar M. Tuberculosis during the COVID19: impact, challenges and Management. J Exp Biol Agric Sci. 2020;8:79–86.
doi: 10.18006/2020.8(Spl-1-SARS-CoV-2).S79.S86
Gupta A, Singla R, Caminero JA, Singla N, Mrigpuri P, Mohan A. Impact of COVID-19 on Tuberculosis services in India. Int J Tuberc Lung Dis. 2020;24(6):637–9.
doi: 10.5588/ijtld.20.0212
pubmed: 32553014
Husain AA, Monaghan TM, Kashyap RS. Impact of COVID-19 pandemic on tuberculosis care in India. Clin Microbiol Infect. 2021;27(2):293–4.
doi: 10.1016/j.cmi.2020.08.014
pubmed: 32822881
Iyengar K, Jain V, Tuberculosis. and COVID-19 in India-double trouble! Indian J Tuberc. 2020;67.
Shrinivasan R, Rane S, Pai M. India’s syndemic of tuberculosis and COVID-19. BMJ Glob Health. 2020;5(11):e003979.
doi: 10.1136/bmjgh-2020-003979
pubmed: 33199280
Awasthi AK, Singh PK. Tuberculosis management in India during COVID-19 crisis. J Public Health Policy. 2021;42(1):185–9.
doi: 10.1057/s41271-020-00265-8
pubmed: 33235251
Dookie N, Padayatchi N, Naidoo K. Tuberculosis elimination in the era of Coronavirus Disease 2019 (COVID-19): a moving target. Clin Infect Dis. 2020. ciaa1400.
Jain VK, Iyengar KP, Samy DA, Vaishya R. Tuberculosis in the era of COVID-19 in India. Diabetes Metab Syndr Clin Res Rev. 2020;14(5):1439–43.
doi: 10.1016/j.dsx.2020.07.034
Malik AA, Hussain H, Maniar R, Safdar N, Mohiuddin A, Riaz N, et al. Integrated Tuberculosis and COVID-19 activities in Karachi and Tuberculosis Case notifications. Trop Med Infect Dis. 2022;7(1):12.
doi: 10.3390/tropicalmed7010012
pubmed: 35051128
pmcid: 8778721
Dara M, Kuchukhidze G, Yedilbayev A, Perehinets I, Schmidt T, Grinsven WLV, et al. Early COVID-19 pandemic’s toll on tuberculosis services, WHO European Region, January to June 2020. Eurosurveillance. 2021;26(24):2100231.
doi: 10.2807/1560-7917.ES.2021.26.24.2100231
pubmed: 34142649
pmcid: 8212590
Homolka S, Paulowski L, Andres S, Hillemann D, Jou R, Günther G, et al. Two pandemics, one challenge—leveraging Molecular Test Capacity of Tuberculosis Laboratories for Rapid COVID-19 Case-Finding. Emerg Infect Dis. 2020;26(11):2549–54.
doi: 10.3201/eid2611.202602
pubmed: 32956612
pmcid: 7588527
Liu Q, Lu P, Shen Y, Li C, Wang J, Zhu L, et al. Collateral impact of the Coronavirus Disease 2019 (COVID-19) pandemic on Tuberculosis Control in Jiangsu Province, China. Clin Infect Dis. 2021;73(3):542–4.
doi: 10.1093/cid/ciaa1289
pubmed: 32857838
Pai M, Kasaeva T, Swaminathan S. Covid-19’s devastating effect on Tuberculosis Care — a path to recovery. N Engl J Med. 2022;0(0):null.
Ghosh S, Moledina N, Hasan MM, Jain S, Ghosh A. Colossal challenges to healthcare workers combating the second wave of coronavirus disease 2019 (COVID-19) in India. Infect Control Hosp Epidemiol. 2021;1–2.
Behera D, Behera RK. COVID-19 & the National Tuberculosis Elimination Programme of India. Indian J Med Res. 2021;153(5–6):533–6.
doi: 10.4103/ijmr.IJMR_2763_20
pubmed: 34643563
pmcid: 8555605
Guest G, Namey EE. Public Health Research Methods [Internet]. 1 Oliver’s Yard, 55 City Road London EC1Y 1SP: SAGE Publications, Inc.; 2015 [cited 2024 Jan 9]. https://methods.sagepub.com/book/public-health-research-methods .
World Health Organization. Workload Indicators of Staffing Need - User’s manual [Internet]. 2010 [cited 2022 Apr 21]. https://www.who.int/publications-detail-redirect/9789241500197 .
India National TB Elimination Program. Tuberculosis Unit [TU] | Knowledge Base [Internet]. [cited 2022 Jun 3]. http://ntep.in/node/1528/CP-tuberculosis-unit-tu .
Central TB, Division India. Nikshay. [cited 2022 Apr 29]. Dashboard::Nikshay Reports. https://reports.nikshay.in/ .
Central TB, Division, Ministry of Health and Family Welfare. India TB Report 2022: Coming Together to End TB Altogether [Internet]. New Delhi, India: Central TB Division; 2022 Mar p. 145. http://www.tbcindia.gov.in .
Sousa A, Scheffler RM, Nyoni J, Boerma T. A comprehensive health labour market framework for universal health coverage.:3.
Pratley P, Dong D, Bhatnagar A, Mutasa R, Dieleman M, Kumar V. Evidence Based Assessment for Planning and Management of Human Resources for Health to meet national tuberculosis elimination program targets in India. The World Bank Group, Oxford Policy Management, Central TB Division India, National Health Systems Resource Center, KIT Royal Tropical Institute; Publication Forthcoming.
Global tuberculosis. report 2021 [Internet]. [cited 2022 Apr 29]. https://www.who.int/publications-detail-redirect/9789240037021 .
Guidance note bi. -directional TB and COVID screening.pdf.
Cuevas LE, Santos VS, Lima SVMA, Kontogianni K, Bimba JS, Iem V, et al. Systematic review of pooling Sputum as an efficient method for Xpert MTB/RIF tuberculosis testing during the COVID-19 pandemic. Emerg Infect Dis. 2021;27(3):719–27.
doi: 10.3201/eid2703.204090
pubmed: 33622482
pmcid: 7920689
Forbes India [Internet]. [cited 2022 Apr 29]. Forbes India - ASHA Workers: The Underpaid, Overworked, And Often Forgotten Foot Soldiers Of India. https://www.forbesindia.com/article/take-one-big-story-of-the-day/asha-workers-the-underpaid-overworked-and-often-forgotten-foot-soldiers-of-india/69381/1 .
Creswell J, Khan A, Bakker MI, Brouwer M, Kamineni VV, Mergenthaler C, et al. The TB REACH Initiative: supporting TB elimination efforts in the Asia-Pacific. Trop Med Infect Dis. 2020;5(4):164.
doi: 10.3390/tropicalmed5040164
pubmed: 33114749
pmcid: 7709586
Wandwalo E, Kamara V, Yassin MA, Morrison L, Nwaneri NB, Asiimwe S, et al. Enhancing tuberculosis case finding in Tanzania: implementation of a quality improvement initiative. Public Health Action. 2020;10(2):57–9.
doi: 10.5588/pha.19.0065
pubmed: 32640006
pmcid: 7316434
Field Guide 3. Finding Missing People with TB in Communities | Stop TB Partnership [Internet]. [cited 2022 Apr 29]. https://www.stoptb.org/field-guide-3-finding-missing-people-with-tb-communities .
Field Guide 4. Intensified TB Case Finding at Facility Level | Stop TB Partnership [Internet]. [cited 2022 Apr 29]. https://www.stoptb.org/field-guide-4-intensified-tb-case-finding-facility-level .
Official Website Ayushman Bharat | HWC [Internet]. [cited 2022 Apr 29]. http://ab-hwc.nhp.gov.in/ .
CDC. Centers for Disease Control and Prevention. 2020 [cited 2022 Apr 29]. Coronavirus Disease 2019 (COVID-19). https://www.cdc.gov/coronavirus/2019-ncov/global-covid-19/task-sharing.html .
PHMC-BOOKLET-2022. pdf [Internet]. [cited 2022 Apr 29]. https://nhm.gov.in/New_Update-2022-23/NHM-Guidelines/PHMC-BOOKLET-2022.pdf .
Kumar DP, Anupama A. Establishment of Public Health Management Cadre in India and guidelines for implementation – 2022. 2022.
Public Health Management Cadre. | National Health Systems Resource Centre [Internet]. [cited 2022 Apr 29]. https://nhsrcindia.org/public-health-management-cadre .