Simple strategies if adopted by the Tamil Nadu health system can foster trust and confidence, which is very much needed during this crisis.
A robust risk communication strategy that strikes a balance between transparency and avoiding unnecessary panic among the people must be evolved to promote trust and confidence building (Vijaykumar and Raamkumar 2018). Such a transparent communication provides credible information to the people. This helps people perceive the seriousness of the situation and cooperate with the public health interventions. The Tamil Nadu health system brings out a daily news bulletin and shares it with the media. Ensuring that this line of open and transparent communication is continued is particularly important. Close attention to the words used in reporting, the flow of provision of information, avoiding unnecessary sensationalism and providing accurate facts are strategies that can attempt to strike this delicate balance. In the background of a past history of lack of transparency described in the previous section, demonstration of the openness of information is very important to nourish trust.
The interventions that the state is adopting to control the pandemic must be backed by sound evidence and must be scientifically valid. If not, it will lead to harm to the people and cause gross trust erosion. Use of evidence-based interventions generates a feeling among people that whatever interventions that are being provided are well intentioned.
There is significant social stigma associated with being identified as a patient with COVID-19 (Ramakrishnan 2020). The health workers visit the home of the patient, paste stickers on their door indicating that it is a quarantined house, mark an indelible seal on the hand of the quarantined person and carry out disinfection activities in and around the house of the patient. These interventions invade the privacy of individuals and breaches confidentiality of the health information of the people. It subjects people to shame and stigmatization. This is likely to prevent more and more people from reporting their symptoms and not coming forward for testing in order to escape the stigma associated with the disease. On one hand, these interventions are important to contain the rapid spread of the infection; they also force people to hide from the system out of fear of shame and stigma. This can heavily impact on the success of the containment strategies. Preventing public display of the details of infected persons, protecting the privacy of the infected to the maximum extent possible, treating the infected person with respect and dignity and ensuring equal treatment of all people who are infected can promote trust.
Community engagement can be carried out for most public health interventions (Schoch-Spana et al. 2007). Community-based active surveillance in the containment areas by volunteers, community-based quarantine and isolation facilities with active community participation, community policing of lockdown measures and distribution of lockdown relief materials through local leaders are all potential community engagement strategies, all of which can encourage trust and promote cooperation. Community engagement helps to ensure a sense of ownership of the intervention by the community. It also ensures that the interventions are appropriate and acceptable to them. Community engagement gives voice to the affected community and therefore helps to adopt the public health interventions to the values and preferences of the people.
Primary care services are fundamental rights as they address social determinants of health and are basis to the health and well-being of the people. Therefore, there is an ethical imperative to build a resilient health system that can continue to offer routine primary care services such as maternal and child health services, immunization and non-communicable disease services (Martineau 2016). The state has taken several measures to ensure the uninterrupted maternal and child health services and services for non-communicable diseases such as diabetes and hypertension. Women who are due for delivery have been enumerated and the system sends ambulances to the homes of these women to pick them up and drop them back after safe delivery in a hospital. Similarly, patients on haemodialysis as well as cancer chemotherapy are picked up and dropped in their homes to ensure uninterrupted services (Chandna 2020). These interventions help foster confidence and trust. However, these services do not reach everyone in the state, and those who do not receive these services develop a sense of being let down by the system and experience an erosion of confidence. Building a resilient health system that withstands the stress of such pandemics and continues to offer regular services is an important measure to build trustworthiness.