Introduction

The COVID-19 pandemic ravaged health systems around the world with countries struggling to cope with the rapid surge of cases and the after-effects. India is the second worst-hit country and is on track to surpass Brazil given its massive population of 1.3 billion and the relaxation of containment measures such as lockdowns [1]. The predicted peak in India was delayed by an estimated 34 to 76 days, due to the eight-week lockdown [2]. This period allowed the government to strengthen the public health system to respond to the pandemic by shoring up resources and infrastructure. Despite a reduction in cases by 60% with lockdown measures and pandemic response preparedness, projections by some researchers indicate that there could be inadequate isolation beds, intensive care unit (ICU) beds, and ventilators within 3 to 5 months [3]. Streamlining the workflow for rapid diagnosis and isolation, triaging, clinical management, and infection prevention is important, not only for COVID-19 patients but also for other patients who are at risk of nosocomial transmission.

India had a dramatic rise in COVID-19 cases and deaths in April 2021 and in the first half of May 2021. The cases peaked around mid-May and the deaths peaked in late May. The country recorded the second-highest number of cases in the world with estimates of at least 31,613,993 reported cases and 4,23,810 reported deaths by July 31, 2021 [4]. The projections for estimated deaths due to COVID-19 till December 1, 2021, were 4,51,063 as per official estimates and 12,65,887 if the unreported deaths were included [5]. Thus, the public health system in India clearly needs to be better prepared to handle future surges.

The sudden surge in COVID-19 cases during the second wave in India highlighted the lack of preparedness for critical care in terms of infrastructure and human resources at the state, district, and sub-district levels. Efforts to build resilient and responsive health systems were the need of the hour. It was critical to ensure that the health system is well prepared to handle the current COVID-19 pandemic and similar future threats. The challenges to the healthcare system during the second wave of COVID-19 included overstressed human resources in tertiary facilities, lack of trained healthcare workers and infrastructure at secondary-level facilities, and a shortage of beds, ventilators, oxygen, and medicines at COVID care facilities. As many as 52.8% of the healthcare workers were reported to have COVID-19 pandemic-related burnout [6]. Other challenges were lack of resources/capacity for setting up ICUs, unutilized ICU equipment at secondary-level facilities, and lack of operational planning, coordination, and support.

Jhpiego’s Innovative Response for Critical Care Management of COVID-19 Patients in India Through RISE Project

Through the Reaching Impact, Saturation, and Epidemic Control (RISE) Project, Jhpiego got an opportunity to work closely with various state governments to respond quickly to critical care management of COVID-19 patients in India. RISE is a 5-year global project funded by the U.S. Agency for International Development (USAID). RISE works with countries with the aim of achieving by 2024 a shared vision of attaining and maintaining epidemic control with strong local partners capable of managing and achieving results through sustainable, self-reliant, and resilient health systems.

During the first wave of COVID-19 in June 2020, USAID’s RISE project provided technical assistance to 29 facilities in 15 states and 3 union territories. Two hundred ventilators were provided by the US Government through the Government of India. Since the majority of the facilities were regional, the All India Institute of Medical Sciences (AIIMS) and other medical colleges could act as centers of excellence for capacity building and strengthening critical care management of COVID-19 patients for other networked COVID care facilities. Since the care of severely ill COVID-19 patients requires a multidisciplinary approach that ensures coordinated and comprehensive utilization of skills, knowledge, and expertise of various cadres of health professionals involved in care, it was decided to create institutional mechanisms for critical care decision-making by setting up critical care working groups (CCWGs) and by establishing a mechanism for the continued utilization of ventilators. The members of CCWG were representatives from the departments of anesthesiology, medicine, pediatrics, pulmonology, psychiatry, ophthalmology, obstetrics, and gynecology among others.

A “Hub and Spoke” model was employed to train and mentor approximately 350 networked COVID care facilities for building the critical care capacity of more than 12,000 critical care providers including doctors, nurses, counselors, and technicians by the end of July 2021. This capacity-building initiative included standardizing care through hands-on training, clinical case discussions, and stress management sessions. In order to ensure the sustainability of these capacity-building and knowledge management initiatives, RISE joined hands with the World Health Organization (WHO) Collaborating Center for Emergency and Trauma. RISE also developed technical resources including standard operating procedures (SOPs) and information, education, and communication (IEC) material.

The project was able to harness and leverage the expertise of premier institutions like the Johns Hopkins University (Baltimore, USA), the WHO Collaborating Center for Emergency Care, the All India Institute of Medical Sciences (AIIMS), Delhi, several regional AIIMS, the North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, the Mahatma Gandhi Institute of Medical Sciences (MGIMS), Wardha, and the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, as capacity-building hubs to reach out to field-level COVID dedicated facilities that were designated COVID health centers (DCHCs) across various states.

The RISE project worked closely with the national training hubs to conduct training on various topics. A few of these are listed in Table 1.

Table 1 Types of capacity-building initiatives
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Table 2 Details of e-grand rounds conducted by RISE in collaboration with the CCWG of respective facilities, July 2020 – July 2021
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Besides the established seven hubs, in consultation with various states, additional hubs are in the process of being developed by the RISE team in all the intervention states. The Maharashtra Government is keen to establish 8 state-level hubs to build the capacity of all public and private sector facilities using the Hub and Spoke model.

Going forward for the next two years, the USAID-RISE Project intends to support and strengthen the states’ response to the impact of the current and future waves of COVID-19 across 20 states by building a resilient and responsive health system that is well prepared to handle future waves and other threats at secondary- and tertiary-level facilities.

The RISE project has a pan-India approach. It plans to work with 20 states namely Andhra Pradesh, Assam, Chhattisgarh, Delhi, Goa, Gujrat, Haryana, Himachal Pradesh, Jharkhand, Karnataka, Kerala, Madhya Pradesh, Maharashtra, Odisha, Punjab, Rajasthan, Tamil Nadu, Telangana, Uttarakhand, and West Bengal and to respond to other states that emerge as high burden COVID-19 states or have an urgent need for technical assistance (TA) to respond to COVID-19. RISE is also supporting the training hubs at AIIMS, Patna, and NEIGRIHMS in Bihar and Meghalaya, respectively. Thus, apart from the 20 direct intervention states, RISE ensured capacity-building support to 8 other states (Figs. 1 and 2).

Fig. 1
A map of India. Spoke state of N E I G R I H M S includes Sikkim, Arunachal Pradesh, Nagaland, Manipur, Mizoram, and Tripura. Intervention states of the hub-n-spoke model include Bihar and Meghalaya. Intervention states of COVID-19 response include all states except Ladakh, Uttar Pradesh, and Jammu Kashmir.

Source RISE COVID response coverage

RISE COVID response coverage—Intervention states.

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Fig. 2
An illustration of Strategic T A and expansion support. Below are infographics for building state-level oxygen, building the healthcare workforce, enhancing lab capacity, improving vaccine coverage, and strengthening the B M W management system. Below is a bi-directional arrow labeled cross-sectoral partnerships.

Source RISE COVID response

RISE COVID response—Goals and objectives *In the states of Meghalaya and Bihar, the established hub of NEIGREIHMS supports the spoke facilities in the northeast, and AIIMS, Patna supports the spoke facilities in Jharkhand and Bihar.

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Hub and Spoke Model

The plan is to reach out to more than 4,000 secondary and tertiary healthcare facilities in both the public and private sectors by scaling up the robust and sustainable “Hub and Spoke” model that was developed to respond to the first wave of the pandemic.

During the first wave, the hubs disseminated their knowledge, practice, and experience in managing COVID-19 patients to other facilities, the spokes. In the coming months, RISE intends to provide technical assistance to secondary and tertiary care facilities through the proposed hubs to build their capacities in the areas of critical care management of COVID-19 patients, medical oxygen and oxygen delivery equipment management, and the rational use optimization of laboratory capacity and testing capabilities for COVID-19 and other emerging pathogens, strengthening vaccination sites, improving vaccination coverage, and managing biomedical waste.

Improving Vaccine Coverage

By the end of July 2021, 420 million (26% of the total population) had received at least one dose of the vaccine. Only about 91 million (7%) had received both doses [7]. The vaccination sites were facing challenges related to session planning, vaccine supply, vaccine wastage, and adverse effects following immunization (AEFI) [8]. Additionally, many sub-populations were hesitant to accept vaccination, deterred by legitimate concerns and misinformation spread by those with anti-vaccination and other socially disruptive agendas [9]. Jhpiego’s own social media research in Delhi and Mumbai showed that over 30% of social media users were hesitant because they had concerns about the side effects of vaccines.

RISE intends to improve vaccine coverage through effective planning and operational support for vaccine delivery. It will implement strategies for infection prevention control (IPC) and training programs to support the monitoring and management of AEFI. RISE is working to achieve this strategic objective in the network of intervention facilities by strengthening existing vaccination centers through capacity building with a special focus on reducing vaccine wastage, infection prevention, safe injection practices, improving AEFI management, and enhancing data use for evidence-based planning. This also includes ensuring COVID appropriate behavior by providers and beneficiaries to minimize the risk of any vaccination activity becoming a super-spreader event. RISE is working toward utilizing existing digital solutions in improving the quality of vaccination services. The project is engaging with various professional bodies to enhance the role of the private and non-government sectors and to build the capacity of the private sector in AEFI management as per Government of India guidelines. While there is an effort to improve reporting and investigation of AEFI cases through the existing Co-WIN platform, the project is also exploring opportunities for deploying digital solutions to strengthen systems for AEFI data capture and collation. The project aims to support AEFI monitoring and improve AEFI management and referral.

As a part of the response to addressing the issue of vaccine confidence, RISE is initiating a rapid formative research/listening session/rumor monitoring of both traditional and social media as well as communication planning and evaluative research on the effectiveness of messages. RISE plans to conduct sentiment analysis and social listening focused on COVID-19 vaccination across five cities of India covering five geographical areas—North, South, East, West, and Central. Based on the findings of this assessment, RISE will identify potential informers and messages and use them for broader social media campaigns to address vaccine misinformation and improve vaccine confidence. RISE intends to engage with community-based organizations and faith-based organizations to address vaccine hesitancy and improve vaccine confidence. It will use existing communication strategies for improving vaccine confidence in the networked facilities to ensure that the messages are effective in promoting the uptake of safe and efficacious vaccines. The project is also promoting COVID appropriate behavior and respiratory etiquette through effective communication.

Strengthening Oxygen Ecosystem

Recently, the Government of India received and deployed oxygen delivery equipment including cylinders, oxygen concentrators, and pressure swing adsorption (PSA) plants. However, there are challenges related to the optimal utilization of oxygen produced and the delivery equipment because of systemic and competency gaps that could affect the management of oxygen at the facility level during future surges.

During the surge, there was insufficient production of medical oxygen and insufficient availability of containers and cylinders for transport and use of the existing supply which led to significant patient mortality [9]. There is, therefore, a need to build oxygen production and supply chain networks for a future surge.

RISE intends to build state- and facility-level oxygen ecosystem capacity by providing training and operational and coordination support. RISE is identifying partners and innovations within the oxygen ecosystem to amplify existing activities and develop data-informed management systems. RISE will work with partners in the networked facilities to understand hospital capacity including critical oxygen capacity by conducting a pragmatic assessment of the facilities. Through these partners, RISE will train technicians and healthcare workers on the operations and maintenance of the oxygen delivery equipment and will develop a toolkit for capacity building of healthcare workers on oxygen equipment and the hygienic use of equipment so that the state-level facilities can sustain this initiative beyond RISE’s presence. RISE also plans to support the facilities for operationalizing and maintaining oxygen delivery equipment that was received during the surge including that which was received from the US Government.

To ensure systemic resilience, RISE will develop modules, provide training to district and state program management units, and conduct trainings of trainers at the hub facilities for capacity building of stakeholders on the oxygen ecosystem including sources, supply, safety, maintenance, operations, costing, specifications, conversion factors, vendor landscaping, operationalization and maintenance of oxygen delivery equipment, rational and hygienic use of oxygen, monitoring of PSA post-operationalization, and oxygen quality testing protocols.

The project will develop digital solutions to manage the oxygen supply chain for oxygen equipment management, transportation, and distribution tracking while piloting initiatives on energy-efficient and environment-friendly solutions. The project will provide digital solutions such as the creation of dashboards to showcase the capacities of mapped facilities (hub and spoke facilities) for quick referrals as per need. It will also support a national oxygen grid system for private and public health facilities to ensure sustained oxygen supply during future surges.

Strengthening Competency and Resilience of Healthcare Workforce

While there has been a rapid increase in investment in the infrastructure of secondary care facilities to capacitate them to manage the surge of cases, the lack of a sufficient healthcare workforce trained in critical COVID-19 management and respiratory care (doctors and nurses) remains a critical bottleneck [10]. There is also a lack of capacitation of those working in these understaffed facilities, i.e., standardized guidelines on procedures and processes and knowledge of clinical case management for providing secondary care. There is an urgent requirement for comprehensive and technology-enabled capacity-building platforms for critical care that are scalable and sustainable. Additionally, with the pandemic stretching into the second year, the healthcare workforce is overstretched and is facing physical and psychological exhaustion [11].

The overwhelming burden of COVID-19 illness stressed the capacity of the health system and had adverse effects on healthcare workers including the risk of infection. Considering the prevailing scenario, the need of the hour is to build the capacities of the existing healthcare workforce and equip it with the knowledge and skills for providing quality healthcare. The capacity of the existing workforce can be strengthened by adopting mechanisms to establish and strengthen the training ecosystem in the intervention states for the critical care of adults and children using the Hub and Spoke model, implementing e-curricula, and creating a knowledge hub.

The primary focus of the RISE program in the first wave was healthcare workforce capacitation through training using a Hub and Spoke model. Therefore, RISE leveraged its learnings from the first phase to build healthcare workforce capacity through training for COVID-19 and acute hypoxia. The training was provided to use a combination of hub and spoke model-based classrooms, hands-on learning experiences, e-curricula, and competency-based training approaches. RISE implemented a knowledge management strategy that integrates collaborative learning and adapting (CLA) practices during the program cycle. RISE started to engage and train providers on critical care of adult and pediatric COVID-19 patients while continuing to work with existing hubs. The project is developing and curating educational material along with the hubs to facilitate capacity-building initiatives for COVID-19 case management for healthcare providers at the spokes.

The project is working with several agencies to disseminate high-quality onsite and virtual simulation-based and skills-based learning resources (workshops and courses) such as the WHO Basic Emergency Care (BEC) Course, the WHO Essential Critical Care Course, E-mentoring sessions, and clinical case-based discussions in partnership with the JHU Center for Emergency Care and Clinical Global Health Education. Because of the fear that the third wave may affect children, many states have requested pediatric courses. RISE worked with one of its hubs, NEIGRIHMS, to develop a month-long virtual pediatric ICU certificate course series which was attended by more than 1,000 participants from across eight North Eastern states of India. RISE is also working with other agencies to curate and standardize learning resource packages (LRPs) for pediatrics critical care that can be used by other states. Workforce resilience training is also being introduced in collaboration with specialized institutions such as the National Institute of Mental Health and Neurosciences (NIMHANS).

RISE is working with a partner agency to conduct demand modeling to identify capacity-building needs during the surge and provide modeling tools to sustain the planning and preparedness process. The project aims to strengthen critical care services in the network of facilities with unutilized or understaffed ICUs and other facilities that are seeing surges in patient loads through remote ICU solutions (tele ICU). Cognizant of the involvement of faith-based organizations in the care of COVID patients during the surge, RISE plans to facilitate catalytic grant funding support to these facilities for activities such as upgrading the physical and medical infrastructure to provide COVID-19 treatment to vulnerable and marginalized communities.

Within two months of the second phase, RISE had conducted 26 capacity-building events [13 virtual and 13 onsite] reaching out to more than 3,000 participants. Apart from the one-month certificate course on Pediatric Intensive Care Unit (PICU) by NEIGRIHMS, RISE partnered with the Government of Bihar to provide training of trainers (ToT) on critical care for COVID-19 at the knowledge hub, AIIMS, Patna, for all designated COVID health centers (DCHCs) and designated COVID hospitals (DCH) of the state. By the end of July 2021, RISE had associated with 11 hubs and more than 4,000 spoke facilities in collaboration with the state governments.

Enhancing Laboratory Capacity for COVID Testing

The fundamental principle to counter any infectious epidemic is to detect/isolate/treat/manage cases early and prevent the occurrence of new cases. In the absence of an effective treatment for COVID-19, prevention is the best strategy which involves testing. In a diverse country like India, for inclusive and equitable access to testing, optimization of resources based on the evolving epidemic was an essential part of sustainable scaling up. As the epidemic evolved, India’s testing strategy underwent iterative calibration to keep pace with the changing epidemiology and the extent of the infection. In the current response to COVID-19, a limited number of reverse transcription-polymerase chain reaction (RT-PCR) laboratories, lack of competent laboratory personnel, and unorganized laboratory processes led to delays in reporting. With an increased focus on the whole genome sequencing (WGS), the challenges are expected to increase in terms of sample collection, processing, transport, and testing quality [12].

RISE is working toward enhancing laboratory capacity in the networked facilities to improve efficiencies and support the scale-up of testing capabilities for COVID-19 and other emerging pathogens. The project will map RT-PCR machines in the public and private sectors that can be used for the scale-up of testing facilities, develop strategies for repurposing existing tuberculosis diagnostics, support the supply chain, undertake the gap analysis, and plan for test kits and laboratory consumables. Strategies are implemented to enhance and empower laboratories, including the dissemination of guidelines and SOPs to laboratories engaged in COVID-19 testing and training healthcare workers on sample collection safety, maintenance of samples, and the appropriate use and interpretation of test results. RISE is in partnership with several agencies for undertaking capacity-building initiatives to familiarize the laboratory workforce with the use of RT-PCR machines, collection and processing of samples, safety measures, biomedical waste management, and laboratory information management systems and also in the effective implementation of national testing guidelines including guidance on genome sequencing and quality management of laboratories.

RISE is working with partner agencies for developing and disseminating a capacity-building toolkit/SOPs/guidance document for the hubs to undertake the training of laboratory personnel on collection, storage, and transportation of samples (triple layer sample packaging, handling dry ice, and infectious clinical material) and decontamination procedures in case of sample spillage during transportation of COVID genomic surveillance. Through a collaborative effort, RISE intends to improve the efficiency of COVID testing laboratories by bridging the gaps in the supply chain and the quality management system (QMS). This technical assistance also involves helping them monitor data on testing capacity, number of tests performed, consumption of commodities, usage rates per test, stocks, and expiries. RISE is working toward the development of digital solutions to improve efficiencies in the existing testing and reporting mechanisms.

Strengthening Biomedical Waste Management

An unprecedented outcome of personal protective equipment (PPE) such as masks, eye wear, and coveralls not only for clinical and paraclinical care providers, but also for patients and their family members has been the generation of biomedical waste which rapidly overwhelmed the resources that the health system had at its disposal [13]. Apart from the fact that the generation of BMW increased exponentially, many healthcare staff who were dealing with waste management were unaware of the updated guidelines to process BMW adequately.

RISE intends to improve biomedical waste management (BMW) processes and practices by streamlining BMW collection, storage, transport, and disposal in the network of RISE facilities. The project will continue to implement existing WHO courses. It also proposes to implement case-based e-learning courses targeted at supporting applied BMW management in India. While RISE will develop appropriate Livelihood Restoration Plan (LRP), information, education, and communication (IEC) material, and job aids for capacity building and ensuring adherence, it will also support a network of facilities to plan and strengthen BMW management, national quality assurance standards, and will standardize COVID-19 SOPs and guidelines. The project will adapt the government guidelines and develop SOPs for the safe collection, storage, transport, and disposal of biomedical waste from the point of generation to the point of final processing (in-house or through common waste treatment facilities).

Building Cross-Sectoral Partnerships for Large-Scale Response

As the pandemic began to spread in India, international not-for-profit organizations like Jhpiego stepped in immediately to support the government at the national and state levels with innovative strategies, technical assistance, and field-based support to deal with this public health emergency. RISE also worked actively with other agencies to facilitate cross-sectoral partnerships with public, private, and faith-based organizations to scale up and amplify response capabilities.

A “Learning Laboratory” Approach: Model COVID-19 Care Clinics

Considering the emergency nature of the interventions, almost a pan-India presence, proposed rapid scale-up, a leaner project team structure, dependence on the hubs for the delivery of capacity-building interventions, and a large number of secondary and tertiary facilities (to be engaged through the “Hubs and Spokes” model) to undertake monitoring, mentoring, and supervisory opportunities, made it difficult to understand the facility-level gaps and challenges and the facilitators and barriers to effectively translate capacity-building interventions into practice and eventually improve patient care [14]. RISE used a learning laboratory approach to test effectiveness and to develop a deeper understanding of the perceived limitations (mentioned above) of technical assistance to provide coordinated technical assistance and facilitate implementation support to 40–50 facilities in 3–4 districts (one district each from Jharkhand, Madhya Pradesh, Assam, and Telangana). The learning laboratories ensured coordinated and facilitated support for the implementation of proposed activities at the facility level under RISE. They were provided with one dedicated district officer per district to facilitate uniform implementation across all the identified facilities, a counselor, and a medical assessment coordinator to facilitate quick triaging and appropriate counseling of the suspected and confirmed COVID-19 cases. These human resources ensured focused monitoring, mentoring, supervisory support, and forward referral linkages for effective management and hand-holding support for periodic assessments, recordings, and reporting.

These learning laboratories provide a deeper understanding of the facility-level gaps and challenges and various facilitators and barriers for the effective translation of capacity-building interventions into practice. They also assessed the effects of coordinated and facilitated support for overall outcome/impact and for establishing a feedback loop to facilitate the iterative project development process.

Outcome and Insights

  1. 1.

    The capacity-building initiative through the Hub and Spoke model led by the management of hubs as well as CCWG was appreciated by the national and the state governments. It was observed that all CCWGs were actively involved in taking forward this initiative despite their very busy schedules and priorities. We strongly feel that this has now become their initiative and is, therefore, likely to be sustained beyond Jhpiego technical assistance.

  2. 2.

    E-grand rounds as well as clinical case discussion series were found to be very useful for both the faculty and the participants. There was the active involvement of presenters as well as of participants.

  3. 3.

    RISE generated tremendous interest among tertiary care facilities to develop SOPs, competency-based training, and mentoring of lower-level facilities. The State Government of Bihar (Office of Additional Chief Secretary, Health, Government of Bihar) issued an official letter appreciating the Critical Care Working Groups (CCWGs) in medical colleges, district hospitals, and sub-divisional hospitals across all the districts in the state. With the support of the CCWG team, AIIMS, Patna, and the RISE project mentors these facilities (Fig. 3).

    Fig. 3
    A block diagram depicts the ways to strengthen the health system for the management of COVID-19 in India. It includes high-level strategies like improving vaccination coverage, enhancing lab capacity and building a cross-sectoral partnership to yield immediate, mid-term, and long-term outcomes.

    Source RISE COVID response

    RISE COVID response: Theory of change.

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Box 1 Training of trainers on critical care in COVID-19 at AIIMS, Patna

RISE India, in collaboration with AIIMS, Patna, organized 7-day state-level training of trainers on the critical care program for COVID-19

With the unprecedented surge of cases during the second wave of COVID-19 and the impending third wave, additional healthcare workers and nursing staff from various healthcare facilities needed to be mobilized to manage the surge more efficiently and effectively (20). With a shared vision of attaining and sustaining the control achieved over the pandemic, the All India Institute of Medical Sciences (AIIMS), Patna, in collaboration with the USAID-funded and Jhpiego-led RISE program, supported the Government of Bihar to build the capacity of healthcare providers in critical care services. AIIMS, Patna as a Center of Excellence, provided training to over six batches thus reaching out to 234 participants across all the 38 districts in Bihar. These became master trainers for their respective districts. This training was facilitated by the Critical Care Working Group (CCWG) of AIIMS, Patna.

A collage of six photographs. The top panel has photos of people with face masks in a lab, a group of people who pose with a certificate on a dais, and a group of healthcare providers in front of a machine. The bottom panel has photos of people seated in a theatre and demonstrating a human dummy.

The 7-days Training of Trainers program for the first batch was initiated on June 16, 2021 in the august presence of Hon’ble Minister of State for Health and Family Welfare, Government of India, Shri Ashwini Kumar Choubey, Hon’ble Minister of Health, Government of Bihar, and other dignitaries. These trainings were facilitated by the AIIMS, Patna and the CCWG team and was a mix of classroom-based and hands-on ICU-indoor training for COVID-19 critical care.

This capacity building initiative was welcomed by the state government of Bihar and received appreciation from Hon’ble Minister of State for Health and Family Welfare, Government of India, Shri Ashwini Kumar Choubey, who said that the training will prove to be a milestone in the comprehensive management of not only COVID-19, but also for patients suffering from other critical illnesses.

Four images. The image on the left is a letter in a foreign language. The next three images are screenshots of social media posts.

The intervention also received wide media coverage in the local media, both print and television. The news articles highlighted the importance of the training organized by CCWG team at AIIMS, Patna in collaboration with the USAID/RISE program in preparation for the anticipated third wave of COVID-19 pandemic as well as for standardizing critical care across facilities. The capacity building initiative also received good coverage on social media, including tweets from the Minister of State for Health and the Family Welfare, GoI, and the Minister of Health, Government of Bihar. The official twitter handle of AIIMS, Patna also covered the training extensively.

Note: Images from the trainings at AIIMS, Patna.

Box 2 JHU RISE case series

The session under the John Hopkins University and USAID RISE Clinical Case Discussion Series on COVID-19 was held on July 9, 2021 in collaboration with the All India Institute for Medical Science (AIIMS), Rishikesh. It focused on COVID-19 related respiratory failure and mechanical ventilation. The bi-weekly clinical case discussion series on COVID-19 was developed with the aim to combat misinformation and lack of evidence-based practices by leading the discussion with internationally recognized thought leaders. The session was followed by a detailed review of the topic including slides and synopsis, pre- and post-session surveys. The participants were provided relevant literature sites, complementary resources, relevant reference guidelines/protocols, and job aides. The virtual session was attended by 306 participants including 270 critical care providers (90 doctors, 167 nurses. and 16 paramedics) across 27 states and 2 union territories in India.

Two screenshots of an online meeting. The top right displays a video of a person who makes the presentation on the proposed treatment approach.

Way Forward: Toward Resilient Healthcare Systems

Healthcare system resilience is defined as the capacity of the health system to prepare for and effectively respond to crises, maintain essential functions when a crisis hits, be informed by lessons learned during the crisis, and reorganize if conditions require it to do so (15). Health systems are resilient if they protect human lives and achieve good health outcomes for all during a crisis and in its aftermath. Response to a crisis, be it a disease outbreak or any other disruption resulting in a surge of demand for healthcare (e.g., a natural disaster or a mass casualty event), needs both a vigorous public health response and a highly proactive and functioning healthcare delivery system.

Beyond the acute phase of COVID-19, where the focus has largely been on mitigation and preparedness for the pandemic, Jhpiego implemented the RISE program with the aim of providing technical assistance for building resilient healthcare systems through capacity building, better coordination, and more importantly, facility-level and state-level capacitation to prevent, detect, and respond to infectious diseases in line with global guidance and international health regulations. Jhpiego plans to provide technical assistance for health workforce protection by enhancing the technical knowledge and skills of healthcare teams; supporting competency development; advocating for task-shifting/task-sharing; developing an enabling policy environment; facilitating the provision of adequate personal protective equipment; and ensuring the mental wellbeing of healthcare providers.

Jhpiego’s goal is to save lives, improve health, and transform the future of women, children, families, and communities. It continues to partner with governments, health experts, and local communities to build systems that guarantee a healthier future for women and families. Through these partnerships, it continues to build more resilient healthcare systems that are better prepared to deal with health emergencies and can protect all, especially the most disadvantaged and vulnerable communities.