A STUDY ON AWARENESS OF HEALTH CARE

SERVICE IN PRIVATE SECTOR

 OVERVIEW
In Many Developing Countries, When People First Seek Diagnosis And Treatment For An Illness They Visit A
Private Pharmacist, Nurse, Midwife, Doctor, A Drug Seller Or Traditional Practitioner. People Use These
Private Sector Providers (Peps) Because They Are Often Nearer, Open For Longer Hours, And Are Seen As
More Considerate And Sometimes Less Expensive Than Their Public Sector Counterparts. Psps Are Often A
Significant Part Of The Health System In Developing Countries. Consequently, They Are An Important Focus
For Governments Which Aim To Improve The Performance Of Their Health System. Poor People In Particular
Visit PSs For Diagnosis And Treatment Of Illness, Including Those Illnesses Which Contribute Most To The
Population Disease Burden, Such As Malaria, Sexually Transmitted Infections, Diarrhoea And Tuberculosis.
They Often Pay Out Of Their Own Pockets For Health Services And Products From Psps As They Are Not
Generally Members Of Pre-paid Health Schemes. Poor People Are Thus Both Vulnerable To The Drain On
Their Resources Resulting From Ineffective Treatment And To The Sometimes Catastrophic Costs Of Serious
Illness. Both May Lead To Further Impoverishment.
 INTRODUCTION
India Braces For The COVID-19 Pandemic; Healthcare Workers On The Frontlines Are Particularly Vulnerable To This
Infection. The Virus That Causes COVID -19 Was Initially Called As 2019-ncov And Was Then Termed As Syndrome
Corona Virus 2 (SARS-COV-2) By The International Committee On Taxonomy Of Viruses (ICTV). It Is A New Strain
Discovered In 2019 Which Was Not Found Previously In Humans.
Previously, The Severe Acute Respiratory Syndrome-corona Virus (Sars-cov) And The Middle East Respiratory Syndrome-
corona Virus (Mers-cov) Have Been Known To Affect Humans. Outbreaks Of Respiratory Disease Caused By These
Viruses Seem To Have Originated In Animals Before Moving Into Other Hosts Like Humans. MERS-COV Was Found To
Be Transmitted From Arabian Camels To Humans, Whereas SARS-COV Was Transmitted From Civet Cats To Humans.
SARS-COV-2 Seems To Have Originated From Bats And First Reports Of Cases Were From Wuhan, Hubei Province In
China, Suggesting An Animal-to-person Spread From A Live Animal Market. The Virus Then Spread Outside Hubei And
Subsequently, To The Rest Of The World Via Human Transmission. Several Countries Have Now Reported Community
Spread. The World Health Organization (WHO) Declared Corona Virus Disease As A Pandemic On March 11, 2020.
 RESEARCH METHODOLOGY

This Survey Was Conducted At A Tertiary-care Hospital And Clinic In Uttar Pradesh. The Survey Was
Prepared In The Form Of An Offline Form And Was Sent To 260 Potential Responders Who Included Doctors
And Staff At Various Healthcare Institutions In The UP East Region, India. The Period Of The Survey Was
March 12-19, 2020, And A Total Of 200 Responders Completed The Survey With A Response Rate Of 76%.
The Self-administered Questionnaire Consisting Of Socio-demographic Questions, And Questions Based On
Knowledge And Infection Control Practices Related To Covid-19 Disease In The Healthcare Setting Were
Adapted From The Current Interim Guidance And Information For Healthcare Workers Published By The
Icmr, Updated On March 7, 2020. The Questionnaire Also Included Questions Related To Hand Hygiene
Techniques Based On The “Five Moments Of Hand Hygiene” Described By The WHO, Which Were Used To
Test Participants’ Knowledge In Optimal Hygiene Practices.
 SAMPLING METHOD

A Systematic Sample Was Generated In Order To Ensure A Representative Sample. This Was Possible Due To
The Random Order Of The Sample Units In The Sampling Frame. A Comprehensive List Of Private Sector
General Practitioners And Specialists Practicing In The Study Site Was Obtained From The Medical Care
Coalition, A Private Sector Doctor Grouping Database, The Med Pages’ Directory And The Doctors’ Guilds.
This Comprehensive Sampling Frame Ensured That All Medical Practitioners Practicing In The Study Area
Were Included. From The Comprehensive List After Deleting Duplication Of Doctors’ Information, The First
Doctor Was Randomly Selected; Thereafter Every Fourth Doctor Was Systematically Chosen To Compile The
100 Doctors, Study Instrument The Instrument Used Was A Self-administered Close-ended Anonymous,
Coded Questionnaire. The Questionnaire Was Divided Into Sections Using Variables To Obtain Demographic
Data Of Participants And Their Specialties, As Well As Their Knowledge, Awareness And Their Readiness
For The Proposed National Health Insurance. With Regard To Knowledge The Doctors Were Asked To Rate
Their Knowledge Of The NHI By Ticking Appropriately The Boxes Marked Excellent, Very Good, Good,
Satisfactory, Poor, Or No Knowledge.
 REQUIRED MEASURES


FREE HEALTH CARE FOR ALL HEALTH WORKERS:-
The Announcement By The Finance Minister Of A Special Life Insurance Scheme For Health Workers Is Misleading And
Insufficient. Despite An Announcement That All Health Workers Would Be Covered, The Package Covers Health Workers
In The Private Sector Only If They Are Drafted For COVID-19 Responsibilities. The Recent Case Of Health Workers
Getting Infected At The Private Facility Delhi State Cancer Institute Shows That This Is Insufficient. Further, This Is Subject
To The Numbers Indicated By Mo HFW. The Figure Of 22 Lakh Health Workers Is A Gross Underestimation Of The Actual
Size Of The Workforce In The Country, As Mentioned Earlier. The Estimate Should Be Modified Correspondingly And
Increased To At Least 40 Lakh Health Workers And The Omission Of Healthcare Workers In The Private Sectors Needs To
Be Corrected Immediately To Avoid The Possibility Of Denial Of Compensation. Most Importantly, This Scheme Is Grossly
Insufficient As It Does Not Provide Any Support To Health Workers And Their Families Unless The Worker Dies. In Case
Health Workers Are Infected By COVID-19 They Should Be Given Treatment, Care And Support Free Of Cost. Considering
That Health Workers In Informal Employment Conditions Are More Vulnerable As Employers Can Hide Behind This
Informality To Deny Their Responsibility Towards Them, It Is Important That They Are Given Special Attention In This
Regard. The Latest Testing Protocol (31 March) Has Expanded Testing Only To Symptomatic Health Care Workers,
Whereas There Is Clear Evidence Of Asymptomatic Cases.
  SPECIAL COVID-19 RELATED PAID LEAVE AND
COMPENSATION
Health Workers Are At A Higher Risk Of Contracting Infectious Diseases, Which Is The Case With COVID-19
As Well. Reports Estimate Close To 100 Infections Already Confirmed In India, Though There Is No Systematic
Reporting Of This Data. As Facilities Are Short-staffed, Managements Of Facilities Are Extending Working
Hours. They Might Try To Keep Health Workers On The Job Even When They Are Already Showing Covid-19-
like Symptoms, As We Saw In Mumbai And In Bihar. Workers Who Have Tested Positive With Covid-19 Should
Not Be Asked To Continue With Their Duties If They Are Showing Symptoms. This Is Against Protocols And
Puts The Workers At More Risk Of Developing More Severe Symptoms If They Are Not Able To Rest
Adequately. Managements Of Facilities Might Also Deduct Leave Taken For Sickness Or Quarantine From
Existing Leave Provisions, And When These Are Used Up, Take Recourse To Cutting Workers’ Wages. Informal
Workers Have A Limited Amount Of Paid Leave That Will Run Out Quickly. Those On Daily Wages Do Not
Even Have Paid Leave. Special Paid Leave In Case Of Covid-19-related Sickness And Quarantine Should Be
Provided, Including To Workers On Short-term Contracts And Employed Through A Third Party. A Special
Compensation Should Also Be Announced For Health Workers Who Contract COVID19 In Line With The WHO
Definition That If Exposure To Corona Virus Sars-cov-2 Happens At The Workplace, Contracting COVID-19
Should Be Considered An Occupational Disease.
  MENTAL HEALTH SUPPORT AND THE
RIGHT TO OPT OUT
Health Workers Undergo Considerable Stress During Emergencies Such As The One We Are Facing.
Counseling And Mental Health Support Should Be Made Available For Health Workers. Breaks And Time-
off Should Be Maintained, As Healthcare Workers' Burnout Could Contribute To Both Their Catching The
Virus And Its Spread. As Per WHO Guidelines, Health Workers Should Not Be Required To Return To A
Work Situation Where There Is Continuous Or Serious Danger To Their Life Or Health. Health Workers'
Right To Opt Out Of Work When They Are Not Provided With A Safe Working Environment And Adequate
Protective Equipment Should Be Respected, Without Undue Consequences. Health Workers Who Are
Pregnant, Or Have Co-morbidities Have Higher Chances To Contract The Infection And Develop More
Severe Symptoms.
  ACTIVE INVOLVEMENT OF
REPRESENTATIVES OF HEALTH WORKERS

The Government Should Engage With Trade Unions Of Health Workers To Ensure That The Guidelines
Effectively Reach All Concerned Health Workers. For Instance, There Is A Need For Clear Information And
Training Regarding PPE Use, Disposal, And Care. Health Worker Unions Are Well Positioned To Contribute
To This Process, As They Have The Organizational Ability To Reach Out To Large Sections Of Workers
Quickly.Hence, We Urge That Different State Governments Involve Health Worker Unions In The Process Of
Information-sharing, Training, And Workers’ Safety. Facility Management Should Facilitate An Active Role
For Health Workers' Representatives In Determining Safety Measures And Safeguards Of Their Health .
  ORGANIZATION OF WORK IN
HOSPITALS THAT MINIMIZES RISK OF
EXPOSURE TO HEALTHCARE WORKERS
The Other Part Of Risk Protection Is The Proper Organization Of Work Processes That Would Limit
Hospital Infection To Patients As Well As To (All) Health Workers. This Is A Part Of Most Quality
Accreditation Programs, Such As The National Quality Assurance Standards For Public Health
Facilities And Multiple Systems For Private Healthcare Facilities. However, Only A Small Proportion
Of Facilities Are Registered Under These Frameworks. One Of The Reasons Why Kerala Has Reported
Fewer Infections Among Workers And Less Spread Of The Virus Overall Is Because It Has Much
Better Level Of Accreditation And Infection Control. The Infection Control Component Of The Quality
Accreditation Programs Must Be Implemented Universally Across States, Including In The Private
Sector, Along With A Monitoring Mechanism By The Government.
  WAGES AND EXTRA-TIME TO BE
REMUNERATED AS PER THE LAW
As Society Recognizes That Health Workers Are Contributing To The Common Good By Standing At
The Frontlines Of The Battle Against The COVID-19 Outbreak, Longstanding Violations Of Legal
Provisions With Regard To Their Wages Should Be Acknowledged And Addressed. Notifications
Should Be Issued So That Wages Are Provided As Per Existing Government Norms, And Wage
Discrimination Against Workers In Informal Employment Should Be Addressed. The Current
Budgets Of Most Municipal Hospitals And State Hospitals Are Too Small To Provide The Legal
Wages To All Workers, Which Has Been Covered Up Through Outsourcing Of Services Such As
Cleaning And Housekeeping. The Central Government Has Formalised The Central Role Of Ashas In
Containment And Community Outreach, Highlighting Once Again Their Role As An Essential
Workforce Of The State Health System.
 NEED OF PRIVATE HEALTH CARE
SERVICES
Foreigner In Increasing Numbers Are Now Coming To India For Private Health Care, They Come From
The Middle East, Africa, Pakistan, And Bangladesh, For Complex Pediatric Cardiac Surgery Or Liver
Transplants – Producers That Are Not Done In Their Home Countries. Thy Also Come From The United
Kingdom, Europe, And North America For Quick, Efficient, And Cheap Coronary Bypasses Or
Orthopedic Procedures. A Shoulder Operation In The UK Would Cost L 10 000 (S 17 460; E 14 560)
Done Privately Or Entail Several Months’ Wait Under The NHS. In India The Some Operation Can Be
Done For L 1700 And Within 10 Days Of A First Email Contact.
 CONCEPTUAL DESCRIPTION OF TOPIC
We Are Collectively Facing A Pandemic Threat That Is Sweeping Across The Humanity Beyond Oceans
And Borders. Considering The Seriousness Of COVID-19, It’s About Time We Step Up Against This
Deadly Disease. For The Sake Of Lives Lost And The Rest Of Humanity, Let Us All Pledge To Beat
Corona Back. Acknowledge The Issue, Care For Precaution, Act In The Best Health Interest Of Your
Society And Isolated, Yet Together, We Shall Hurt Corona. A Total Of 200 Responders From The Uttar
Pradesh East Zone Completed A Questionnaire-based Survey On The Awareness, Knowledge, And
Infection Control Practices Related To COVID-19 Infection In The Healthcare Setting. The Questionnaire
Was Adapted From The Current Interim Guidance And Information For Healthcare Workers Published By
The Indian Government Convenient Sampling Method Was Used For Data Collection And The Distribution
Of Responses Was Presented As Frequencies And Percentages. Descriptive Statistics Were Performed For
All Groups And Subgroups Based On The Percentage Of Correct Responses. Individual Pair Wise
Comparisons Were Done Using The Median Test For The Percentage Of Correct Responses.
 CHARACTERISTICS OF PRIVATE HEALTH
CARE PROVIDERS

Private Health Care Providers In India Can Be Divided In To The Following 4 Sub Types, Unregistered Quacks: The
Exact Number Of Quacks Is Unknown But It Is Estimated To Be More Than One Million.These Are Ubiquitous In
Rural Areas As Well As In Urban Slums Where They Are The Only Sources Of Health Care To The People Living On
The Margins Of The Society. These Quacks Described By Media As ‘Jhola Chhaps’ Are Without Any Medical
Qualification And Most Of Them Not Even Completed Their Basic Education. At The Most They Have Assisted Some
Doctor Or RMP At The Beginning Of Their ‘Career’ And This Is The Only Source Of Their Information. Because Of
Lack Of Proper Training They Usually Indulged In Many Harmful Practices Like Misdiagnosis, Misuse Of Steroids
And Antibiotics, Illegal And Unsafe Abortions, Excessive Use Of Injections And Delayed Referrals. India Does Not
Have A Comprehensive Law Against The Quackery Many States Have Different Legislation In Place But They Are
Seldom Get Implemented Registered Medical S (RMP) And Practitioners Of Indian System Of Medicine:
 RESULT
A Total Of 200 Healthcare Professionals From The UP East Region Responded To The Survey. The
Majority Of The Responders Were From The Age Group Of 30-55 Years. Approximately 76% Of The
Responders Were Responded And 24% Of The Responders Were Not Able Take Part In This Survey
Because Of Their Busy Schedule. Most Of Them Were From The City Of Ghazipur. Among The Various
Sub-groups, Few Of Them Were Surgeon, Orthopedic And Some Of Them Were Homeopathic, And Very
Were Working In Clinic Medical Staff Of The Medical Postgraduates, Fellows, And Faculty Completed The
Survey. I Have Made The Report Of Their Responses In Other Report, I Have Written Remarks Given By
Them To Fight The Corona Virus If People Start Following The Guidelines Given By The Government,
Health Care Provider Than We Can Resist The Spreading Of Deadly Virus In Much Effective Manner.In
India It Is The Public Health Sector That Has Borne Most Of The Burden Of Providing Testing And
Medical Care For The Detection And Treatment Of Over 20,000 Covid-19 Positive Patients. Considering
The Significant Presence Of The Private Health Sector In India, There Were Expectations That Private
Hospitals And Facilities Would Step Up And Make Major Contributions Towards Managing The Covid-19
Pandemic. The Private Sector Has Grown Significantly In The Last Two Decades, Due To Government
Subsidies And Policies That Actively Promoted The Privatization And Commercialization Of Healthcare.
Even Under The Pradhan Mantri Jan Aarogya Yojana (PMJAY) Of Ayushman Bharat, Nearly Two-thirds Of
The Claims Amounts Have Gone To The Private Sector.
 DISCUSSION
Since Its Initial Outbreak In China In December 2019, The COVID-19 Disease Has Had A Cascading Effect
Worldwide. According To The ICMR Update On March 23, 2020, More Than 400 Individuals Have Been
Confirmed Positive In India. The Identification And Isolation Of A Suspected Case Is The Most Important
Step In Curbing The Spread Of COVID-19. However, In Our Study, Less Than Half Of The Responders Were
Aware Of Defining A "Close Contact." According To The US CDC, A "Close Contact" Is Defined As: “Being
Within Approximately 6 Feet (2 Meters) Of A COVID-19 Case For A Prolonged Period Of Time Or Having
Direct Contact With Infectious Secretions Of A COVID-19 Case. Similarly, Various Other Key Definitions
Have Been Provided In Interim U.S. Guidance For Risk Assessment And Public Health Management Of
Healthcare Personnel With Potential Exposure In A Healthcare Setting To Patients With Corona Virus Disease
(COVID-19) Published By The CDC. Awareness Was Low Among All Subgroups With The Lowest Being The
Non-clinical/Administrative Staff. Even Though This Group Is Not Actively Involved In Patient Management,
There Are High Chances Of Non-clinical Staff Having Patient Contact At Some Point In The Healthcare
Setting And Therefore At Risk Of Contracting And Spreading The Infection
 • FINDINGS
Regularly And Thoroughly Clean Your Hands With An Alcohol-based Hand Rub Or Wash Them With Soap And Water. Why?
Washing Your Hands With Soap And Water Or Using Alcohol-based Hand Rub Kills Viruses That May Be On Your Hands.
Maintain At Least 1 Metre (3 Feet) Distance Between Yourself And Others. Why? When Someone Coughs, Sneezes, Or
Speaks They Spray Small Liquid Droplets From Their Nose Or Mouth Which May Contain Virus. If You Are Too Close, You
Can Breathe In The Droplets, Including The COVID-19 Virus If The Person Has The Disease. 
Avoid Going To Crowded Places. Why? Where People Come Together In Crowds, You Are More Likely To Come Into Close
Contact With Someone That Has COVID-19 And It Is More Difficult To Maintain Physical Distance Of 1 Metre (3 Feet).
Avoid Touching Eyes, Nose And Mouth. Why? Hands Touch Many Surfaces And Can Pick Up Viruses. Once Contaminated,
Hands Can Transfer The Virus To Your Eyes, Nose Or Mouth. From There, The Virus Can Enter Your Body And Infect You.
Make Sure You, And The People Around You, Follow Good Respiratory Hygiene. This Means Covering Your Mouth And
Nose With Your Bent Elbow Or Tissue When You Cough Or Sneeze. Then Dispose Of The Used Tissue Immediately And
Wash Your Hands. Why? Droplets Spread Virus. By Following Good Respiratory Hygiene, You Protect The People Around
You From Viruses Such As Cold, Flu And COVID-19.
Stay Home And Self-isolate Even With Minor Symptoms Such As Cough, Headache, Mild Fever, Until You Recover. Have
Someone Bring You Supplies. If You Need To Leave Your House, Wear A Mask To Avoid Infecting Others. Why? Avoiding
Contact With Others Will Protect Them From Possible COVID-19 And Other Viruses.
 RECOMMENDATIONS
 Government Needs To Urgently Take Control Of The Situation And Invoke Its Powers To Bring Part Or All Of
Select Private Hospitals, Facilities And Services Under Common Public Health Command, At Its Own Terms
And Conditions, And Delegate Tasks To Them.
 All Testing And Treatment Related To Covid-19 Should Be Free Of Cost To The Patient And Available As Close
To District Level As Possible. States May Reimburse Private Facilities As Per Fixed Rates For Their Services,
While Taking Care That It Should Not Involve Transfer Of Excessive Public Budgets To The Private Sector.
 For The Management Of Mild And Moderate Cases, Private Nursing Homes, Hostels And Hotels Should Be
Requisitioned To Serve As Isolation Hospitals.
 For Managing Critical Cases, Part Or All Of Very Select Private Sector Hospitals Who Have Such Capacity
Could Be Converted Into Dedicated Covid-19 Hospitals And Brought Under Public Authority. Such
Arrangements Would Have To Be Negotiated With Private Managements, Who May Continue To Undertake
Many Management And Staffing Functions And Be Reimbursed At Suitable Rates.
 The Current Moves To Re-purpose Well Functional Secondary And Tertiary Level Government Hospitals, Into
Covid-19 Hospitals By Pushing Out A Large Number Of Poor Patients Are Unacceptable And Must Be
Discontinued Immediately. Where Government Hospitals Are The Only Option For Covid-19 Critical Care,
Only A Part Of The Hospital Should Be Re-purposed, Leaving Other Essential Care In Place, Or As Has Been
Done In Many Countries, New Public Hospitals Should Be Rapidly Built Up In Available Or New Infrastructure
 CONCLUSION

Healthcare Professionals Were From Different District Of Uttar Pradesh East Showed Adequate Awareness Of
COVID-19 In The Healthcare Setting With An Overall Percentage Of 76%correct Answers. A Higher
Percentage Of Correct Responses Were From Senior Medical Doctors And The Lowest Was From Non-
clinical/Administrative Staff. This Study Shows That There Is A Strong Need To Implement Periodic
Educational Interventions And Training Programs On Infection Control Practices For COVID-19 Across All
Healthcare Professions. Conducting Periodic Webinars For Educational Intervention For All Healthcare Person
And Professionals Including Non-clinical And Administrative Staff, Paramedical And Nursing Sub-groups
Could Be A Useful And Safe Tool To Create More Awareness. By Doing Several Surveys To This People We
May Help To Provide Some Good Point To Improve The Condition Of This People Who Were In The Frontline
To Fight Against This Virus. So Their Safety Is Very Important Because We Are Totally Dependent On Them
For Our Good Health. So By Doing Surveys We Add Up Some Point On Which Government Should Pay More
Attention To Improve The Facility Given To Them. In Several Places I Got The Remark That They Were Not
Receiving Personal Protection Kit (PPE) On Time, So These Things Should Be Improved. Ant The Last Point
Which I Came On Conclusion Because Of The Survey Is That We Can Easily Stop The Spreading The Virus In
Our Society By Taking Well Precaution Like Maintain Social Distancing, Use Hand Sanitizer, Covering The
Face With N-95 Mask Whenever A Person Should Feel The Need Of Going Outside Of House.
Thank you