Patients queued up to get tested, vaccinated and get emergency care at a cluster of auxiliary health facilities (AHFs) set-up at the Fakir Mohan Medical College and Hospital (FMMCH) in Balasore district – also known as Baleswar district -- in the eastern Indian province of Odisha.
The Odisha government set up AHFs at seven sites in Balasore in June 2021 to provide uninterrupted COVID-19 as well as essential health services during the second surge in India.
The high-performance tents (HPTs) used to set up AHFs in Odisha are from among the 128 tents of varying sizes provided by World Health Organization and operationalised in collaboration with EU Humanitarian Aid to support India’s surge response. The AHFs became operational within a week of reaching the state on 2 June 2021,with the services being inaugurated by Odisha Chief Minister Naveen Patnaik on 9 June 2021.
“The AHFs were provided to us at a juncture when we were struggling to ramp up testing and run fever clinics during the second wave in May 2021. The hospitals were overburdened and even finding space for COVID-19 vaccination was becoming a concern. WHO filled critical gaps. The timely support boosted hospital capacity and equipped us to save lives,” said Dr Dulalsen Jagatdeo, Chief District Medical Officer, Balasore.
AHFs brought treatment and care closer home in a district vulnerable to floods, cyclones, storm surges and heat waves. Mr Birendra Rout, a 56-year-old teacher who was the first reported COVID-19 case in Balasore in March 2020, had to travel 200 km to get treated at Kalinga Institute of Medical Sciences in Bhubaneswar, the state capital, because COVID-19 treatment wasn’t available in his district.
"I was hospitalised far away from home. Isolation, fear, and the lack of proper treatment made me very anxious. The AHFs set-up for fever cases, testing, and vaccination at FMMCH are spacious, well-organised and patient-friendly. I got my wife vaccinated there,” said Mr Rout.
Between 1 June and 15 January 2021, 251 396 samples were collected at the testing facility for RT-PCR and RAT testing, resulting in the identification of about 13 546 positive cases. More than 53 000 vaccination doses have been administered during the period.
“When COVID-19 cases declined, the AHFs were used for triage fever clinic, sample testing, waiting area, and pharmacy,” said Dr Archana Gayen, WHO Surveillance Medical Officer, Bhadrak Unit.
Eleven AHFs serving a cumulative population of 250 000 have been set up at seven sites in Bhograi primary health centre (PHC); G K Bhattar Hospital, Jaleshwar; Bhograi PHC; Sub Divisional Hospital (SDH) Nilagiri; Iswarpur Community Health Centre (CHC); Jaleswarpur CHC; and Berhampore CHC in Balasore district. These blocks (a cluster of around 300 villages) were selected because they had a COVID-19 test positivity rate of over 10%.
These AHFs also mitigated the impact of Cyclone Yaas, which made landfall in Odisha on 26 May 2021. With the support of the Odisha Disaster Rapid Action Force and other line departments, the state government established AHFs in remote coastal areas such as Bhograi, which were severely affected by the cyclone.
“The AHFs provided shelter and emergency medical care to displaced at-risk communities, especially women, children, and older people. The state has taken cognizance of such innovative practices. We will integrate these best practices in our disaster management planning,” said Dr K Sudarshan Chakravarty, District Collector, Balasore.
“With COVID-19 testing and vaccination moved from the hospital to these well-ventilated tambus (tents) outside, I feel safer. I got my second COVID vaccine dose today, my daughter-in-law received her first,” said Ms Sita Rani Giri, who was here with her daughter-in-law Ms Silpa Giri, who is expecting her first child.
In areas where cases are down, the AHFs have been repurposed to deliver flexible and integrated health services to the rural and underserved communities. “AHFs have made round-the-clock testing possible and contributed to robust surveillance, containment of transmission, and strengthening the peripheral health infrastructure. Those who had stopped going to hospitals for essential health services fearing infection now avail services in the safety of AHFs,” added Dr Gayen.
“Apart from COVID-19 testing and vaccination, AHFs are being used as diabetic clinics and for routine immunisation activities, sector meetings, orientation of health care workers on SAANS (social awareness and actions to neutralise pneumonia). Antenatal care to mothers and newborns was also given there during the newborn care week in November,” said Dr Braja Dulal Kar, Medical Officer (Ayush), Bhograi PHC.
“AHFs have proved to be highly valuable assets in augmenting the surge capacity in 51 sites in the six states of Arunachal Pradesh, Maharashtra, Manipur, Mizoram, Nagaland, and Odisha. Other than Odisha, the AHFs are operational in 45 districts in four northeastern states i.e., Arunachal Pradesh, Manipur, Mizoram and Nagaland. These are being used as fever clinics, vaccinations sites, and testing centres – supporting health service delivery flexibly. Three other states -- Assam, Bihar, and Jharkhand -- have received and stored them for readiness for future waves of the pandemic or emergencies from various hazards,” said Dr Roderico H. Ofrin, WHO Representative to India.
“AHFs have enabled faster response during emergencies. These can be relocated easily and repurposed as medical tents for use during health emergencies and natural hazards, especially for providing care to at-risk communities such as pregnant women, mothers, and children living in high-risk areas,” said Mr Niranjan Mishra, Director Public Health, Government of Odisha.
