Udupi-Manipal Model: Public-Private Partnership during a Public Health Emergency

    MAHE dedicated one of its hospitals in the heart of Udupi as a COVID-19 hospital, with additional human resources and supplies to face the challenge.

    MAHE dedicated one of its hospitals in the heart of Udupi as a COVID-19 hospital, with additional human resources and supplies to face the challenge.
    MAHE dedicated one of its hospitals in the heart of Udupi as a COVID-19 hospital, with additional human resources and supplies to face the challenge.

    Realizing the enormity of this problem very early in Udupi, they sought the help of the  MAHE for patient care

    The reality of COVID-19 pandemic dawned on many Indian citizens on Sunday, March 22, 2020, when our Prime Minister, Shri Narendra Modi, called for a “Janata curfew”. One of the world’s strictest lockdowns ensued, which kept COVID-19 cases under a tight leash, and importantly, gave our public health and healthcare systems adequate time to gear up to face the gargantuan the challenge of COVID-19.

    Udupi district in coastal Karnataka has a good record of accomplishment in healthcare as demonstrated by favourable development and health indices. However, getting ready to face COVID-19 was a challenge like no other. The district administration led by the Deputy Commissioner anticipated the return of many natives of Udupi district from other places including Mumbai and Gulf countries where a sizeable population has migrated for employment. Realizing the enormity of this problem very early, they sought the help of the Manipal Academy of Higher Education (MAHE) for patient care. MAHE dedicated one of its hospitals in the heart of Udupi as a COVID-19 hospital, with additional human resources and supplies to face the challenge. Not only that, MAHE even announced free treatment for all COVID-19 patients. With this arrangement, Udupi rose to the occasion to meet the challenge of COVID-19.

    Except for two mortalities that happened even before the diagnosis of COVID-19, possibly unrelated to the viral infection, there have been no hospital deaths in the district due to confirmed COVID-19 as on June 20, despite more than a thousand diagnosed cases.

    The common goal of this public-private partnership was to face the challenge of COVID-19, and the obvious limitations to overcome was that of the healthcare system, where even Italy and the US were struggling despite their relatively efficient and modern systems.

    The district administration was very proactive in identifying, tracking, and quarantining the returnees. They tested the vulnerable returnees on priority and identified cases early. As early as April 17, the Udupi district topped the state of Karnataka in the number of samples collected per million population. As more and more natives returned, they efficiently collected hundreds, sometimes thousands, of samples per day, as per the prevalent testing strategy. As of 18 June, the Udupi district has crossed 10,000 tests per million population, which is more than double the current national-level testing of 4600 tests per million population.

    Patient management was in designated hospitals based on the clinical category. Public hospitals and facilities managed asymptomatic and mild cases (category A). Dr. TMA Pai Hospital, Udupi, of MAHE, managed all the significantly symptomatic, vulnerable, and sick patients (category B and C), as MAHE had the facility and expertise for managing critical cases.

    Furthermore, experts from the Hospital Infection Control Committees (HICC) of MAHE hospitals trained the medical and nursing teams of the public and private hospitals in infection prevention and control protocols in online programs organized by the district administration. Doctors and nurses from public hospitals visited Dr. TMA Pai Hospital and observed infection prevention and management protocols. In turn, the MAHE teams also visited the public hospitals and offered their feedback for improving infection prevention and control practices.

    Dr. TMA Pai Hospital Udupi of MAHE, Manipal – a classic example of a public-private partnership at the time of a public health emergency.

    Dr. TMA Pai Hospital is probably the only private hospital in Karnataka that was designated as a Dedicated COVID-19 Hospital (DCH) in March 2020 itself, thanks to the partnership between Udupi district administration and MAHE. With fully functional ICU and operation theatres, and with central oxygen supply for most of the general beds, it was well equipped for COVID-19 management. Allocation of clinical expertise, workforce, and resources was generous, enabling close monitoring of vulnerable patients and protocol-based timely escalation of care. Except for two mortalities that happened even before the diagnosis of COVID-19, possibly unrelated to the viral infection, there have been no hospital deaths in the district due to confirmed COVID-19 as on June 20, despite more than a thousand diagnosed cases.

    This arrangement has also given adequate time for the district administration to upgrade the capacity and workforce in the public hospitals, and train the doctors, nurses and support staff in infection prevention and control practices as well as in the management of critical patients.

    The success of Udupi district in maintaining a low mortality rate despite over a thousand of COVID-19 positive cases is due to the proactive district administration, triaging of patients based on clinical condition, and expert clinical management of high-risk patients at Dr. TMA Pai Hospital Udupi of MAHE, Manipal – a classic example of a public-private partnership at the time of a public health emergency.

    Note:
    1. The views expressed here are those of the author and do not necessarily represent or reflect the views of PGurus.

    Shashikiran Umakanth

    1 COMMENT

    1. While other capitation fee colleges did not maintain high standard of basic medical science and clinical training, as a Canadian, I was amazed to see KMC, MAHE at Manipal maintained superior standard of education and clinical management. They took students who could not get into state and federally managed medical colleges on merit but turned out better physicians who have done well to enter clinical Residency program abroad. Wish Pais run all private medical, dental and engineering institutions.

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