In a significant development, the Karnataka government issued orders on May 7 directing to set up Ward Decentralised Triage and Emergency Response (DETER) Committees for COVID-19 management in all 198 wards in Bengaluru. The ward level committees will have officials of the Bruhat Bengaluru Mahanagara Palike (BBMP), ward committee members, government officers, volunteer RWAs and civil society organisations.
"This will help in the decentralisation and provide better supervision for ward-level COVID governance," read the order issued by Manjunath Prasad, the Principal Secretary of the Revenue Department in the state government.
So far, the COVID-19 response in Bengaluru was coordinated with a main helpline number 1912 and zonal level helplines for each of the BBMP's eight zones — West, East, South, Yelahanka, Mahadevapura, Bommanahalli, Rajarajeshwari Nagar and Dasarahalli.
The decision to decentralise comes after a similar move by the Brihanmumbai Municipal Corporation (BMC), which helped the city reduce the spread of COVID-19. "Ward level Community Triage is seen as a successful intervention in many cities including Mumbai. Currently there is a delay in informing the test results to the patient due to the centralised ICMR process followed by BU number generation process," reads the order by the Karnataka government.
The ward DETER committees (WDC) will now be set up in all 198 wards of the BBMP and they will be entrusted with activities related to COVID-19 management. The WDCs will be headed by a ward nodal officer and the order states that ward level war rooms can also be set up. The main objective of setting up the WDCs is that it becomes the first point of contact with the government for COVID-19 patients or their attenders in Bengaluru.
The WDCs will carry out the following functions:
> To establish trust with citizens and ensure Covid appropriate behaviours; contact tracing and testing.
> Support home isolation to respond to citizen needs in the ward to minimise hospital load.
> To inform and communicate based on ground realities, policies and practices at the zonal and city levels.
> To redress grievances of citizens, address and escalate.
> Mobilization of resources and community volunteers, ensure availability, accessibility and proper utilisation of resources and medical supplies in the ward (general practitioners, masks, pulse oximeters, essential medicines, oxygen).
> To achieve universal vaccination.
> To connect with the hearse van and crematorium team.
> Taking all above functions into account, to become the first source of data related to COVID infections and response.
In addition, nodal officers for each ward will identify locations for isolation centres within the ward, collate and verify lists of general practitioners in the ward and establish a triage centre in the ward to bring in patients that need to be examined.
The focus of the ward level committees will be in helping people access hospital beds. In particular, the role of a triage coordinator is outlined in the order. This is someone who offers community triage services with the help of a support stuff. A competent and trained doctor can guide to manage the triage centre while doctors, interns, final year students of MBBS, Dental, Nursing or AYUSH doctors will also be at the triage centre. This centre will work with the WDC.
"To reduce delay in results and avoid panic, positive cases are relayed to the triage coordinator directly from the PHC throughout the day. The triage coordinator will delegate numbers to relevant citizen volunteers. The volunteers must be trained to do triage to identify persons who need to be admitted to ICU and those who require hospitalisation or should be sent to COVID-Care Centres or isolated at home," reads the order. The data of those in ICU, hospital, CCC or at home will be maintained by the triage centre.
The order also discusses an efficient exit strategy to ensure bed turnaround time in hospitals is reduced. This includes limiting hospital admissions to people with severe illness and shifting those with moderate illness to CCCs in five days. The WDCs will be tasked with doing bed audits thrice a day and prioritise admissions to those who need it the most.
Each ward level war room will be equipped with a call centre and training will be given on the use of oxygen, pulse oximeters. The WDCs will also work with RWAs and social organisations in their respective wards. COVID-19 testing coverage will also be increased and vaccination drives will be conducted in different wards when the stocks of vaccines are replenished.