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SIKKIM
Home-based Management of COVID-19: Best Practices Adopted by States
HOME-BASED MANAGEMENT OF COVID-19
BEST PRACTICES ADOPTED BY STATES SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States Innovative Approaches adopted by states for Home based management of COVID-19II |
Home-based Management of COVID-19:
Best Practices Adopted By States
Publishing Agency: NITI Aayog
Year of Publication: 2021
Disclaimer: Every care has been taken to provide accurate information along with references thereof. Only
validated data and photographs submitted by competent authorities at the district and state levels have been
used in the document. However, NITI Aayog shall not be liable for any loss or damage whatsoever, including
incidental or consequential loss or damage, arising out of, or in connection with any use of or reliance on the
information in this document. SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
GOVERNMENT OF INDIA
Innovative Approaches adopted by states for Home based management of COVID-19| i
HOME-BASED MANAGEMENT OF COVID-19
BEST PRACTICES ADOPTED BY STATES ii |
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States | iii
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Over the past two years, the country has been facing an unprecedented public
health crisis in the form of COVID-19. Since the onset of the pandemic, our state
governments have responded with various innovative measures to contain the
spread of the virus. The unprecedented challenges caused by COVID-19, was
managed collectively by both governmental and non-governmental support. The
changing dynamics of the COVID-19 infection called for an early identification,
remote monitoring and appropriate referral mechanism in order to reduce the
number of severe cases and deaths. This called for formulation of ‘Home-based
care model for COVID-19.’ During these testing times, the management models
adopted at the national and at the state level were recognized globally.
The innovative and reliable models of home-based care created ample
opportunities for provision of care and support needed for recuperation. These customized and state
specific models were successful due to the coordinated efforts between various state departments and
Community Based Organizations (CBOs). The intervention focused on setting up of district control rooms
for monitoring, enhancing community engagement, updating clinical guidelines, mobilizing appropriate
resources and addressing the psycho-social needs of vulnerable populations that kept the disease in
control. The COVID-19 response control rooms set up by various states were well equipped with the
tracking systems and digital facilities for providing real time situation analysis and imparting immediate
response to the critical patients. The home-based care models supplemented the government’s efforts in
monitoring the patients under home isolation.
This compendium aims to provide information focused on sustainability and scalability of home-based
care models adapted by various states of India. I am hopeful that this document will act as an essential
knowledge resource for the stakeholders from other Low- and Middle-Income Countries (LMICs) across
the globe and this will go a long way in strengthening our battle against COVID-19 and similar pandemics
in the future.
Dr Rajiv Kumar
Vice Chairperson
NITI Aayog
Government of India
New Delhi, India
Message, Vice Chairperson, NITI Aayog | vHome-based Management of COVID-19: Best Practices Adopted by States
The COVID-19 pandemic has highlighted the importance of public health
response during health emergencies. State governments responded quickly
and innovatively to face this unprecedented crisis despite structural limitations
imposed by limited resources. One such critical innovative practice was providing
home-based care to a large number of patients. In collaboration with Government
of India, home based care guidelines, SOPs for identifi cation, treatment and
referral were adapted by states to spread awareness and prepare innovative
home care models.
Home-based care can signifi cantly augment health systems capacity with the
help of digital tools. Treatment and care provided at home can signifi cantly reduce
complications, improve recovery, reduce spread of infection, and reduce hospital
admissions. There was seamless integration of digital tools with health system delivery in providing
care at home. In almost all states/UTs, Integrated control and command centres became the nerve
centre which connected patients at home with doctors and health care workers, through telemedicine
and connected them to ambulances and higher-level facilities when needed. eSanjeevani, the national
telemedicine helpline and eOPD, was a boon for many recovering at home. Patients and families felt
psychologically more stable at home.
This document presents various home-based care models adopted by states and summarizes basic
principles and practical recommendations. Several of these successful strategies can be replicated and
scaled. It is intended that adaptation of this resource material will be used for guidance by decision-
makers and strategic direction for sustainability at national and subnational levels.
Amitabh Kant
Chief Executive Offi cer
NITI Aayog
Government of India
New Delhi, India
Foreword, CEO, NITI Aayog | vii
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
The states in India were quick to recognize the threat of COVID-19 and introduced a
series of strategies to contain the virus transmission. They successfully implemented
the concept of home-based care as a viable and effective health care delivery
mechanism. In view of the changing needs of the pandemic and to curb the spread
of the virus, Government of India released telemedicine guidelines in March 2020,
which led to the implementation of telemedicine and home healthcare services in
India. Home healthcare, along with remote monitoring and telehealth technologies,
played a critical role in COVID-19 management.
Ministry of Health and Family Welfare (MoHFW), Government of India (GoI), issued
guidelines and released SOPs on medical and social eligibility criteria for home isolation. These SOPs
included self-monitoring and guidelines on when to seek medical care for patients under home isolation.
The states also came up with home care solutions managed through multidisciplinary teams assigned
for supervision, periodic assessments and linking the patients to medical/ nursing care in case of need.
Home based care became a safe and socially acceptable alternative to hospitalization for patients with
mild symptoms and asymptomatic cases. This in turn resulted in availability of beds for the severe and
critical patients. Thus, making more beds available for symptomatic/ more critical patients.
During fi rst wave of COVID-19, patients did not opt for home isolation due to the high fear factor among
family members and community. However, during the second wave, with the unprecedented surge in cases,
patients went to the hospital only when needed. Patients and families felt psychologically more stable and
safer at home and preferred monitored treatment at home or closer to home. Seeing the impact of fi rst
wave and second wave, home-based care under supervision of medical offi cers and health workers with
decentralized and digital management became a reliable solution. This provided timely and appropriate
healthcare and averted many deaths.
States developed various innovative models on home-based care. Many civil society organizations, SHGs
and private sector aided the government in these initiatives. They adopted a multipronged approach
covering an array of services, such as teleconsultation, IVRS helplines, various self-monitoring applications,
providing medicines, arranging ambulance services, arranging doctor visits and follow-ups, and IT and
logistical support to ensure prompt and smooth management of COVID-19.
NITI Aayog initiated the task of developing a comprehensive compendium that documents the various
decentralized models of home-based management of COVID-19 patients across the country with an aim to
promote cross-learning and sharing of valuable experiences. In July 2021, an email was issued to all states
and union territories (UTs) requesting them to share their COVID-19 management practices and models. A
format was shared within a pre-structured criteria/categorization to ensure uniformity in the documentation
of the models. The email was followed up with phone calls to the nodal offi cers from the health departments
in states and UTs. Thorough literature and web study review were conducted to strengthen this document.
This compendium provides information on the various practices and models implemented by Indian
states, districts, and cities to manage COVID-19 patients under home isolation and home quarantine.
Section A of this compendium highlights the states that formally provided the information, while Section
B highlights the states wherein information was obtained through a detailed literature review and data
collection from informal resources.
Case studies/reports/papers highlighting good practices/models implemented by state or in collaboration
with civil society, private sector, and international organizations and non-governmental groups that
assisted state and local governments have been annexed.
Dr Vinod K Paul
Member, NITI Aayog
Preface, Member, NITI Aayog | ixSECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
The compendium of state specific Home-Based Care models during COVID-19 has been prepared to
showcase the commendable work done by the states during the first and second wave of COVID-19, with
the inputs from respective states and development partners.
We would like to especially thank all the states’ health departments for sharing their interventions, success
stories and learnings to make this compendium a reality. We are deeply thankful to all those who reviewed
the compendium and shared inputs for improvisation.
The document was designed and conceptualised under the guidance of Dr Vinod K Paul, Member, NITI
Aayog and Mr Amitabh Kant, CEO, NITI Aayog.
We appreciate the support from USAID-NISHTHA/Jhpiego team in editing and designing the document.
We are hopeful that this document will aid in showcasing the various home-based care interventions
during these testing times and help in cross learning between states.
Acknowledgements | xiHome-based Management of COVID-19: Best Practices Adopted by States
CONTENTS
Message, Vice Chairperson, NITI Aayogiii
Foreword, CEO, NITI Aayogv
Preface, Member, NITI Aayogvii
Acknowledgementsix
Table of Contentsxi
List of Abbreviationsxii
Executive Summaryxvi
1. Section A: State Practices (information shared by the states) 1
1.Arunachal Pradesh3
2. Assam6
3. Bihar9
4. Chandigarh11
5. Chhattisgarh13
6. Delhi16
7. Goa19
8.Jammu and Kashmir22
9.Haryana (Karnal)23
10.Madhya Pradesh28
11. Manipur32
12. Meghalaya36
13. Mizoram39
14. Nagaland42
15. Puducherry44
16. Punjab47
17. Rajasthan50
18. Sikkim53
19. Telangana56
20.Uttar Pradesh58
21.West Bengal61
2. Section B – State Practices (information collected through
secondary research)65
22.Andhra Pradesh67
23. Jharkhand69
24. Karnataka71
25. Kerala75
26. Maharashtra79
27. Odisha80
28.Tamil Nadu83
3. Annexures86
CONTENTS xii |SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
HbA1CGlycated Hemoglobin
ACAssistant Commissioner
ALSAdvance Life Support
AMOAdministrative Medical Officer
ANMAuxiliary Nurse Midwife
ASHAAccredited Social Health Activist
AWWAnganwadi Workers
AYUSHAyurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy.
BBMPBruhat Bengaluru Mahanagara Palika
BDOBlock Development Officer
BiPAPBilevel Positive Airway Pressure
BLOBooth Level Officer
BLSBasic Life Support
BMCBrihnamumbai Municipal Corporation
BPBlood Pressure
BPLBelow Poverty Line
CABCOVID-19 Appropriate Behavior
CBACCommunity Based Assessment Checklist
CBCComplete Blood Count
CBNAATCartridge-Based Nucleic Acid Amplification Test
CBOCommunity Based Organization
CCCCOVID-19 Care Centers
CCCCCommunity COVID-19 Care Centers
CCHCOVID-19 Care Homes
CCMTCommunity COVID-19 Management Team
CDMOChief District Medical Officer
CFLTCCOVID-19 First Line Treatment Centers
CHCCommunity Health Centre
CHICCommunity Home Isolation Centre
CHIKCOVID-19 Home Isolation Kits
CHOCommunity Health Officer
CMOChief Medical Officer
COVID19 Coronavirus Disease 2019
CPHCComprehensive Primary Healthcare
CPMSCOVID-19 Patient Management System
CPTOCOVID-19 Patient Tracking Officers
CRPC-Reactive Protein
LIST OF ABBREVIATIONS | xiiiHome-based Management of COVID-19: Best Practices Adopted by States
LIST OF ABBREVIATIONS
CSRCorporate Social Responsibility
CTComputed Tomography
DCHDiploma in Child Health
DCHCDedicated COVID-19 Health Centre
DDPODistrict Development & Panchayat Officer.
DFYDoctors for Your
DHDistrict Hospital
DNODistrict Nodal Officer
DSODistrict Surveillance Officer
EDDExpected Date of Delivery
EMRIEmergency Management and Research Institute
ENTEar Nose and Throat
FBSFasting Blood Sugar
GDMOGeneral Duties Medical Officer
GISGeographic Information System
GNCTDGovernment of National Capital Territory of Delhi
GOIGovernment of India
GPGram Panchayat
GPSGlobal Positioning System
GPUGram Panchayat Units
HBCMHome Based Care Management
HCAHHealth Care at Home
HCLHindustan Computers Limited
HDUHigh Dependency Unit
HFCHealth Facility Centers
HFSVHand Wash- Facemask- Social Distance- Vaccine
HIHome Isolation
HISPHealth Information Service Provider
HITAMHome Isolation Treatment and Monitoring Protocol
HIVHuman Immunodeficiency Virus Infection
HMSHealth Management System
HQHeadquarters
HRHeart Rate
HSCHealth Sub Centre
HULHindustan Unilever Limited
HWCHealth and Wellness Centre
ICCCIntegrated Command and Control Centre
ICMRIndian Council of Medical Research
ICMSIntegrated COVID-19 Management System
ICUIntensive Care Unit
IDSPIntegrated Disease Surveillance Project
IECInformation Education and Communication xiv |Home-based Management of COVID-19: Best Practices Adopted by States
LIST OF ABBREVIATIONS
ILIInfluenza-Like Illness
IMAIndian Medical Education
IVRSInteractive Voice Response System
JNIMSJawaharlal Nehru Institute of Medical Sciences
JPHNUnion Public Health Nurses
KCGMCHKalpana Chawla Government Medical College
LDHLactate Dehydrogenase
LLTFLocal Level COVID-19 Task Force
LSGLocal Self Government
MBBSBachelor of Medicine and A Bachelor of Surgery
MDDoctor of Medicine
MHIMManipur Home Isolation Management
MISManagement Information System
MLHPMid-Level Healthcare Provider
MOMedical Officer
MoHFWMinistry of Health and Family Welfare.
MPMadhya Pradesh
MPHWMulti-Purpose Health Worker
MPWMulti-Purpose Worker
MSFMédecins Sans Frontières
NCCNational Cadet Corps
NCDNon-Communicable Disease
NGONon-Governmental Organization
NHMNational Health Mission
NICNational Informatics Centre
NICUNeonatal Intensive Care Unit
NIMHANS National Institute of Mental Health and Neuro Sciences
NIPINational Iron Plus Initiative
NITINational Institution for Transforming India
NMONational Medicos Organization
NONodal Officer
NSAIDNonsteroidal Anti-Inflammatory Drugs
OPDOut Patient Department
ORSOral Rehydration Solutions
PCRPolymerase Chain Reaction
PHCPrimary Health Centre
PHSMPublic Health & Social Measures
PM-CARES Prime Minister’s Citizen Assistance and Relief in Emergency Situation
PPEPersonal Protective Equipment
PR,Pulse Rate
PRIPanchayati Raj Institutions
PTAPatient Transport Ambulance | xvHome-based Management of COVID-19: Best Practices Adopted by States
RATRapid Antigen Test
RDRPRNA Dependent RNA Polymerase
RGUHSRajiv Gandhi University of Health Sciences
RIMJSRajendra Institute of Medical Sciences
RRTRapid Response Team
RTPCRReverse Transcription Polymerase Chain Reaction
SARISevere Acute Respiratory Infections
SARSSevere Acute Respiratory Syndrome
SDMSub-Divisional Magistrate
SHCSub Health Centre
SHGSelf Help Group
SIRDState Institute of Rural Development
SNOState Nodal Officer
SOPStand Operating Procedure
SPO2Oxygen Saturation
SRFIDSpecimen Referral Form Identification
STNMSir Thutob Namgyal Memorial Hospital
STOTShort-Term Oxygen Therapy
TBTuberculosis
TORTerms of Reference
TVTelevision
UNICEFUnited Nations Children’s Fund
UPHCUrban Primary Health Centre
USAIDU.S. Agency For International Development
UTUnion Territory
VICVillage Isolation Centers
VLTFVillage Level COVID-19 Task Force
WHOWorld Health Organization
YMAYoung Mizo Association
ZNOZonal Nodal Officers
LIST OF ABBREVIATIONS xvi |SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Awareness and Communication
The most important factor in preventing the spread of COVID-19 is to empower people with the right
information at the right time. With an aim to inform and educate communities on COVID-19 management,
multiple awareness-raising strategies, methods and tools have been adopted by state governments and
Union Territory administrations including use of job aids, posters, banners, videos on various aspects such
as home isolation, proning, use of pulse oximeter etc. Health departments organized many campaigns
and activities through Accredited Social Health Activists, Community Health Workers and Self-Help
Groups who worked with community members to raise community awareness on home care protocols.
Frontline workers including community health workers/ Accredited Social Health Activists/ Anganwadi
Workers/ Volunteers were enlisted to conduct house-to-house visits, identify and monitor cases, and
provide home based care. To ensure that Accredited Social Health Activists worked efficiently in the field,
they were trained and re-trained from time to time on Standard Operating Procedures and Guidelines that
were issued by the Government of India, The Indian Council of Medical Research, Central Government
Health Scheme and States.
To strengthen community surveillance, governments implemented a Community Surveillance Plan with
the goal of identifying potential cases of Severe Acute Respiratory Infections/ Influenza-Like Illness /
fever or other health conditions (malaria, diarrhea, dengue fever, etc.) with the support of local Accredited
Social Health Activists. Community monitoring groups like ‘Village Nigrani Samiti’ encouraged community
participation in managing COVID-19 positive and Influenza-Like Illness cases at home (in states of
Rajasthan Uttar Pradesh). The home isolation guidelines outlined who was eligible to remain under home
isolation, how to self-monitor and isolate at home. The patient’s and caregiver’s contact information were
shared with the helpline numbers.
EXECUTIVE SUMMARY
Home-based care has emerged as an important pillar of pandemic management. Various home
care best practices included in this document provided holistic support to patients and their
families. Home-based care is a low-cost model and can reach many people at the same time with
the help of digital tools such as telemedicine/call centres/apps etc. However, there could be some
limitations if all services are not connected and integrated at all levels and if there are delays in
referrals, transportation, and admissions. There is a risk of the spread of infection to family members
if protocols are not followed properly. Clear standard operating procedures and triaging are therefore
extremely critical for efficient home care. Hospitalization should be accessible at well-functioning
referral facilities. The integrated command and facilitation centres should be flexible, adaptable, and
resilient for use in COVID-19, and adaptable non-COVID-19 related services in a quiescent pandemic
situation. Community engagement and management have contributed to the large-scale take-up of
home-based care. Local efforts are essential for better case management and for reducing fear and
stigma. Community preparedness can help in ensuring that no one is left behind. The practices on
home-based care described in this compendium may be adopted, adapted, and replicated by the
states/UTs for scale-up in respective contexts, building on their experiences. | xviiHome-based Management of COVID-19: Best Practices Adopted by States
SUMMARY
These protocols were endorsed with the help of village employees and block level offi cials. Young Mizo
Association, medical personnel in the local level and volunteers created WhatsApp groups to track patients
under home isolation via chats and phone calls. In Punjab, a house-to-house survey known as Ghar-
ghar nigrani was conducted. In addition, the Panchayati Raj department in Sikkim provided advocacy and
counselling services.
Many states adopted the test-track-treat concept and identified cases early on. However, at times, the
test-track–treat protocol proved difficult to follow especially during the second wave. To combat this,
track-treat was adopted to help people to be treated through a home-based care system.
Doctors and Health workers’ visits and support
The COVID-19 pandemic and associated containment measures posed several challenges to medical
treatment and consultations. During this public health crisis, patients under home isolation needed
appropriate care and psychosocial support. In many cases, frontline workers and doctors visited rural
areas to reach vulnerable communities which were diffi cult to reach, maintaining all protocols (Assam,
Sikkim, Bihar, Chhattisgarh, Madhya Pradesh etc.). Frontline workers made visits to check patient’s
oxygen saturation level and enquire about other signs and symptoms for early identifi cation of symptoms
and referral. Dedicated ambulances were stationed near homes, facilities, block, districts and COVID-19
testing centers for immediate shifting of COVID-19 patients to Care Centers for providing intermediary
care and hospital admission.
For instance, ‘Doctors on Wheels’ in Puducherry and ‘Sanjivani van’ with ‘Doctors on call’ in Gujarat were
some initiatives that provided last mile delivery of healthcare. In Chandigarh, Rapid Response Teams
visited homes for referrals services and provision of medical supplies.
Awareness generation amongst community in Chhattisgarh xviii | Home-based Management of COVID-19: Best Practices Adopted by States
Monitoring of patients under home isolation in Sikkim
SUMMARY
Medical kits and Supplies
Almost all states proactively provided medicine kits to home isolated patients through front line
workers, free of cost. These kits contained basic medicines (Paracetamol, Vitamins, Antibiotic),
Ayush products (Arunachal, Assam, Chhattisgarh, Chandigarh, Goa, Jharkhand, Mizoram). Medical
kits were provided to COVID-19 positive and Influenza-Like illness cases with an instruction
leaflet for the patient and their family. Add-on facilities like COVID-19 kits containing Personal
Protective Equipment and masks were provided in most states (Arunachal, Punjab, Assam, Goa,
J&K, Chandigarh, Bihar, Manipur, Mizoram, Delhi, Nagaland, Meghalaya, Rajasthan, Tamil Nadu)
and thermometers and pulse-oximeters were also provided on returnable basis in a few states like
Nagaland and Assam. Nine different kits according to age, comorbidity and symptomatic condition
were prepared and distributed, for example in Punjab, food kits were also provided to home isolated
patients.
During the second wave, there was an unprecedented increase in demand for medicines and oxygen
concentrators. Many districts set up oxygen concentrator banks for the distribution of oxygen
concentrators to home isolated patients. The oxygen concentrators were made available to patients
on a temporary loan basis against a nominal security deposit which was refunded upon return (Delhi,
U.P, Nagaland, etc.). The Ola Foundation provided free oxygen concentrators to patients in quarantine
in Chennai and Tamil Nadu. | xixHome-based Management of COVID-19: Best Practices Adopted by States
SUMMARY
Community Health Offi cer of Seikhazou
HWC conducting teleconsultation in Nagaland
Medicine kits at HWC in Durg, Chhattisgarh
Telemedicine and Helplines
During the surge in COVID-19, telemedicine emerged as an innovative and safe interactive system for
patients and health workers. Many states and districts implemented call centers and telemedicine facilities
to manage COVID-19 patients under home isolation and recorded their vitals in a database. Facilities such
as assessing patients on call, daily monitoring by health workers, Doctor-on-call, COVID-19 Helpline, health
and psychosocial counselling and nutritionist-on-call etc. were offered. Some of the helplines also assisted
in facilitating visits of doctor/ nurses when required. States connected patients to doctors through dedicated
telemedicine platforms, Interactive Voice Response System and helpline numbers. xx |Home-based Management of COVID-19: Best Practices Adopted by States
A few state governments also deployed interns from medical colleges to aid in on-call medical consultation
in case of escalations (West Bengal, Punjab and Haryana). In Jharkhand, through the Swaraksha Portal,
patients got video consultations of 4 kinds: Allopathic, Ayurvedic, Homeopathic, and Unani. Various apps
were successfully implemented in many states such as CallDoc (Delhi), Swasthya Nidhi App (J&K), mDoc
(Jharkhand), ChatBot (Punjab), NISHTHA Tele-Track (Arunachal Pradesh, Nagaland, Mizoram), NISHTHA
COVID-19 Sanchar (Madhya Pradesh and Sikkim) and HIT App (Bihar).
A national level telemedicine platform called eSanjeevani was launched in April 2020 and was adopted
by all 36 States/ Union Territories. It has provided 1 crore consultations as on August 24, 2021. 60,000
doctors and paramedics have been trained and over 430 online eOPDs have been made operational.
The leading 10 States are Andhra Pradesh (2,751,271), Karnataka (19,39,444), Tamil Nadu (14,76,227),
Uttar Pradesh (12,32,627), Gujarat (4,16,221), Madhya Pradesh (3,69,175), Bihar (3,43,811), Maharashtra
(3,31,737), Kerala (2,37,973), Uttarakhand (2,26,436).
Home isolated patients were followed up through the 104-helpline number to take updates on their
physical condition. Psychological support was given to patient as well as family members, as and when
required. In Assam, all calls for home isolated patients were managed through the hub at the COVID-19
command room at the state HQ and were managed by Team SAMPARK doctors under the eSanjeevani
telemedicine platform.
Several states received support from non-governmental organizations and NIMHANS to expand
psychological counselling services to patients in home isolation by providing trained social workers and
mental health professionals (West Bengal, Arunachal, Puducherry, Odisha, Madhya Pradesh).
Community Participation
Community-based management and community engagement have been the key factors that have
contributed to the large-scale uptake of home based care. Local efforts are necessary and essential for
better case management and to ensure a reduction in mortality rates. The community-based management
of COVID-19 not only helped in reducing fear and stigma, but improved community preparedness for
future re-emergence of infectious diseases and to ensure that no one is left behind.
Governments of many states (J&K, Kerala, Punjab, M.P, Odisha, Rajasthan) established COVID-19 care
committees at all gram panchayats to monitor the overall operation of COVID-19 care homes (CCHs)/
Centers (CCCs). These gram panchayats were entrusted with the responsibility of isolating suspected
cases. Sarpanch, the elected representative of Gram Panchayats was empowered to take decisions that
worked best in their respective areas. Activities such as provision of medicine kits, food materials to home
isolated patients etc. and transport to CCHs when needed were managed under his/her supervision.
Integrated control and facilitation centers
As part of the efforts to curb the spread of COVID-19, integrated control and facilitation centers were set
up to provide all types of COVID-19 related data. Almost all states, including Assam, Delhi, Haryana, Kerala,
Punjab, Madhya Pradesh, Manipur, Meghalaya, Rajasthan, Sikkim and Uttar Pradesh set up a control
room, each with a team of doctors/ nurses/ volunteers and support staff. The team ensured that the
space provided to patients at home had all the basic requirements for home isolation, based on guidelines
issued by Ministry of Health and Family Welfare/ State Governments. These centers largely monitored
home isolated and COVID-19 care center patients through phone calls, based on which swift follow up
action was taken. These centers actively provided and arranged tele-consultations through eSanjeevani
or other such other telemedicine platforms. They monitored quarantine facilities, provided self-monitoring
app facilities to quarantined people and gave them support to track the health of suspected patients and
their contacts under home quarantine. In some states, apart from teleconsultations, these integrated
SUMMARY | xxiHome-based Management of COVID-19: Best Practices Adopted by States
centers also, provided real-time tracking of ambulances, disinfection services, and virtual training to
doctors and healthcare professionals etc.
These command centers acted as a bridge between the fi eld teams and district administrations and
coordinated the various apps and helplines. The control rooms worked in close coordination with the
ambulance management cell for timely provision of ambulance services. Bed availability was reflected on
a real time basis so that patients could be connected when required. These centers also managed calls
made to the 104 and 108 helpline numbers for ambulance, oxygen support and home quarantine facilities.
The technological features of the Integrated centers included an integrated technology platform,
Integrated Voice Response System, mobile based monitoring of vitals and symptoms, triaging by certifi ed
doctors for severity assessment, teleconsultations and emergency response. There were dedicated
tele-caller units with qualifi ed Medical/ AYUSH/ Nursing background trained professionals, a pool of
specialists with physicians, ENTs, mental counsellors, psychologists, nutrition counsellors and need-
based super specialists such as pulmonologists, cardiologists etc. Counselling for health and well-being
by trained counsellors was made available. Linkages with public health facilities were presented for drugs,
diagnostics, ambulance & hospitalization.
In Bengaluru, these integrated centers operated 24x7 and mapped each COVID-19 positive case using GIS,
and highlighted the containment plan using heat maps. The Tamil Nadu government launched a dedicated
Twitter handle – @104_GoTN, through the integrated center for people seeking beds for COVID-19 patients.
In Haryana, the integrated center proactively reached out to all the patients who tested positive for COVID-19
through various helplines/ chatbots/ apps. Patients could reach the district administration through the 1950
helpline number, specially created WhatsApp chatbot and the state government web portals.
In Bengaluru, these integrated centers operated 24x7 and mapped each COVID-19 positive case using GIS,
and highlighted the containment plan using heat maps. The Tamil Nadu government launched a dedicated
Twitter handle – @104_GoTN, through the integrated center for people seeking beds for COVID-19 patients.
Integrated Control and Command Center in Sikkim
SUMMARY xxii |Home-based Management of COVID-19: Best Practices Adopted by States
In Haryana, the integrated center proactively reached out to all the patients who tested positive for COVID-19
through various helplines/ chatbots/ apps. Patients could reach the district administration through the 1950
helpline number, specially created WhatsApp chatbot and the state government web portals.
Collaborations and Partnerships
During the pandemic, collaborations and partnerships were important as they strengthened government’s
efforts and provided a full range of services and expertise to patients. The multi-sectoral approach and
public-private partnerships, along with use of technology and robust monitoring systems was able to
provide holistic supervised home care to COVID-19 patients.
USAID-NISHTHA, implemented by Jhpiego partnered and supported 13 state governments, with
special focus on the North East region. StepOne, a volunteer network partnered and supported 16
state governments. Manipur involved Medicine Sans Frontier (MSF), state government of Haryana in
partnership with Deloitte in Karnal launched ‘Sanjeevani Pariyojana’. Norway India Partnership Initiative
(NIPI) in Jammu and Kashmir, Sri Aurbindo Society in Puducherry, and Prakriti E-mobility in Delhi, were
some of the prominent collaborations that supported states in rolling out home isolation models and
strategies.
WHO, UN agencies and USAID developed courses for various groups focusing on training on COVID-19
management, and psycho-social training, etc. More than 1,80,000 doctors, nurses, paramedics, AYUSH,
sanitary workers, police, frontline health workers, and volunteers were trained with the help of these
agencies.
SUMMARY | xxiiiHome-based Management of COVID-19: Best Practices Adopted by States| xxiiiHome-based Management of COVID-19: Best Practices Adopted by States
1
2
3
4
5
6
7
Doctor and
Health
worker visits
Medical kits
and supplies
Telemedicine
and Helplines
Community
Participation
Integrated
control and
facilitation
centres
Collaboration
and
Partnerships
Elements
of Home Care
Models
Awareness
and
Communication xxiv |
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States | 1
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
SECTION A
STATE PRACTICES
(Information shared by the states) 2 |
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States | 3
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
During the second wave, more than 80 percent of mild COVID-19 cases (either asymptomatic
or had mild symptoms) were treated at home. Given the rapid increase in the magnitude
of cases along with the shortage of facilities to manage the high caseload, mild and
asymptomatic patients were actively monitored at home. In view of the overwhelming
burden on the health systems and health care providers, Arunachal Pradesh partnered
with USAID’s flagship health system strengthening project NISHTHA, implemented by Jhpiego, to initiate
a comprehensive technology-based model for home isolation known as ‘NISHTHA Teletrack’ This model
was implemented in Itanagar Capital Complex and Papumpare Districts, which reported high caseloads.
The state followed a Tele-caller home-based isolation monitoring model wherein a team under the District
Surveillance Unit monitored, followed and responded to patients under home isolation.
The objective of this model was to regularly monitor patients under home isolation and identify early
symptoms to enable and provide the right care at the right time. The platform acted as an enabler for
effective monitoring and tracking of COVID-19 patients and also had functionalities for recording vitals of
home isolated cases on a daily basis, provide regular & need based SOS telemedicine consultations with
through a pool of physicians, digital reporting and with a generation of system alerts in case a patient
developed symptoms and required referral. This ensured that immediate action was taken in case of
worsening of patient’s symptoms Further, through this platform accurate and timely information was
disseminated and also addressed queries raised by the patients under home isolation.
Inclusion and Eligibility Criteria
Patients who tested positive for COVID-19 through any confi rmatory test (RT-PCR/
RAT/ TRUNAAT) based on the assessment by healthcare providers in Triage Centers/
Flu Clinics/ Checkpoints/ Gate of entry and were psychologically fi t, were advised home
isolation. In case of mild cases of COVID-19 with controlled comorbidities, availability of
a caregiver at home was a pre-requisite
Intervention Details
As a fi rst step, a series of awareness campaigns were conducted with all local leaders
and community leaders through video conferencing to spread awareness on home
isolation. Communication material, including posters and handouts on home isolation
and NISHTHA tele-track application were developed, displayed and distributed to patients
under home isolation. Given that this was a tech-enabled model, community workers like
the Accredited Social Health Activists (ASHAs) were leveraged for mobilizing the community for testing,
following up with NISHTHA tele-track patients under home isolation, reporting on Influenza-Like Illness
(ILI) cases and responding or directing calls from the community to the tele-track platform.
ARUNACHAL PRADESH 4 |
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Comprehensive Tech Enabled Home Based Care Model
States/ districts (EKH & WGH) share
information with NISHTHA on a daily basis
Onboarding activities on Day 1
»Inbound call by Tele-Track team for onboarding (remotely)
»Assisted registration of patient on the Mobile App
»Informed about daily vitals tracking and tele-helpline
»Linkages with 144100for teleconsultation and emergency care
»Counsellingon basic home isolation guideline
Features of NISHTHA Tele-Track Platform
Suspected PatientRT-PCR / Rapid
Antigen Test
Patient Tested
Positive
Asymptomatic /
Mild Symptomatic
Patients
Referred for Home
Isolation
Daily self / Assisted
reporting of vitals and
symptoms in the App
Doctor Tele
Consultation On
Day 1 and 5
Nutritionist Tele
Consult Day 2
Mental Health Tele
Consult On Day 10
Telecaller On Day 1
and SOS
Doctor/ Specialist
Tele Consult SoS
Alert mechanism
for state/ district
for critical patients
Reporting to
state/ district on a
regular basis
Access to live dashboard for
state/ districts for real time
monitoring of the patients
12
3
4
5
6
7
8
9
Day 1 – Patient Registration
on Tele-Track | 5
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
A district-wise protocol was devised and detailed information of individuals under home isolation was
shared regularly with NISHTHA, Jhpiego. Following this, the NISHTHA team reached out to the patient
and provided the scheduled services for ten days. Given below is a snapshot of the day-wise activities:
Day 0 - State to share daily data of both districts with NISHTHA
Day 1- Onboard COVID-19 cases through tele-caller from NISHTHA Tele-Track
Facilitate tele-consultation with Medical Offi cers (MOs) and counselling on basic home isolation guidelines
Day 2 to Day 10 – Self-tracking of vitals and symptoms by patients. Fixed tele-consultations organized as
below:
Day 2 - Nutritionist Tele Consult
Day 5 - Tele-consultation with Medical Offi cer
Day 10 - Tele-consultation with Mental Health Counsellor
Daily reports were shared with the district on a defi ned set of indicators, which includes the list of patients
who could not be reached for three consecutive days. This enabled timely response by the District Rapid
Response Teams (RRTs) to locate and contact them. In addition, alerts were raised on a WhatsApp group
and Emails for all state and district offi cials and RRT team leads. As soon as the alert was raised, the RRTs
of a respective ward/ block would respond and activate the team for physical assessment of the alerted
patient. Based on the assessment the patient would either be referred to a higher facility or advised to
continue home isolation. This was followed by distribution of home care kits containing a mask, oximeter,
thermometer, basic medicines and AYUSH products. BLS Ambulances were kept on standby for any cases
requiring referrals to higher facilities in case of emergencies.
Patients’ counselling in process by Community Health Offi cers on use of tech-based platform, NISHTHA Tele-Track, for
monitoring patients under home isolation in Arunachal Pradesh. 6 |
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
The COVID-19 pandemic has been a humungous healthcare challenge across the world
including India. The state of Assam took this challenge head-on and has been managing
the pandemic effectively through robust planning and quality implementation with a
focus on multi-pronged strategies of 3Ts (TEST, TRACE, TREAT), encouraging COVID-19
Appropriate Behaviors (CAB) and COVID-19 vaccination. The state ensured maximum
emphasis on promotion of healthy practices to strengthen preventive strategies against COVID-19. Assam
adopted a multi-pronged strategy including awareness generation, tele-consultation services, provision of
home isolation medical kits and Interactive Voice Response System (IVRS) based platforms for follow up
and monitoring of patients.
The state aimed to strengthen management of COVID-19 at home, community and facility level awareness
generation on Public Health and Social Measures (PHSM) for following CAB. The state ramped up
testing to isolate positive cases to curb the spread of COVID-19. Contact tracing of COVID-19 patients
using a snowball approach for early isolation and management of cases were done. The government
provided treatment based on the triaging of COVID-19 positive cases at appropriate COVID-19 health
facilities. Efforts were also made to increase uptake of COVID-19 vaccination by addressing myths and
misconceptions on vaccines.
Inclusion and Eligibility Criteria
Persons who tested positive for COVID-19 either by Rapid Antigen Test (RAT) or RT-PCR
test. In case the person tested negative for RAT, an RT-PCR test was done. For such
cases, isolation was advised till the results of the RT-PCR test were known. For persons
with comorbidities/ uncontrolled comorbidity/ vulnerable conditions, special care was
provided from the beginning and these groups were advised to remain at home. Persons
who were psychologically fi t and willing to be under home isolation were allowed to, provided they satisfi ed
the conditions based on the guidelines.
Intervention Details
Awareness generation and Community Engagement: The Assam Health Department
undertook a mega campaign under community awareness on Public Health & Social
Measures through Accredited Social Health Activists (ASHAs), who in turn had been
working with community members for generating awareness on home care protocols
with focus on CAB and voluntary testing of persons on a timely basis. ASHAs have played
a critical role in reaching the last mile by spreading awareness on health messages including on COVID-19.
To ensure that ASHAs were equipped with the right skills, the state government of Assam ensured that
ASHAs were trained on a timely basis. Further, the state had devised need-based protocols on COVID-19
management, including home isolation protocols, which were revised based on inputs from the fi eld and
changing needs of the pandemic.
ASSAM | 7SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Provision of Home-Based Medicine Kits: The state also ensured that medicines were provided free of
cost to all patients under home isolation. As part of this, frontline workers visited the homes of COVID-19
patients on a regular basis to check their oxygen saturation levels and other signs and symptoms to
ensure early and timely referral and treatment based on their symptoms. As part of these visits, the
frontline workers also distributed medical kits to patients. So far, more than 2.15 lakh COVID-19 positive
patients under home isolation were under constant monitoring and more than 1.75 lakh home isolation
patients were provided Medical Kits for COVID-19, since April, 2021.
Teleconsultation Services: To ensure availability of treatment and follow up while sitting at home, the
health department of Assam initiated eSanjeevani teleconsultation from December 17, 2020 as ‘SAMPARK’
teleconsultation services for populations with comorbidities. Under SAMPARK, healthcare providers
(specialists/ General Duty Medical Officers) were based at the hub and anyone in need of healthcare
services could connect to these providers through the eSanjeevani app, which is downloadable on any
android mobile phone. On contacting the hub, an e-prescription would be generated, which could be used
at Health and Wellness Centers (HWCs) or at pharmacies to avail medicines. This enabled people to
access healthcare from home except when a physical assessment was required. Assam was ranked 11th
in providing teleconsultation among all states in the country. The state is also in the process of increasing
the number of hubs to reach a wider population.
Interactive Voice Response System (IVRS) helplines and NISHTHA COVID-19 Sanchar: The state used the
104-call center to follow up with persons under home isolation wherein patients were checked on their
physical status, as well as psychological support was provided through the helpline. To further strengthen
the 104-call center initiative, the state partnered with USAID-NISHTHA/Jhpiego to launch an IVRS based
remote monitoring model called NISHTHA COVID-19 Sanchar in Kamrup Metro district. NISHTHA
COVID-19 Sanchar ensured regular monitoring and follow-up of patients under home isolation and ensures
early identification of symptomatic cases. This was a hybrid model deployed by using the IVR technology,
web-based google form, and tele-calling by trained human resources to ensure seamless follow-up of
home isolated patients, which aimed to increase recovery rates and thereby reduce overall morbidity and
mortality due to COVID-19.
Partnerships with private sector: Assam also partnered with private providers in addressing the
COVID-19 crisis for different aspects, including COVID-19 treatment, maintaining non COVID-19
healthcare services and COVID-19 vaccinations. The government collaborated with private providers
to reduce and standardize the rates of COVID-19 treatment across all facilities to ensure that everyone
had access to quality healthcare.
Medical Support and Monitoring
As part of the teleconsultation services, all calls for home isolated patients were managed
through the hub at the COVID-19 Command Room at the state headquarter, which was
managed by doctors under SAMPARK as part of eSanjeevani telemedicine services. The
performance of Team SAMPARK was monitored on a daily basis at the state headquarters
and necessary instructions were issued to the districts and the 104 call center staff.
The state also ensured that medicines were provided free of cost to all patients under home isolation. As
part of this, frontline workers visited the houses of COVID-19 patients on a regular basis to check their
oxygen saturation levels and other signs and symptoms to ensure early and timely referral and treatment
based on their symptoms. 8 |SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
The state prioritized testing and initiated
testing facilities at vaccination centers.
Further, people who went for vaccination
were also tested before getting vaccinated,
which helped in identifying many more cases
and deferring their vaccinations, as per
guidelines. The state also emphasized on
the need for surveillance at the community
level. The government rolled out the Assam
Community Surveillance Plan with an aim
to list out potential cases of Severe Acute
Respiratory Infections /Influenza-Like Illness/
fever or people with other health issues (malaria, diarrhea, dengue, MR, JE etc.) with help of the village
ASHAs.
Scalability and Replicability
Since the state adopted a multi-pronged approach, all the approaches can be replicated
and scaled based on the changing needs of the pandemic. The state also scaled up
some of the initiatives implemented in the first wave during the second wave. Assam had
implemented a scheme called ‘DHANWANTARI’, under which medicines were distributed
at home (free up to Rs. 200) for even Non COVID-19 patients. However, during the second
wave, with all medical shops open on a 24x7 basis, free COVID-19 medicines were provided only for
patients under home isolation, thereby adopting an ‘adaptive’ and need based approach based on the
changing needs of the pandemic for all home isolated COVID-19 patients only. So, the learning is that the
system needs to be more ‘adaptive’ with the situation around and necessary actions need to be taken.
COVID-19 screening in Assam | 9
SIKKIM
Home-based Management of COVID-19: Best Practices Adopted by States
BIHAR
Overview
Home isolation of COVID-19 patients, who are asymptomatic or have mild symptoms,
has been recognized as an important strategy as it reduces the burden on the healthcare
establishments and results in effi cient utilization of scarce resources for moderate and
severe COVID-19 patients. Home isolation with appropriate guidelines provide some
distinct benefi ts such as care in a familiar home environment, less stress on family,
reduced burden on healthcare services, lower risk of healthcare associated infections/ nosocomial infect
and reduced cost of care to the families.
Intervention Details
COVID-19 management in Bihar was handled by the Corona Control Team, which was
divided into fi ve sub-teams: containment, testing, isolation and medicine, training, and
coordination (by IDSP cell). COVID-19 positive patients were confi rmed using tests such
as RT-PCR, NAAT, and RAT. Personal details such as name, address, phone number were
noted for all COVID-19 positive patients and patients with mild symptoms were advised
to undergo home isolation. The Bihar government engaged StepOne for effective tracking and monitoring
of home isolated cases and the list of home isolated patients was shared with them on a regular basis.
Awareness generation was also done through Information Education Communication (IEC), campaigns,
Twitter and newspapers in the State. District-specifi c toll-free number for COVID-19 related information
was also widely circulated.
Medical Support and Monitoring
The agency used an IVR system with fi ve COVID-19 symptoms as IVRS options; if the
patient’s COVID-19 symptoms worsened, the IVRS server detected this fluctuation and
volunteers were notifi ed to conduct a tele-consultation session with the patient.
The agency shared lists of patients who may require hospitalization with the State control
room, which then notifi ed the respective district control rooms. If required the doctor from
respective PHC would visit the home isolated patient for a check-up. If the patients’ health deteriorated
further, an ambulance service was made available to them. On an average 100 to 200 such case referrals
were handled during the second wave.
Accredited Social Health Activists (ASHAs) provided medical aid through distribution of home isolation
kits to the COVID-19 patients as per the State protocol dated 21/4/2021. Medicine kits were also made
available for the home isolation patients. However, pulse oximeter or thermometer were not provided in
the kits.
The Home Isolation Tracking (HIT) application was launched in fi ve districts of Bihar initially and then
scaled up to all the districts. Auxiliary Nurse Midwives (ANMs) visited the patients’ homes and tracked 10 |SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
vitals such as temperature and oxygen saturation; the readings were entered into the HIT app on their
tablets, and the patients’ need for additional medical care/ hospitalization was reflected on the app.
Scalability and Replicability
Following successful implementation in pilot districts, all home-based care models used
in Bihar were scaled up. However, death cases were not adequately recorded in home-
isolated cases, resulting in skewed death case data for Bihar. If home-based care models
are to be used, a mechanism for accurate reporting of death cases must be devised. | 11SIKKIM
Home-based Management of COVID-19: Best Practices Adopted by States
CHANDIGARH
Overview
Home care system for COVID-19 mitigation in Chandigarh was successful due to strong
and coordinated activities among various departments of the Chandigarh Administration,
including Health, Municipal Corporation, Transport Department, Red Cross Society, and
others. The city was divided into five medical zones, each led by a Senior Medical Officer
for effective home care management of patients under home isolation.
Intervention Efforts
Five medical zones and Rapid Response Teams (RRTs), consisting of trained Doctors
and Paramedical staffs were constituted, who were responsible for screening and
transporting COVID-19 cases as per the need. The roster and phone numbers were shared
with the concerned persons who were seeking the services of the ambulances either for
examination or transporting suspected COVID-19 cases to the health facilities. RRTs were
made in charge of clinical assessment and further management of patients under home isolation, and all
dispensaries doctors and staff were involved in day-to-day monitoring, assessment and record keeping.
All COVID-19 positive cases were verified by the RRTs to ensure that they adhere to the criteria as per the
guidelines for home isolation. The SDM teams further ensured that home isolation was feasible for such
patients. Field teams also confirmed the availability of separate rooms with an attached washroom for
home isolation. In case of any limitations, field teams facilitated the transfer to the COVID-19 care centre.
Patients with comorbidities and the elderly who required intensive care were immediately transferred to
health facilities. Infants and younger children, as per MoHFW guidelines, were kept under supervision of
parents/ guardians.
Parents/ caregivers were advised to keep patients hydrated and provide them with a nutritious diet. Older
children and family members were encouraged to stay in touch via phone, video calls, etc. Wellness Kits
were provided to home isolated patients, which included information on the dos and don’ts, as well as
contact information for the Help Desk and relevant officials.
The Chandigarh Administration had also standardized rates for availing oxygen cylinders and refilling the
Type B Cylinder. A press release and information on web portals were used to raise public awareness.
The administration, in collaboration with the Red Cross, established an oxygen concentrator bank for
the general public. Chandigarh has 32 ambulances (provided by Health Department UT Chandigarh, RED
CROSS and NGOs) which were used for home visits by RRT, referral, distribution of medicines.
In addition to telephonic consultations, the Telemedicine Solution of eSanjeevani OPD was made
operational, allowing patients to avail online consultations through this platform. In the second wave,
mobile testing teams visited the doorsteps of positive case contacts to conduct testing. As a result, the
contacts were tested and isolated right away rather than being transported in ambulances.
During the second wave, patients were regularly monitored by home visits by the RRT teams, daily
telephonic/ video calls were done by dispensary medical officers and if the SpO2 of patient fell below
94, patients would be shifted to hospitals. The tele-consultation and help desks were expanded and a 12 |SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
greater number of telephone lines for tele-consultation were added for monitoring of home isolated and
quarantined patients. The COVID-19 wellness kits were refined and augmented with provision of pulse
oximeters (to all symptomatic, elderly and co-morbid patients), thermometers, triple layer masks, hand
sanitizers, and Ayush medicines. Special card board boxes were developed for the distribution of above
medicines. These boxes were used to provide IEC in the form of list of vaccination centres, COVID-19
appropriate behaviour, RRT zones Helpline numbers, and home monitoring instruction sheets. The RRT
team ensured that those whose vitals were stable were allowed to isolate at home.
Scalability and Replicability
In Chandigarh, the COVID-19 mitigation model, through an effective Home Care system,
was successful. The model is scalable as home care beds are an extension of hospital
beds if there is a dedicated team of physicians, nurses, lab technicians, and ward servants
available for home isolation.
It is critical to understand the management of patients under home isolation as the
existing hospital infrastructure may fall short in the event of a future surge. | 13
SIKKIM
Home-based Management of COVID-19: Best Practices Adopted by States
CHHATTISGARH
Overview
The state of Chhattisgarh has been fi ghting the pandemic head on with multiple on-
ground innovations and approaches. Owing to the rapid increase in the number of cases
in the state of Chhattisgarh and in-line with the Government of India’s strategy, the option
of home isolation was provided to asymptomatic and mildly symptomatic patients. The
state adopted a patient feedback mechanism for persons under home isolation to ensure
quality of care and adherence to home isolation guidelines. This feedback mechanism
was rolled out with support from USAID-NISHTHA/ Jhpiego in co-ordination with other partners such
as Indus Action, Samarthan and Piramal Health. The patient feedback mechanism was designed to
strengthen quality of care for COVID-19 patients under home isolation, ensure accountability and quick
decision making to improve patient responsiveness.
During the second wave, when physical verifi cation and follow up was not possible, the state-initiated
contact tracing telephonically. This initiative was also launched in partnership with USAID-NISHTHA/
Jhpiego. Under this, patients were remotely monitored to enable early identifi cation of symptoms and
were evaluated for 10 days based on a standardized checklist. On the seventeenth day, a fi nal evaluation
was done. Following this, feedback was collected from the patients through manual calls and web-link
provided to the home isolated patients. The data was then analyzed and used to rank districts on quality
of management of COVID-19.
The state highlighted Durg as a model district which was ranked highest in the feedback mechanism.
Durg also set up 40 fever clinics to fi rst monitor Influenza-Like Illness (ILI) patients.
Inclusion and Eligibility
Criteria
Patients with Rapid Antigen Test (RAT)
positive results were examined for
symptoms and further investigation,
while patients with negative RAT test
results had to undergo RT-PCR testd.
Decisions on allocation of asymptomatic or mildly
symptomatic patients with co-morbidities were taken
by a medical consultant.
Intervention Details
Under Durg’s home care model,
medicine kits were provided for
patients and prophylaxis kit for
family members at the fever clinics.
Nine different kits according to age, 14 |
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
comorbidity and symptomatic condition were prepared and distributed. Durg district was divided into
seven zones. In order to ensure that all zones had adequate staff, the district appointed one AYUSH
medical officer for each zone along with 5-6 assistant consultants (AYUSH and Dental Interns) and
four to five nursing staff in each zone. A dedicated round the clock ambulance service was made
available for shifting patients in and out of the district. 15 ambulances (108) were dedicated for this
service and five more private vehicles were recruited during the second wave.
Under the patient feedback mechanism, the model was developed in a robust and scientifi c manner
focusing on domains of quality of care, as defi ned by the World Health Organization (WHO), such as
- Safe, Effective, Patient-centered, Timely, Effi cient and Equitable. Feedback was collected through a
standardized questionnaire covering thirteen parameters. This helped in setting accountability systems,
ensuring quality of care and adherence to home isolation guidelines. Given below is a snapshot of the
process:
Home isolated patient details shared with telecallers
USAID-NISHTHA team receives details of home isolated patients
from portal developed by state containing daily entries of district-wise
patients and shares with tele caller
Tellecaller contacts home isolated patients for feedback
Tele caller calls patients under home isolation on Day 3 to collect
feedback on quality of care based on a list of 13 questions
Patient feedback reports collected and analyzed
Feedback from 10 districts were collected by NISHTHA/Jhpiego while
other 18 districts were covered through other partner organizations.
The feedback information collected is shared with NISHTHA team who
then analyze fi ndings and create district-wise daily and weekly reports
and rankings to share with State government.
Dissemination of reports by state government
The State government disseminates reports to public to ensure
transparency and accountability and issues directives to districts for
improvement
District level action based on state directives
Based on the directives and reports, districts make the required
changes which help improve services. District-wise rankings also
create a healthy competition between them | 15SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Medical Support and Monitoring
Daily telephonic monitoring was done by Assistant Medical Officers (AMO), interns and
nursing staff on key vitals. The contact tracing team visited people’s homes and conducted
physical verification based on a checklist. The team also ensures distribution of medicine
kits to COVID-19 positive patients after telephonic evaluation by medical consultant and
AMOs. During the second wave, the state conducted telephonic contact tracing due to
the surge in the cases. A few districts also adopted the telemedicine platform to reach patients. The
Dantewada administration expanded Danteshwari telemedicine facility not only to hospitals but also to
patients under home isolation. Patients were able to register themselves for the facility at their homes
through the link provided or through the district website with their mobile phones. After the registration,
the health consultation was given free of cost by doctors on the video link received on the patient’s mobile
phone.
Sustainability and Replicability
The feedback mechanism for strengthening the quality of care for patients under home isolation intervention has been a model example in managing the pandemic effectively. It has clearly demonstrated the justified use of feedback mechanism from the beneficiary perspective to improve quality of care. While comparing baseline data of week 1 (10-16 April 2021) with the endline data of week 13 (05-11 July 2021), it is evident that the
quality of care and adherence to home isolation protocols improved. The table below depicts domain wise improvement in the quality of care of home isolated patients. A total of 1,26,308 home isolation cases were followed up till July, 2021. Between September 5, 2020 and July 17, 2021, the state reported a total of 70,653 patients under home care of which 18 deaths were reported.
Teleconsultation at HWCs in Surguja, Chhattisgarh 16 |
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
The COVID-19 pandemic brought many challenges to the National Capital and the
government made multiple efforts to combat the pandemic. In the fi rst wave itself, Delhi
witnessed tie-ups with private entities to enable home care of patients in the state, by
providers such as Portea, StepOne, Prakriti E-mobility, CallDoc Application and Health
Care at Home (HCAH). Home isolation was a big part of the capitals fi ght against the
pandemic. The government also launched a dedicated website i.e.https://delhifi ghtscorona.in which
contained all COVID-19 related information collated in one place.
The emergency handling system for home isolation cases operated stage by stage in Delhi. It involved
control room doctors, nurses in dispensaries, primary health nursing offi cers in subdivisions, doctors
engaged by the government for home isolation and bureaucrats monitoring the system.
Inclusion and Eligibility Criteria
The patients who were clinically assigned as mildly symptomatic/ asymptomatic by
the treating Medical Offi cer (MO) were advised for home care. Such cases needed to
have the requisite facility at their residence for self-isolation and for quarantining family
members. A caregiver and communication link between the caregiver and hospital was a
prerequisite for the entire duration of home isolation. Elderly patients over the age of 60
and those with comorbidities such as Hypertension, Diabetes, Heart disease, Chronic lung/ liver/ kidney
disease, Cerebro-vascular disease etc. were allowed home isolation after proper evaluation by the treating
MO. Patients suffering with immunocompromised status (HIV, Transplant recipients, Cancer therapy etc.)
were not recommended for home isolation. The caregiver and all close contacts of such cases were
advised to take Hydroxychloroquine prophylaxis as per protocol and as prescribed by the treating MO.
Intervention Details
The Delhi model to fi ght the COVID-19 pandemic included digital and community level
interventions. A dedicated website (delhifi ghtscorona.in) was created and it provided
access to detailed lists of testing centers, beds, teleconsultation leads with contact
details of individual doctors, ambulance services etc. to citizens.
All patients were in regular communication with a treating physician and needed to inform in case of
any deterioration. Patients were expected to continue the medications for other co-morbid illness after
consulting the treating physician. In case of falling oxygen saturation or shortness of breath, patients would
be hospitalized or were advised to get immediate consultation of their treating physician/ surveillance
team. Patient’s care givers kept monitoring their health. Immediate medical attention was provided in
case of serious signs or symptoms such as diffi culty in breathing, dip in oxygen saturation (SpO2 < 94
percent on room air), persistent pain pressure in the chest and mental confusion.
DELHI | 17SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Centralized Accident and Trauma Services (CATS) an Autonomous body of Government of National
Capital Territory of Delhi, provided 24x7 free ambulance services through a single toll-free number i.e. 102.
Maximum rates for private PTA (Patient Transport Ambulance), Basic Life Support (BLS) and Advanced
Life Support (ALS) were set by the government and strict actions were taken against violators.
Distribution of home care kits containing masks, oximeters, thermometers, Ayush products and basic
medicines like paracetamol, Vitamin C and Zinc were done by the district teams.,
In the first wave, oxygen provision at home was not recommended for patients under home isolation.
However, during the second wave, Oxygen concentrator banks were created, with 200 oxygen concentrators
set up in each bank in every revenue district of Delhi. In case patients under home isolation required
oxygen, the Delhi government’s team ensured the oxygen concentrators would reach their homes within
two hours. A technician also accompanied the team who explained to the family members how to use
the oxygen concentrator. Patients who were not enrolled under home isolation could call 1031 and avail
the facility. Domiciliary oxygen support was provided to all patients categorized as moderate to severe
who recovered, were discharged from the COVID-19 designated facilities and were prescribed domiciliary
oxygen support/short-term oxygen therapy (STOT) at home. For this purpose, a portal, on delhi.gov.in was
launched in May 2021, through which patients requiring oxygen could apply with a valid photo ID, Aadhar
card details, COVID-19 positive report and other documents like CT scan/ report, if available.
The government partnered with Prakriti E-mobility in April 2021 to provide transportation of COVID-19
positive patients to nearby healthcare facility via a sanitized vehicle through the Jeevan Seva App.
Many hotels were attached to private hospitals, which admitted COVID-19 positive patients as per the
patient’s medical condition and in case the patient’s condition deteriorated during their stay in the hotel,
they would be immediately transferred/ admitted to the attached private hospital at reduced rates set by
the government.
Similarly, Honeywell established a COVID-19 critical center in the state that was equipped with beds,
oxygen, personal protective equipment kits, and basic medical infrastructure. It also funded the donation
of oxygen concentrators and N95 respirators to the facility.
Awareness campaign on home care protocols were done by districts through Munadi, Nukkad natak,
distribution of pamphlets and through electronic media. Incentives were provided on per case basis to
Accredited Social Health Activists (ASHAs) workers and Auxiliary Nurse Midwives (ANMs). The two-
member teams were given incentives at the rate of Rs. 200 per patient visited i.e. Rs.100 per team member.
Further, an additional Rs. 200 for two-member team was given for refreshments.
Medical Support and Monitoring
For teleconsultation purposes, list of doctors apart from private agencies were made
available. Health officials posted in government dispensaries were part of the lowest rung
of a multi-layered monitoring system that monitored home isolated patients. Emergency
contact numbers were shared with each patient in home isolation. They had to either call
up their nearest dispensary from where they received health check calls or call up the
district control room. Dispensaries operated from 9am to 5pm. Beyond these hours, the control room was
the only contact point in case of an emergency.
Round the clock teleconsultation was made available through doctors of Government of N.C.T of Delhi
via the 1031 COVID-19 help line number. Medical support was provided to COVID-19 patients under home 18 |SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
isolation through District Surveillance Officer, Medical Officer in-charge of facility, ANM, ASHA. Patients
were contacted at least once a day. A widespread network of government testing centers providing free
testing was established in the State. The surveillance and contact tracing of family members was done
by districts under supervision of DSO and was reported to state Integrated Disease Surveillance Project
(IDSP).
Home Isolation Services were provided by Portea in partnership with Delhi government: Started in June
2020 by Government of Delhi, patients were monitored remotely through a comprehensive tracking
system involving government doctors and experts from Portea for the entire mandated isolation period of
17 days. Portea also submitted regular reports on their condition flagging off any health complications. If
required, the company arranged for a teleconsultation with Delhi Government doctors using its technology
platform. For cases where hospitalization was needed, Portea notified the appropriate government agency
for action on the ground. This arrangement was discontinued within a month due to unsustainable cost
to the Government.
Monitoring: Health Care at Home (HCAH) and StepOne: This organization was engaged by Delhi
government to provide remote monitoring services and was instrumental in reducing the burden on
hospitals that were overcrowded. StepOne was another partnership which provided tele-consultation and
counselling services to the patients.
StepOne is an empaneled partner for telemedicine consultations on Aarogya Setu Mitr, an ancillary service
on the Aarogya Setu app that enables free teleconsultation for those with COVID19-like symptoms. A
plasma bank initiative was also piloted in Delhi in partnership with StepOne. The government partnered
with them for 24x7 free online medical consultation services through the CallDoc app for non-emergency
medical needs. This was an alternative to in-person OPD. They had 100 doctors on board for this purpose.
Sustainability and Replicability
As per its home isolation policy during the first wave, the Delhi government monitored the
condition of patients through teleconsultation facilities and also distributed oximeters
to help them keep a tab on their oxygen levels. The timely testing, isolation and early
institution of treatment of COVID-19 positive cases were followed. COVID-19 appropriate
behaviors were ensured among the population, which played a vital role in prevention of
the next wave. An Integrated Command and Control Centre (ICCC) to manage COVID-19 on a real-time
basis in the city was established which integrated all the above services. | 19
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
In Goa, health services were delivered at community level and to home isolated patients by
community health workers including Multi-Purpose Health Workers (MPHW), Anganwadi
Workers (AWWs), traditional medicine practitioners (AYUSH), social care workers (NGOs
– Rotary club, Lion’s Club, Jaycees), and a variety of formal and informal community-
based providers (Churches, Temples, prominent citizens, trusts, CSR).
StepOne helped in telemonitoring of patients under home care during the second wave. (StepOne, is a
non-profi t volunteer driven collective of 7,000 doctors. The organization launched a National COVID-19
Telemedicine Helpline, offering 24x7 access to healthcare experts, free of cost).
Inclusion and Eligibility Criteria
Home care was only considered for adults with confi rmed or suspected COVID-19
symptoms. Psychologically fi t patients with mild or asymptomatic cases were advised
for home isolation. Also, the presence of a willing caretaker and appropriate home
environment were prerequisites. Patients were excluded from home care if abnormal self-
monitoring parameters were observed, including SpO
2
< 95 percent, Pulse rate > 100/ min
and temperature > 100F. Patients with uncontrolled or severe comorbidities, pregnant women, patients
without caretakers and children with moderate COVID-19 symptoms were restricted from home care.
Intervention Details
The state government rolled out innovative and engaging communication messages to
educate communities on COVID-19 management. For awareness generation, information
education communication van with pictographs, billboards and pamphlets were sent
across the state. Village wise posters and banners were installed at public places which
explained the concepts of hand-wash, social distance, importance of facemask and
vaccination. Door to door surveys and campaigns by MPHWs, AWWs, local governing bodies (Panchayat
members) were initiated to explain home isolation protocols.
Home based testing was provided for disabled and elderly. Telemedicine facilities were started at hubs
staffed by Medical Offi cers (MOs) and counsellors. Transfer protocol was prepared to transfer patients to
COVID-19 Care Centers (CCC) through a designated ambulance in case of moderate or severe symptoms.
Medicine kits were distributed at home by MPHWs. These kits included instructions on use of medicines
by the health department of Goa. Medicines were provided free of cost to patients at the Primary Health
Care (PHC) level. In addition, pulse oximeters and thermometers were provided with batteries. Personal
Protective Equipment (PPE) for 10 days home isolation (N95 face mask, 3 ply face mask, gloves, sanitary
wipes, sanitizers) were made available for all home isolated patients.
GOA 20 |SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Oxygen saturation through self-monitoring was supervised by MOs through telemedicine. The portal was
also used to triage and transfer patients to CCCs. Dedicated ambulance with Basic Life Support (BLS) was
arranged for home pickup and drop to CCC. MOs-initiated referral and supervised transfer for all patients
who developed severe and moderate symptoms. Many private providers helped in this initiative. Private
companies like Syngenta Indian Limited, Deccan Chemicals provided vehicles for patients transfer. Jindal
Steel Works provided a BLS equipped ambulance for COVID-19 patients under their Corporate Social
Responsibility (CSR) initiative. Rotary Club provided two RT-PCR testing machines worth Rs. 80 lakhs at
North Goa District Hospital facilitating decentralized processing of test results.
Medical Support and Monitoring
A district wise call center was set up. PHC MOs supervised home isolated patients through
telephone and maintained their records (Pulse, temperature, oxygen saturation) on a daily
basis. Every patient was contacted daily until their home isolation period was completed.
Auxiliary Nursing Midwives (ANMs) were tasked with Sub Centre based vaccination and
supervising home-based isolation by phone. Home isolation monitoring services were
offered through StepOne. Day 1-10 schedule was maintained to monitor patients. Automated Int calls
from Day 2 till Day 9 were done to monitor patients’ symptoms. Patients were called on Day 10 to check
their discharge from home isolation. Automated Interactive Voice Response (IVR) calls were done from
Day 11 to Day 17 for case of symptomatic patients.
The Government of Goa partnered with StepOne to create a Goa Online Portal with a Home isolation
monitoring channel, which helped track and monitor home isolated persons and proved to be a better
model than the one where calls were made by persons.
Medical kit | 21
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
During the fi rst wave, transmission was mostly reported through tourists coming into the state followed
by the local transmission. However, in the second wave there was a sudden increase in local transmission
with an increase in asymptomatic cases being reported. As hospitals were burdened with the surge in
cases, COVID-19 Care Centers (CCCs) were made functional with oxygen transport and storage facilities.
Decentralized oxygen therapy was commenced at the CCC. Further, efforts were made to provide care to
home isolated patients and large-scale vaccination drives were conducted in old age homes.
Scalability and Replicability
Going forward, the state aims to focus on testing patients through Mobile Vans in schools,
factories, housing localities as per localized outbreaks. Further steps have been taken
towards empowerment and integration of AYUSH doctors for preventive and primary care
for mild COVID-19 infections.
Step One System
Cloud
Day 1, Day 10
Telephonic screen-
ing of patients - to
check patient health
and symptoms
Queue of
patients to call
Calls
Updated
health
status
of Home
Isolated
patients
available
List of Covid Positive Patients
under Home Isolation
Doctors call out Covid Positive patients
and monitor symptoms, help identify
patients needing help
Doctor callout
Impact
Ensure Home Isolation patients get
medical and mental health care
Faster response to emergencies
Have full visibility on Home based patients
Ensure Home Isolated patients have full access to doctors via Telemedicine!
Home Isolation Monitoring
Doctor callout 22 |
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
The Government of Jammu and Kashmir (J&K) adopted an innovative approach to manage
and contain the pandemic. There were local district level triage centers to ensure proper
patient examination and referral, reducing unnecessary burden on tertiary and referral
hospitals. COVID-19 kits were given to patients and Interactive Voice Response System
(IVRS) was made available on round-the-clock helpline 104. The state partnered with Norway
India Partnership Initiative (NIPI) and Health Information Service Provider (HISP) India to create a COVID-19
dashboard for the state. 20,000 COVID-19 Care Center (CCC) beds were activated across the state close
to rural areas in all the 20 districts with 1,000 beds each. Patients requiring isolation were identifi ed by the
Panchayats/ concerned Medical Staff and Accredited Social Health Activist (ASHA) workers.
Intervention Details
Over 20,000 CCC beds were made available across J&K for COVID-19 positive patients
with no or moderate symptoms who did not have the necessary facilities in their homes
for home isolation. Districts established local district level triage centers to ensure proper
examination of patients and correct referral, reducing unnecessary burden on tertiary
and referral hospitals. Further, COVID-19 kits containing an oximeter, basic medicines,
vitamins, cough syrup, and pamphlets of dos and don’ts were distributed to COVID-19 positive patients in
home isolation.
State government’s outreach measures included consultation services over the IVRS and a round-the-
clock helpline number 104. At a glance, COVID-19 dashboard provided real time information about
confi rmed, active, recovered cases, deaths, positivity rate, recovery rate, fatality rate, test per million at
a single glance, geotagging and clustering of cases, health system preparedness, ICU availability and
isolation beds available to facilitate and generate appropriate and timely response, etc.
In addition to this, Swasthya Nidhi App provided real-time information on the various surveillance activities
conducted by the state.
Monitoring and Medical Support
Over 300 Anganwadi Workers (AWWs) were tasked to carry out door-to-door visits to
check on the health status of patients on a daily basis. In addition to this, ASHA volunteers
visited patients’ homes daily as part of surveillance measures.
Further, the government established a fi ve-bedded CCC in every panchayat, with one
oxygen supported bed (equipped with an oxygen concentrator) and other basic facilities in
collaboration with the local Panchayat Raj Institutions (PRIs), Departments of Health & Medical Education,
Social Welfare and Education. These centers were equipped with necessary medical kits and mapped to
nearby health facilities with provision of medical consultation, testing, ambulance services and isolation
of positive patients.
JAMMU AND KASHMIR | 23
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
The Government of Haryana, with support from Deloitte, launched ‘Sanjeevani Pariyojana’
(or ‘the life project’), a supervised, virtual home care initiative to provide individuals with
support and resources to manage their care at home, including access to virtual triage, as
well as links to COVID-19 hospitals and inpatient facilities when deemed appropriate by
state-trained medical staff.
The program addressed immediate and intermediate needs while establishing a foundation for long-
term needs in order to reduce the burden on India’s healthcare infrastructure. The main aim was to
augment home care support to enable recovery and treatment while in home isolation. It began with
identifying cases at early stages and ensure early recovery. The model was executed through seven key
interventions carried out in a Public Private Partnership (PPP) mode by the state government, Karnal
district administration, and Deloitte. In just 3.5 weeks, the Karnal district launched and implemented an
end-to-end support system.
This model also served as a guide for other State/District Administration in India for replicating in other
regions. The fi ve key interventions included the following:
Karnal district launched and executed end to end support system in merely 3.5 weeks
HARYANA (KARNAL)
01
STEP
02
STEP
03
STEP
04
STEP
05
STEP
5
Key Interventions
Command Center
Virtual Healthj
Tiered Medical Infrastructure
Outreach, Education and Communicatoins
Scale and Replicate 24 |SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Inclusion and Eligibility Criteria
When a patient was tested positive, a doctor would performed medical triage in accordance
with government guidelines, classifying the case as mild, moderate, or severe. Home
isolation was recommended for mild cases, and ASHA workers delivered home care
kits. In addition, these cases were monitored on a regular basis. Patients with moderate
symptoms were transferred to a field hospital/ isolation ward and were monitored on
a regular basis. In the most serious cases, patients were hospitalized, and community health centers
arranged ambulances and shifted them.
Intervention Details
ASHA workers used Information, Education and Communication (IEC) materials to
generate awareness on COVID-19 appropriate behaviors, helpline, home isolation
protocols and isolation facilities. They were also responsible to conduct early detection/
referrals of suspected cases, assessed health status inquiry of all individuals, monitored
adherence to home-isolation protocols, followed-up with individuals who were referred for
testing and sent updates on the status of the individuals. They also alerted Primary Health Care Medical
Officer (PHC-MO) MO/ helpline if a suspect individual had not gone for testing. Priority health status
check-ins were done for vulnerable populations, including those with a history of contact with positive/
suspected cases. ASHA workers engaged with MOs at PHCs to update their details on the Sanjeevani
app. This information was assessed and monitored by the ICCC at the District level for all home isolation
cases. | 25SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Field-Hospitals were set up and equipped with supplies such as oxygen beds, oxygen concentrators, 24x7
medical teams with dedicated doctors & staff nurses to accommodate a potential surge in COVID-19
patients. Field hospitals had dedicated ALS ambulances stationed round the clock with the idea that
any patient in need of critical care can be shifted to the nearest tertiary facility in the shortest span of
time. Isolation wards were created in 50 villages in the district, wherein patients who were positive and
asymptomatic and were not in need for hospitalization were given support in isolation away from their
families.
Home isolated patients were provided home care kits with basic medical aid equipment and medicines
to effectively monitor home isolation cases or to detect early symptoms. Nodal officers were deputed for
this purpose to ensure last reach through ASHA, ANMs, patwari, gram sachiv (secretary) to ensure every
patient received kits at their doorstep. A home care kit generally included: thermometers, pulse oximeters,
oxygen concentrator, steamer, triple layered masks, ORS packet, medicines (paracetamol, vitamins, etc.)
6,500 home care kits were prepared and distributed which contained 6,500 pulse oximeters, digital
thermometers along with other medical essentials. 200 Oxygen Concentrators were also supplied. In
addition to this, interns from the medical college in the State were roped in to provide medical consultations.
Distribution of medical kits to the community members
Medical Support and Monitoring
A team of 200 final and pre-final medical students (from KCGMCH) were selected to monitor patients in home care. Each member of the team was assigned 25 patients and was responsible for calling them every morning and evening to check their vitals. These readings were entered into a designed proforma tabulated in an excel sheet. If the parameters of any patient on any given day indicated that he or she might require
hospitalization and admission in a field hospital/ tertiary hospital, the issue was escalated to the consultant 26 |SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
(a senior doctor at KCGMCH), who then notified the district administration. Each student received an
honorarium of Rs.5000 per month, as well as extra marks in their internal assessment. In case the patient’s
condition deteriorated, the team coordinated with ICCC to shift the patient to appropriate facilities.
A COVID-19 hotline was set up for citizens. This hotline responded to citizen queries, directed them to
the right medical channel and proactively monitored health status of active / suspect COVID-19 positive
cases. Mobile testing was an important feature of this model. Testing was done on 5
th
/ 6
th
day of all home
isolation cases for Complete Blood Count (CBC), Blood Sugar, C-Reactive Protein (CRP) test (Quantitative)
and results were provided within 24 hours.
The ICCC which was set up as a Smart City initiative was activated for monitoring and management
of COVID-19 care. The ICCC was made responsible for capacity monitoring and management of
medical facilities. Data on healthcare capacity was collected at each hospital, and was entered by the
administrator into Sanjeevani portal. It tracked available capacity across district for beds, ICUs, ventilators
and availability of other infrastructure.
The center also played a major role in inventory management. It tracked inventory within the facility and
provided alerts when stocks dropped below a set minimum level. It showed data on the no. of Personal
Protective Equipment (PPE) kits or other items used in any isolation ward/ healthcare facility and
showcased total consumption and stock remaining for the district. It was also used to capture details
regarding oxygen availability and usage.
The ICCC had a capacity dashboard to aggregate number and real time availability status of all beds
across categories, like normal beds, individual rooms, ICUs, Ventilators, etc. Oxygen Dashboard showed
availability of oxygen, burn rate as well as the time left for the stock to empty. Patient dashboards showed
the numbers of patients in various kinds of admission within various facilities.
The ICCC also supported centralized decision support systems and capacity management by bringing
together patients, doctors, hospitals, labs, specialized treatment centers, hospital administrators, tele-
health professionals, etc., throughout the patients journey to enable a single view of the healthcare
system for the district administration (bed capacity, health care personnel, oxygen, ambulances,
current patient count, status, etc.). It enabled integrated tele-medicine, real-time bed-allocation,
patient shifting and war room dashboards driving efficiencies in field-operational processes at
district/ panchayat/ ward level.
The ICCC was also linked to ambulances, testing and mobile pharmacies. Advanced Life Support (ALS)
ambulances and mobile pharmacies were deployed. Since Basic Life Support (BLS) ambulances cannot
administer medicine, and critical COVID-19 emergencies required advanced care, 8 ALS ambulances were
stationed at Community Health Centers (CHCs) to ensure that any patient in need of care and attention
could be transported to the nearest tertiary care facility. The ambulance association was leveraged
to source ambulances for deployment in a very short time. The administration tied up with a private
agency, Hindustan Wellness Lab for home-based Lab Blood Tests of 3 types (CBC, CRP & Blood Sugar)
at subsidized rates (Rs. 460 per test) that helped district administration identify COVID-19 positive home
isolated patients who were in a need to shift from home to field hospitals/ tertiary hospital. Home
collection of test samples were done through Sanjeevani app.
Dedicated Village Isolation Centers (VICs) were established with the help of Development & Panchayat
Department, Haryana, near the villages Schools / Panchayat Bhavans / Chaupals etc. and had the facilities
of well-ventilated rooms, separate toilet facilities, adequate staff and logistics. DDPOs were designated
as Nodal Officer and also assigned the responsibility of providing logistics & maintaining VIC for patients. | 27SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Gramin Swasth Suraksha App – an application for online and real time screening of village population
through ASHA workers was developed.
Scalability and Replicability
To replicate the model and scale it up to larger geographical units, a playbook has been
created. The book proposes a three-tiered model that could leverage the existing state
administrative structure and allow for the establishment of an ICCC at the state level.
As Medical Colleges were not present in every district and each Medical College served
three to four districts on average, tele-consultation were envisioned at the Division level.
Similarly, Division Level ALS Ambulances were provided to connect CHCs/ District Hospitals to Medical
Colleges.
This model is planned to be replicated in other districts of Haryana and is further planned to be
implemented in few districts of Gujarat and Karnataka (in partnership with Deloitte). However, the model’s
long-term sustainability is yet to be determined; however, it can improve disease surveillance capabilities
by analyzing geo-tagged data to identify potential hotspots and vaccination priorities – and it can be
extended to other primary healthcare priorities (e.g., NCD). 28 |
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
The Government of India has endorsed Home Based Care (HBC) for asymptomatic
and mildly symptomatic COVID-19 patients. HBC if left unmonitored, poses the risk of
inappropriate care, and increased familial transmission. In view of this, Government of
Madhya Pradesh (GoMP), in cognizance with the guidelines from the Government of
India devised a ‘Monitored Care Strategy’ and public health measures for ‘Home care for
patients with COVID-19 presenting with mild symptoms and management of their contacts’.
The key objectives of HBC were to identify and support COVID-19 patients who could receive care at home.
Homes create an opportunity for emotional care and support needed for recuperation. Clinical monitoring
and treatment of COVID-19 patients at home and protocol for referrals of suspects/ symptomatic and
isolation of symptomatic cases leads to decongestion of health facilities and makes room for health
workers to focus on critically ill persons who require face to face examination and treatment.
An integrated tech-enabled HBC model through the ‘NISHTHA Tele-Track’ was launched in two districts,
Khandwa and Rajgarh as an enabler for effective monitoring and tracking of COVID-19 patients with
support from USAID-NISHTHA/ Jhpiego. The platform acts as an enabler for effective monitoring and
tracking of COVID-19 patients and has functionalities for recording vitals of home isolated cases on a
daily basis, provision of regular & need based SOS telemedicine consultations with a pool of physicians,
digital reporting and with generation of system alerts in case a patient develops symptoms and requires
referral.
Inclusion and Eligibility Criteria
Patients who tested positive for COVID-19 either through Rapid Antigen Test (RAT) or RT-
PCR and have mild symptoms or are asymptomatic are eligible for home isolation.
Intervention Details
The Kill Corona Initiative of the state was launched during the fi rst wave of COVID-19 and
was further revamped and re-launched during the second wave. The initiative had put
forth an elaborate plan that effi ciently aided in identifying, testing and treating COVID-19
suspects. The surveillance strategy for the Kill Corona Initiative included house to house
visits for population-based screening at rural and Nagar panchayat areas and setting up
COVID-19 Sahaytha Kendra at urban areas.
Community Health workers and Accredited Social Health Activist (ASHA) workers prepared a line list of
all people who travelled to other countries or other states of India in last 14 days and counselled them
MADHYA PRADESH | 29SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
on COVID-19 appropriate behaviors and home isolation protocols. This line list was then shared with the
Medical Officer (MO) at the Primary Health Center (PHC).
Once tested positive, patients were tracked through the NISHTHA Tele track for 10 days. The team comprised
of Medical Doctors, Nutritionists, Nurses, and counselors. During the 10 days, if there were symptomatic
patients with danger signs, the team immediately initiated referral linkages with the tertiary hospital for
early initiation of treatment. This helped in preventing delays in hospital admission which is considered as
one of the contributing factors for high mortality. Till date, a total of 86 cases have been registered, out
of which 17 cases successfully completed 10 days of home isolation without any complication and were
discharged from home isolation. No case has been referred to a higher facility and no mortality has been
reported till date.
Counselling of COVID-19 positive patients’ family members under home isolation by Community
Health Officer and ASHA workers
Medical Support and Monitoring
A medical team comprised of certified Doctors, Nurses, Nutritionists, and counsellors to do regular follow up on all the positive cases for a period of 10 days for patients who were enrolled in the NISHTHA Tele track platform. The certified doctors consulted with the patients on the first, third and seventh day. The nutritionist followed up on day 2 for nutrition counselling and on the fifth day mental health counselling was provided
by experienced clinical psychologists or counsellors. The nurses followed up for all 10 days to assist patients regularly. There was also a provision for live teleconsultation with a specialist doctor in case of any emergency.
The state also leveraged teleconsultation and helpline through Interactive Voice Response (IVR)
technology which helped in reaching out to patients round-the-clock, improving data quality, reducing
costs by automating communication processes. Primary healthcare workers, Anganwadi workers
(AWWs) and doctors, Auxiliary Nursing Midwives (ANMs) in Primary Health Centers (PHCs)/
Community Health Centers (CHCs)/ District hospitals were deployed to cover 50 households each
where they would keep track of the patient’s vitals on a daily basis. Further Medical Officers (MOs)/
doctors visited the households on first and last day of the home isolation period to determine them
as physically fit. 30 |SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
All the above interventions were connected and
monitored by an integrated command center. The list
of asymptomatic positive patients was provided to the
central command center and patients were monitored
twice a day to assess vital parameters and clinical
condition of patients on a pre-designed questionnaire. In
case the team identified moderate to severe symptoms,
the call would be forwarded to the on-board MOs/ MBBS
doctor to ascertain the condition and provide solution for
the same.
Mobile testing booth and teams were formed to
collect samples of the suspected cases with the
help of the list provided by the central command
center. This was done through the SOS calls received
which were verified by the MO where the details of
the address were forwarded to the ground team to
collect the sample. These results were forwarded to
the respective facilities to determine home isolation or
referral to higher facilities. State and district Rapid Respond Team (RRT) roles were to identify, isolate
and track the contacts of the positive cases with the help of information and lists provided and
submit the report/ data to the control room.
Distribution of medicines to patients by Community Health Officer
Health workers' visit to patients in home isolation. | 31SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Scalability and Replicability
The COVID-19 pandemic is here to stay and the sudden surge of cases in the second
wave highlighted that there is a need to be better prepared to curb the pandemic. With
the third wave approaching, the state has initiated a few models including large COVID-19
vaccination drives, sanitization of market areas, promoting self-hygiene practices,
establishing control room for monitoring and feedback of COVID-19 and other scalable
and replicable models. Other measures include setting of buffer stock of medicines, oxygen cylinders and
concentrators by creating a pandemic/ communicable disease fund, creating Information, Education and
Communication (IEC) materials, building hospitals or scaling up of capacity of hospitals in terms of ICU
beds and oxygen supported beds, earmarking and creation of separate blocks for communicable diseases,
creation of control room for monitoring and feedback of communicable diseases e.g. COVID-19 ,TB etc.
on regular basis for continuum of care and using of GPS facility of mobile for monitoring, surveillance and
contact tracing activities for current and future times. These measures are used for other programs and
can be replicated for COVID-19 as well.
The state has also launched an important initiative called ‘Swasthya Sampark’, a post COVID-19 care initiative
in collaboration with USAID’s flagship health system strengthening project NISHTHA, implemented by
Jhpiego. The platform acts as an enabler for effective monitoring and tracking of post COVID-19 patients
and has functionalities for recording vitals of patients on a daily basis, provision of regular & need based
SOS telemedicine consultations with a pool of physicians, digital reporting with generation of system alerts
in case a patient develops symptoms and requires referral. This post COVID-19 platform is a remote help
desk integrated with telemedicine (teleconsultation & tele counselling) to support individuals recovered
from COVID-19. The patients can connect through a toll-free service care number wherein a trained health
professional will attend to patients calls and address their concerns. Further, patients requiring advanced
care will be connected to a medical doctor through telemedicine, thereby providing timely and right home
care. The platform would also provide services like mental health counselling, dietary counselling through
tele counselling services as well as treatment for any medical ailment developed or worsened during post
COVID-19 period through teleconsultation services. 32 |
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
The state of Manipur adopted ‘Home Isolation’ (HI) for patients who were either
asymptomatic/ mildly symptomatic and willing, fi t or wish to stay under HI to reduce the
burden on the health system. Under this initiative, the state created a HI team at the state
and district levels. The team at the state level was led by the Joint Director whereas at
district level it was led by the Chief Medical Offi cer (CMO). Home isolation team activities
included enrolment, line-listing, drug distribution, tele monitoring, home visits and referral and discharge
of HI patients.
The state adopted a comprehensive home-based care system which included triaging of patients, regular
monitoring through teleconsultation or visits (if required), delivery of home isolation kits (medicines,
mask, pulse oximeter, sanitizer, etc.) and referral services. In case of a surge in COVID-19 cases in the
state, hospitals and services of healthcare professionals need to remain available for treatment of severe
symptomatic COVID-19 patients or other non-COVID-19 ailments, medical procedures, emergency cases,
etc. The adoption of HI will therefore go a long way in curbing the spread, through early containment and
reducing the overall burden on health facilities.
Inclusion and Eligibility Criteria
The CMO designated a medical team to examine and identify the COVID-19 positive
cases eligible for home isolation based on the following criteria: Minors (below 10 years
of age) or babies who were asymptomatic; pregnant women where the Expected Date of
Delivery is at least one month and were asymptomatic; patients with mild symptoms who
did not have any other co-morbid conditions and had the availability of being supervised
by trained health staff; asymptomatic elderly patients (60 years and above) and persons with any of
the following ailments: hypertension, diabetes, heart diseases, chronic lung/ liver/ kidney diseases and
patients who were immuno-compromised could be allowed to remain under HI after proper evaluation by
the medical team.
Intervention Details
Awareness campaigns on home care protocols: Information, Education and
Communication (IEC) materials (posters, leaflets and stickers) on COVID-19 Appropriate
Behaviors and COVID-19 were developed and distributed. The state also developed
videos on home isolation, pulse oximeter, use of masks, mental health etc. to educate
the community which were telecast on electronic media and social media. Videos on
proning and home isolation were developed by USAID-NISHTHA/ Jhpiego which were shared with all the
Community Health Offi cers (CHOs), who further disseminated it to persons under HI under their Health
and Wellness Centers (HWCs). In addition, awareness sessions were conducted by CHOs and Accredited
Social Health Activists (ASHAs) for persons under HI.
MANIPUR | 33SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Co-ordinated efforts at village level: There were coordinated efforts by Civil Society Organizations,
Panchayati Raj Institutions (PRIs), Local Club Volunteer, Teachers, Anganwadi Workers (AWWs), ASHAs,
National Cadet Corps, in manning isolation of mild/ asymptomatic cases at identified Community
COVID-19 Care Centers (CCC) and Community Home Isolation Centre (CHIC). These centers were run
by the concerned assembly constituency of the COVID-19 management team. The district isolation team
including CHOs visited the CHIC from time to time to ascertain the status of the patients.
Distribution of HI Kits: ASHAs supported in identification of houses suitable for HI, distribution of HI kits,
demonstration of pulse oximeter and contact tracing. As on August 3, 2021, 67,978 drug and HI kits were
distributed through ASHAs. Following discharge, pulse oximeters were collected by ASHAs and reused
after sanitization. ASHAs were also given special incentive for recollection of the pulse oximeters. In case
of difficult terrains, special mobile teams and volunteers were deployed.
Referral and helpline support: In case any HI patients required oxygen, they were referred on an immediate
basis to CCC or COVD Hospitals. For patients with moderate/ severe symptoms, the district nodal officer
was informed and these patients were referred using state ambulances deployed at all districts. Currently
the state has 41 Ambulances meant for COVID-19 (12 Advanced Life Support and 29 Basic Life Support).
Partnering with other organizations: The state partnered with Medicine Sans Fontier (MSF) NGO for
conducting home visits for physical examination of patients in Imphal west, Imphal East district and
Thoubal District which had high number of COVID-19 cases. The state was also supported by USAID-
NISHTHA/ Jhpiego for strengthening home based care at the HWC level.
Medical Support and Monitoring
Virtual telemedicine/ helplines/ call centers were set up wherein the State Home Isolation
Control room routinely followed up with HI patients to check their vitals and counsel them
on the home isolation guidelines. Follow up calls were made on the fifth day for early
identification of moderate severe signs and symptoms. Follow up calls were also made to
patients with co-morbidities to check their BP and blood sugar status. In case of patients
who developed moderate or severe symptoms, hourly follow up was done until they were admitted to
COVID-19 Care Centers/ Hospitals. Separate eSanjeevani OPD for HI patients and eSanjeevani helpline
number was also initiated. Two state HI helpline numbers were made operational on a 24x7 basis. In
HI KitsDemonstration by Asha WorkersDelivery by HWC staffs 34 |SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
case of high case load districts, viz Imphal East and Imphal West -10 landlines were made operational in
each control room for daily monitoring. Further, each patient was assigned a Medical Officer (MO) and a
monitoring Team (Nurse/ CHO).
The State Home Isolation Team led by State Nodal Officer HI and assisted by Deputy Director (Public
Health) and Specialist (Public Health) of different division conduct daily supervision of HI line listing, HI
kits and drug distribution.
The medical response team led by Deputy Director (PH) and Clinical Pharmacologist conducted home
visits for examining patients developing symptoms/ patients with comorbid conditions. For such patients
a team of doctors and nurses visited on a regular basis to ensure IV administration, blood glucose test, BP
check-up and other necessary minor procedures.
The State Medical Resource treatment group led by Senior
Specialist doctor were available for immediate online
consultation for all the doctors and nurses in the field. This
team included faculties of RIMJS, JNIMS, IMA and state
Doctors who were available through WhatsApp or telephone
calls.
At the district level, a team including District nodal officer and
Medical officer (CHC/ PHC) in charge, Assembly constituency
level doctor (in-charge of Home isolation), CHO /ANM in charge
of Home Isolation at DH, PHC, HWC, PHSC level visited the
patients on a regular basis. The vitals and symptoms of the HI
patients were recorded in a monitoring sheet maintained by the
health worker. This was also uploaded in the MHIM app.
Weekly Zoom meeting with the districts followed by weekly field visits by the state and zonal doctors to
different PHC /HWC of Imphal East and Imphal West | 35
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Linkages were also established with an integrated command centers, where relevant data was shared
with District Contact Tracing Team. The data was also shared with the Integrated Disease Surveillance
Project (IDSP) team and tracing was done by each team of the districts. The HWC staff also conducted
physical contact tracing in their HWC jurisdiction.
Grievance Cells for HI were also opened at the office of the Chief Minister in the month of May 2021 to
sort out issues/ complaints raised by HI patients through a dedicated Grievance Cell number.
Scalability and Replicability
The state plans to scale up the home-based physical assessment visits for patients
across all districts. This is currently operational in three districts which have the highest
case load. This structure can be integrated with the existing public health system and can
be made sustainable for future emergencies.
The State Model of Home Isolation of Manipur is defined and guided by structured SOPs,
flowcharts and guidelines. The state has clearly defined roles and responsibilities across various levels
which ensures accountability at all levels and an integrated continuum of care. The system can be well
replicated and scaled up to other districts/ state with some adaptations.
Weekly field visits by DNO HI and AC doctors to PHC /PHSC /Community Home Isolation centres and supervisory visits
for any urgent case 36 |
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
During the fi rst wave, 98 percent of the cases in the state of Meghalaya were asymptomatic
and during the second wave in the month of April, 2021 (before starting Home based care
management) 83 percent of the active cases were asymptomatic. Due to the exponential
rise of cases during the second wave there was a need to reduce the burden on hospitals.
The bi-phasic nature of COVID-19 called for an early intervention and monitoring
mechanism in order to reduce the number of severe cases and deaths. This called for a Home Based
COVID-19 Management - a psychological and medical support for the COVID-19 infected patients in
Meghalaya particularly in Shillong, which reported the highest cases in the state with signifi cant mortality
rates.
The urban area of East Khasi Hills, which is divided into 10 zones are manned by two zonal Nodal Offi cers
(ZNOs). Each zone has a mobile team which includes 1-2 Medical Offi cers (MOs) and 5-10 Staff Nurses.
Intensive training by specialists was provided to MOs and Staff Nurses on home-based management
of mild and moderate COVID-19 cases, infection prevention practices, oxygen therapy, non-invasive
ventilation, nebulization, metered dose inhalers etc. These trainings were conducted in partnership with
development partners including USAID-NISHTHA/ Jhpiego, UNICEF, WHO etc. Each team was equipped
with required essentials at fi eld level such as medicine kits for adults/ children, home isolation kits for
COVID-19 positive patients and monitoring formats.
The objective was (i) to provide home Based basic care to mild to moderately affected COVID-19 persons
who did not require in-hospital care (ii) to ensure continuous monitoring of COVID-19 symptomatic
persons (iii) to ensure timely identifi cation of disease prognosis and early referral by understanding the
bi-phasic nature of the disease (iv) to reduce the burden on hospitals (v) to strengthen the knowledge of
caregivers regarding protocols to follow while taking care of COVID-19 positive persons and (vi) to provide
psychological and moral support during times of pandemic.
Inclusion and Eligibility Criteria
Initially home isolation was mandated for COVID-19 patients who were 45 years and
above of age. However, this was later expanded to all age groups. Asymptomatic cases
and mild symptomatic case, persons who were psychologically fi t and willing for home
isolation were mandated for home isolation. Further, home was practiced initially only in
the urban areas of Shillong agglomeration and was later extended to peri urban areas of
Shillong. Over time this was extended to other districts as well.
MEGHALAYA | 37SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Intervention Details
Awareness campaigns were conducted on home care protocols through the state
COVID-19 helpline, innovative IEC messaging including home isolation diaries, COVID-
19-Home Care Hand-Book, posters, banners, advertisements on newspaper and
through field level staff. Front line workers including Accredited Social Health Activists
(ASHAs) / Auxiliary Nursing Midwives (ANMs), Urban Primary Health Center (PHC)
staff were leveraged to create awareness and follow up with patients under home isolation. Community
COVID-19 Management team (CCMT) and Block war Rooms - a one stop center was established at every
Development Block (rural areas) and Zones (urban area). These centers were functioning 24x7 on all
COVID-19 related matters.
The Integrated Disease Surveillance Project (IDSP) team shared the list of all the positive cases from
urban and peri urban areas of East Khasi Hills with respective Zonal Nodal Officers for follow up visits
on a daily basis. The home-based care management team confirmed the same by calling each and every
patient. Confirmed patients and follow-up patients are visited by the team. All asymptomatic and mildly
symptomatic patients were treated and severe patients were referred to hospitals. The onset date of
symptoms was captured by the team and the team regularly followed up from Day 6 to 10 to identify any
biphasic cases. Follow up visits of such patients were also regularly done. Specialists were also engaged
on a need basis under home based care management.
Home care kits including pulse oximeter, thermometer, masks and medicines as per the government’s
guidelines were distributed free of cost at the doorstep of patients. Oxygen concentrator were made
available free of cost to patients. Ambulance services were provided in case of emergency. Block war
rooms also coordinated in deployment of community ambulances.
Medical support and Monitoring
Virtual telemedicine/ helplines/ call centers: 14410 - COVID19 State Helpline number
played an important role in reaching out to people who were both inside and outside
home-based care management areas. The executives were trained on COVID-19 and the
changing needs of the pandemic. They helped the district administration in identifying the
cases where medical assistance was required. Nodal Officer/ MO contact details of each
zone were shared with patients.
All patient’s details were uploaded on Health Management System software on a regular basis, the same
was monitored by the backend team. A home-based care management team consisting of nurses and
supervised by doctors visited the patients on a regular basis. Daily cumulative reports were also submitted
to the Mission Director, NHM. An integrated command center was linked through regular meetings, daily
reports and through HMS software
High risk contacts of the patients were referred to nearest testing centers and whenever the need arose,
testing arrangements were done at door-step. Surveillance teams were headed by a District Surveillance
Officer. 38 |SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Scalability and Replicability
Scalability plan is to scale up this model and cover other urban areas of the state. The
distribution of the population in the state is such that a relatively dense population is found
only in certain pockets and rest are sparsely spread across the entire state. The terrain
is tough but COVID-19 has reached even the remotest region of the state. Keeping this
in mind, home based tele consultation of the COVID-19 patients through NISHTHA Tele-
Track was initiated in collaboration with USAID’s flagship health system strengthening project NISHTHA.
This has been rolled out recently on a pilot basis in the districts of Ri-bhoi and West Garo Hills districts.
This model will complement the home-based care management model of the state.
Meghalaya training pediatric covid-19 care-3 | 39
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
Mizoram being the second least populous state with a population of 11.9 lakhs was also
badly affected by COVID-19. The state somehow managed the fi rst wave of COVID-19
without the need of home isolation for COVID-19 patients. However, with the surge in
cases during the second wave, the state was unable to accommodate all COVID-19
patients in hospitals, thereby necessitating the need for home isolation strategy. Following
the MoHFW’s recommendation, the state government decided to keep patients who were eligible for self-
care under home isolation which comprised of at least 30 percent of the total cases in the state.
One of the main objectives of home-based care for COVID-19 positive patients in Mizoram was to minimize
the burden of health care facilities due to rapid rise of COVID-19 positive patients. The state adopted the
approach of supervised home-based care with an aim to prevent and reduce the severity of the illness by
providing care as per the need of the patient. Further, other approaches included monitoring and tracking
of patient conditions using digital and non-digital interventions, identifying patients with severe illnesses
and ensuring timely referrals.
Inclusion and Eligibility Criteria
Eligible COVID-19 positive patients who were willing to undergo home isolation signed
an undertaking on self-isolation. Patients with no clinical symptoms or very mild cases/
pre-symptomatic cases were cleared by the treating Medical Offi cer (MO) and advised
home isolation. Those who had the requisite facility at their residence for self-isolation
and for quarantining the family contacts were also advised home isolation. It was
necessary that a care-giver was available for 24x7 with a communication link between the caregiver and
the hospital. Patients were also required to monitor their health and regularly inform their status to the
District Surveillance Offi cer for further follow up
Intervention Details
Awareness campaigns on home care protocols was done digitally and through various
other media including local newspapers, local channels, Television scrolls, YouTube
channels, WhatsApp and display of Information, Education and Communication (IEC)
materials related to COVID-19 care on Health Department website.
State level and district level IDSP teams conducted active case fi nding in containment
zones on a regular basis. The active case fi nding team comprised of MOs in charge and healthcare team
in the particular locality or village including Multi-Purpose Workers and Accredited Social Health Activists
(ASHAs). The team was responsible for contact tracing and testing of suspected cases. The state also
leveraged frontline workers in containment zones for contact tracing and active case fi nding.
MIZORAM 40 |SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Medicines were distributed to patients in co-ordination with the Village/ Local level COVID-19 task (VLTF/
LLTF) force who purchased and delivered for purchasing and delivered the medicines to home isolated
patients at their door steps. Patients could also purchase their own medicines through VLTF/ VLTF. Free
medicines were distributed to Community COVID-19 Care Centers (CCCC) for poor patients under home
isolation in their own village/ locality by VLTF/ LLTF. Pulse oximeters were distributed to each Village/
Local Level Task force which was to be loaned to home-isolated patients. AYUSH medicines were also
widely distributed to home isolated patients through local level COVID-19 task force.
Oxygen Concentrators were not provided directly to home isolated patients since provision of oxygen
availability was ensured by the state in each community CCC for each locality. At least 50 percent of the
Oxygen Concentrators received from foreign aid were mainly distributed/ loaned to Community CCC.
Since every villages/ locality where COVID-19 cases were detected established CCCC in their own locality,
patients who needed oxygen were referred to Community CCCs for immediate treatment.
Ambulance service arrangement was made available by the state for referring patients under home
isolation. When a patient under home isolation was referred to the facility by an attending doctor, the
local level task force notified the CMO and ambulance was sent to the patient and transported via the
ambulance to hospital.
Medical Support and Monitoring
NISHTHA Tele-track, a home-based care model for monitoring, care and management
of asymptomatic and mild COVID-19 cases under home isolation was implemented
with support from USAID-NISHTHA/ Jhpiego in two districts - Aizawl East and Aizawl
West. The platform acts as an enabler for effective monitoring and tracking of COVID-19
patients and has functionalities for recording vitals of home isolated cases on a daily
basis, provision of regular & need based SOS telemedicine consultations with a pool of physicians, digital
reporting and with generation of system alerts in case a patient develops symptoms and requires referral.
The service is available 24x7 wherein newly home isolated patients were called for a period of ten days.
On day one, patients were called for doctor consultation, nutritionist counselling on day two, follow-
Health worker examining community members | 41SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
up teleconsultation on day five according to patient’s need and mental health counselling on day ten.
NISHTHA Tele-track mobile App users could fill their daily vitals which is then monitored by tele-callers. An
option for SOS call service was also provided for patients in case of any emergencies.
In addition to tele-consultation, 102 COVID-19 helpline was made available for any patient for COVID-19
related calls. The state has a strong community engagement mechanism for COVID-19 management.
NGOs and Village/ Local Level COVID-19 Task force (VLTF/ LLTF) closely monitor and manage COVID-19
patients at the community level. WhatsApp groups were formed where patients under home isolation
were also group members of and monitoring was done locally via chats and phone calls at the local
level. Referral linkages between the NISHTHA Tele-track callers, local level task force and Chief Medical
Officer (CMO) were created in such a way that patients who needed referral were informed at the CMO
level through the local task force for transportation of patients and admission at hospital.
11 tele-callers and 10 MBBS doctors were appointed for teleconsultation under NISHTHA Tele-track service
from the existing staff. District level home isolation doctor in charge who appointed from to manage the
home isolation patients and necessary co-ordination for referral. The IDSP cell in co-ordination with the
Village/ Local Level task force were involved in the final testing for COVID-19 patients after completion of
10 days of home isolation.
Surveillance for COVID-19 at the community level was done for persons with travel history and contacts
of COVID-19 positive patients. State also mandated for home quarantine for 10 days for those who had
primary and secondary contact with COVID-19 positive patients. IDSP sample collection team collected
the samples from quarantined family through door to door facility once the home quarantine period was
completed. Containment teams were created to conduct active case finding in COVID-19 containment
zones where all the individuals with COVID-19 like symptoms were tested.
Scalability and Replicability
The state needs to strengthen infrastructure and increase human resources to reduce
home isolation cases. However, technology-based interventions such as NISHTHA
Tele-Track and tele-consultation can be scaled across the state. Further, fixed day tele
consultation services can be introduced on existing platforms like eSanjeevani OPD for
COVID-19 patients under home isolation. 42 |
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
With the surge of the COVID-19 pandemic in the second wave, the entire country came
to a standstill. Like any other state, Nagaland too witnessed an alarming statistic with
a positivity rate of about 20 percent. Out of the total cases, 90 percent preferred Home
Isolation as most people with the COVID-19 disease experienced mild to moderate illness
and recovered without requiring special treatment. Therefore, in concurrence with the
MoHFW guidelines on home isolation, the Department of Health & Family Welfare Govt. of Nagaland in
partnership with USAID-NISHTHA/ Jhpiego rolled out a Comprehensive Tech-Enabled Home-Based Care
Model called NISHTHA Tele track (Web-based and mobile application) and an innovative model of floating
COVID-19 home isolation kits (CHIKs) in Kohima and Dimapur.
Inclusion and Eligibility Criteria
The Tele-Track model was rolled out in
two districts of Nagaland-Kohima and
Dimapur. Therefore, all the positive cases
were monitored daily by the NISHTHA
Tele track team. However, for availing of
Home Isolation kits, the following criteria were followed:
(i) COVID-19 positive cases by RTPCT/ RAT who were
65 Years and above with or without symptoms.
(ii) COVID-19 positive cases by RTPCR/RAT who were
64 years and below with co-morbidities or with
COVID-19 symptoms
Intervention Details
Floating Home Isolation Kits: Nagaland had limited resources and provisions for supply
of CHIKs (COVID-19 Home Isolation Kits) for monitoring home isolated COVID-19 cases
resulting in issues around quality of care. To address this challenge, NISHTHA with
the state NHM, District Task Force and local NGO partners (Sewa Bharti in Dimapur)
developed an innovative model - Floating Home Isolation Kit Bank. This involved creating
a rotating pool of home isolation kits at district level on a return after use basis. The home isolation kit
included basic state approved medicine for COVID-19 management, Self-monitoring devices like pulse
oximeter and digital thermometer and personal hygiene products. Given below is the process flow of the
CHIK
NAGALAND
Health worker taking Tele-consultation session | 43SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Medical Support and Monitoring
Leveraging digital technology, the COVID-19 positive patients were monitored through
NISHTHA Tele-track for a period of 10 days. The team comprised of Medical Doctors,
Nutritionists, Nurses, and Counsellors. The certified doctors did a consultation with the
patients on the first, days. The Nutritionist would call up on the 2nd day for nutrition
counselling and on the 5th Day for mental health counselling by experienced clinical
psychologists or counsellors. The Nurses followed up for all 10 days to assist the patients and there
was also a provision for live teleconsultation with a specialist doctor for any emergency. During the 10
days, if there were symptomatic patients with danger signs, the team would immediately initiate referral
linkages with the tertiary hospital for early initiation of treatment and further investigation and treatment.
This helps in preventing delays in hospital admission which was considered as one of the contributing
factors for high mortality. Till date, the team has referred such 6 cases and it has prevented from getting
complications. Once the patient completed 10 days of home isolation, they were linked with the district
hospital for a discharge certificate.
Scalability and Replicability
This model has been rolled out only in two high caseload districts - Kohima and Dimapur
and the state is planning to scale up this model even to the rural districts of Nagaland.
This model has enabled the patients to get in touch with the expert medical team which
brings in an element of trust and also a system for referral linkages for hospitalization if
any complication arises. On the other hand, the system is also able to track and monitor
severe cases for referral linkages with ambulances for hospitalization to avoid late admission and thereby
preventing death due to late admission to the hospital. 44 |
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
As part of the Union Territories (UTs) efforts to prevent the transmission of COVID-19
from infected to healthy individuals, a COVID-19 Triage Team was constituted. The aim of
the COVID-19 triage team was to bring services to patient’s doorsteps and link COVID-19
positive patients with appropriate healthcare services, as per their needs. The outreach
measures also included consultation services over Interactive Voice Response System
(IVRS) and a 104 round-the-clock helpline. In August 2021, the government partnered up with StepOne
and COVID-19 Response team and conducted free of cost triaging and regular monitoring of patients.
Initiatives like “Doctor on Wheels” was also launched to support the home quarantine system.
Inclusion and Eligibility
Patients who tested positive for COVID-19 and were stable were recommended for home
isolation if SpO2 > 92percent, respiratory rate ranged from 12-24 bpm and temperature
ranged from 97-100�.
Intervention Details
The COVID-19 Triage Team consisted of fi nal year MBBS students from various private
medical colleges who volunteered to work together with their respective medical offi cers,
Auxiliary Nurse Midwives (ANMs), Accredited Social Health Activists (ASHAs) workers in
the Primary Health Center (PHC) they were allotted. Each PHC had its own triage team
and conducted home-triaging on a daily basis. The list of patients who were COVID-19
positive was updated daily, which helped the triage team in planning the number of home visits for each
day. Based on symptoms exhibited by patients and other vital questions asked by the triage team, each
patient was segregated and placed either under home isolation or was hospitalized.
A team of over 300 Anganwadi Workers (AWWs) were tasked with carrying out door-to-door visits to
check on the health status of patients on a daily basis. In addition to this, ASHA volunteers conducted daily
home visits as part of surveillance measures. Patients under home isolation were provided medicines and
medical guidance. If the patient required hospitalization, they were transported to the referred hospital via
an ambulance with the help of the triage team. The activities of the team were monitored locally by the
PHC Medical offi cers (MOs) and centrally by the COVID-19 war room. Patients received support from the
triaging team, home isolation medical team, IVRS team and tele screening team.
Doctors on Wheels Initiative: When home quarantined patients made stress calls to the 104-helpline
number, instead of giving medical advice over the phone, a medical team would be sent to their door
step and the patient would receive immediate treatment and care. If the team felt the patient needed
PUDUCHERRY | 45
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
hospitalization, an ambulance would be arranged and the patient would be shifted. This initiative began
in May 2021.
Partnership with StepOne and COVID-19 Response Team: In August 2020, the government launched
an interactive technology platform for operating a remote Home Isolation Monitoring and Counselling
System. The platform offered free of cost help to safely manage mildly symptomatic and asymptomatic
patients under home isolation. The government partnered with two non-profi ts, Project StepOne and
COVID-19 Response, to form a group of volunteer counsellors to support in remote monitoring.
Under this initiative, the list of individuals under home isolation would be uploaded in the system and
day to day monitoring would be done. On day 1, patients would receive a call from the counsellors who
would brief them on the dos and don’ts, generic counselling would be provided and both patient and the
caregiver would be sensitized on safety measures and monitoring symptoms. Patients would receive
IVRS calls at 11 a.m. for 13 days (duration of isolation) and would be expected to report their symptoms
without fail. In case of a missed call, an automated message would go to their mobile number where
they could call and register it. Two reminders would be sent at 4 p.m. and 7 p.m, after which the numbers
would be transferred to the health team and they would call to enquire about the patient’s symptoms. If
during the IVRS call, any symptom got registered, the system would generate a token which would be
shared immediately with the home isolation team to schedule a door-step visit, after a round of tele-
Covid War Room
Covid Triage Team
IDSP
Line LIst
Step one dashboard for
tele-screening
Perfroms
Triaging at home
andsegregates the
patients - Homeisolation
or hospital Admission
Home
isolation List
generated
Home isolation team - follow up people
under home isolation. IVRS calls for all
HI Patients
Flowchart
of Activities 46 |SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
counselling. In case of an emergency, citizens could dial 104, which operated round-the-clock. Online
trainings were conducted for practitioners that had signed-up to support this service.
This initiative helped ease the burden of having to travel to hospitals for triaging. Triaging at home helped
reduce further transmission and workload in hospitals. It also helped in optimally utilizing beds that were
allotted for COVID-19.
Medical Support and Monitoring
Following the visit of the triaging team, a list of people under home isolation would be
generated and transferred to the home isolation team. This team comprised of MOs
who regularly visited homes of patients under home isolation to monitor their health
and progress. Any deterioration in health informed through the 104-helpline was also
addressed by this team of Home-isolation in-charge doctors and further referred to
hospitals. A COVID-19 triaging SOP was followed as below: | 47
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
The Department of Health and Family Welfare, Government of Punjab, began home
based care for COVID-19 positive patients under Home Isolation (HI) during the fi rst wave
of COVID-19. For this purpose, a dedicated agency was selected by the Department to
provide tele consultation services to monitor the health of HI persons across districts.
This was done through a tendering process.
The aim of this system was to ensure that regular contact be maintained with HI and home quarantined
persons so that any medical emergency could be resolved on an immediate basis.
Intervention Details
The department hired a tele monitoring company through tendering process for daily
monitoring of COVID-19 patients under HI. A chat bot was created for self-registration
of patient’s vitals. Dedicated call centers were set up at the district level and they were
responsible to make call and record vitals of patients under HI. They would also provide
support in case of medical escalations through Health Teams. Tele monitoring was being
provided to all COVID-19 positive HI patients (symptomatic or asymptomatic).
To generate awareness among the public regarding the tele monitoring system, IEC activities
through social media, short fi lms, pamphlets, brochures, education material inside Fateh Kit and booklets
on HI were disseminated and published in newspapers. Accredited Social Health Activists (ASHAs) and
the Rapid Response Teams (RRTs) teams were used to shift patients from their homes to the hospital
or testing centers, as required. Fateh Kits which contained face masks, sanitizers, essential medicines,
oximeter, thermometer, Ayush products etc. were given to all HI patients.
The state government also provided food kits
containing essential food items to needy HI
patients. Standard Operating Procedures (SOPs)
were developed to carry out HI monitoring in a more
systematic way.
Mobile based app - ‘Ghar Ghar Nigrani’ was
launched in June 2021 to undertake house to house
surveillance in Punjab until the elimination of the
pandemic. The Health Department’s initiative which
included ASHA workers/ Community volunteers
supported in the early detection and testing of
COVID-19 cases, and preventing its further spread
in the community.
PUNJAB
Medical Kit 48 |SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
The entire rural and urban population of Punjab, above the age of 30 was surveyed as part of the drive. It
also included persons under the age of 30 with co-morbidity or Influenza-Like Illness (ILI)/ Severe Acute
Respiratory Illness (SARI). This was an an-ongoing process that lasted till the virus was contained.
The survey captured the full medical history of a person including the past week and complete details of
their current medical condition, as well as comorbidities (if any). This helped the state to build a database
for evidence-based planning for COVID-19 containment and necessary targeted interventions at the
community level.
The app had been developed and designed in-house by the Health Department and was field tested in
Patiala and Mansa. Around 20,628 persons were surveyed, of which 9,045 were found to be asymptomatic
and 1,583 with symptoms of cough/ fever/ sore throat/ breathlessness etc.
A supervisor would oversee the work of ASHAs/ community volunteers and was engaged on a voluntary
basis (paid Rs. 5,000/ month. The supervisor was responsible for quality check of data that was
uploaded by volunteers, monitoring their daily progress and ensuring COVID-19 testing of those found
to be symptomatic. Community volunteers were mainly engaged in areas where ASHA workers were not
available, for instance in urban areas, or where ASHAs were unable to use the mobile app. A community
volunteer could be any female over the age of 18, with 10+2 or more as educational qualification and a
resident of the same village or ward.
District authorities set up Oxygen Concentrator (OC) Banks for the distribution of OCs to HI patients
across the districts. OCs with flow capacity of 5 L per minute delivering oxygen with concentration of 90
percent or more were recommended by the Health Ministry for management of COVID-19 patients under
HI. The allocation of these 5 L OCs to HI patients was done only with a prescription from the treating
Medical Officer. The OCs were made available to HI patients on a temporary loan basis against a nominal
security deposit which was refundable upon returning the OCs once the patient recovered. This exercise
was undertaken in collaboration with the Red Cross Society.
Deployment of ambulances (Standard/ Advanced Life Support (ALS)) and mobile pharmacies - Ambulance
services were provided to both confirmed and suspected COVID patients on a free-of-cost basis. The
deployment of 108 ambulances was prioritized in zones with high concentration of COVID-19 positive
patients. During the telemonitoring services, in case a HI case was escalated on medical advice of the
specialist, the HI-patient would be transferred to an L2 / L3 facility nearby, based on their condition. ALS
ambulances were used to shift critical patients with rapidly deteriorating vitals to higher facilities. Basic
Life Support ambulances with Oxygen facilities were equally beneficial in transferring COVID patients to
the nearest COVID-19 health facility.
Deployment of Medical Interns: Deputing interns can help in strengthening the monitoring and follow-
up of HI patients, thereby improving home-care quality, reducing COVID-19 mortality and strengthening
people’s faith in the health system. This initiative could also help in improving cooperation between the
patient and the RRTs.
Further teleconsultation services were provided to patients referred to district headquarters by tele-callers
through IDSP Cell / District Call Centre / Control Room | 49SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Medical Support and Monitoring
Regular monitoring was done by the assigned tele-caller agency. Call centers supported
doctors on duty and helped in maintaining health details through patient records.
COVID-19 Patient Tracking officers (CPTOs) in each district were appointed as Nodal
Officers for HI. They were responsible for providing home care to COVID positive patients
in their respective district through tele consultations. The District Administration set up
dedicated call centers for patients under HI to record their vitals and enter them into a database. The
state government deployed medical interns from medical colleges who helped in providing medical
consultations in case of escalations. 50 |
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
The home-based care system proved to be a critical approach in management of
COVID-19 positive patients. Rajasthan moved one step ahead and provided home based
care to Influenza-like illness (ILI) cases as well. Remote consultation by doctors using
technology not only helped in managing cases but also in limiting virus transmission.
Community monitoring groups such as the ‘Village Nigrani Samiti’ encouraged community
participation in managing COVID-19 positive patients and ILI cases at home. Under the supervision of the
Village Nigrani Samiti, door to door surveys were conducted by village level health workers/ Block Level
Offi cers in urban areas to identify ILI cases. Medicine kits were provided to all ILI and COVID-19 positive
cases and follow up was done on a daily basis. Symptoms were monitored and cases were referred higher
facilities, as per the condition of patients.
The overwhelming number of cases in the second wave made it diffi cult to follow the test-track-treat
concept as the virus was spreading rapidly and there were also delays in results. The state took a conscious
decision to follow track-treat concept and identify cases at the early stage and treat them through home
bases care system. To identify cases in early stages, ‘Door to Door’ teams were deployed. This deployment
was under the direct supervision of ‘Village Nigrani Samiti’ at the village and ward level. It was important
to provide medical support to all COVID-19 positive patients and ILI cases without compromising on
quality of care. Cases that did not need direct medical intervention in terms of oxygen support, injectable
medication, were effectively managed at home under the supervision of a medical offi cer. The concept
of management of patients through home-based care was also very useful, especially in the context of
Rajasthan, which has a huge geographical area and many hard to reach areas.
A system of home care was established under the supervision of Medical Offi cers (MOs) from urban and
rural Primary Health Centers (PHCs). COVID-19 positive and ILI cases were assessed by MOs to check
eligibility for home-based care. A medical kit and an instruction manual were provided to all COVID-19
positive patients. The monitoring system was established using WhatsApp, physical daily visits by local
BLO/Accredited Social Health Activists (ASHAs) to monitor temperature, SPO2 level, development of
warning signs and symptoms.
Inclusion and Eligibility criteria
COVID-19 positive cases that were tested by Rapid Antigen Test (RAT) or RT-PCR tests were
included. Other criteria for eligibility included asymptomatic or mildly symptomatic cases,
psychologically fi t and willing for room isolation, adequate space at home for isolation
and not in high-risk category of diseases like comorbid conditions, people over 60 years
of age, pregnant women and young aged children. During the second wave, ILI cases with
mild symptoms also qualifi ed for home-based care.
RAJASTHAN | 51SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Intervention Details
To generate awareness, different Information, Education and Communication (IEC)
methods (banners, leaflets, video) were adopted for wider communication to the
community. Panchayati Raj Department was actively engaged in disseminating messages,
as well as providing support to village level ASHAs and Anganwadi workers to conduct
Door-to-Door surveys and monitoring of cases under home care.
ASHA workers were oriented on home care management and steps needed to be taken by them for
management of COVID-19 positive patients and ILI cases. They were all well oriented and trained to
identify early warning signs and refer cases to higher facilities. ‘Village Nigrani Samiti’ was used effectively
to provide support to ASHAs to limit the movement of COVID-19 positive and ILI cases. ‘Swasthya Mitra’
were present in all villages and supported the ASHAs in daily monitoring of positive cases.
A protocol was developed and finalized for COVID-19 positive cases under home isolation. As per the
protocol, all ILI and COVID-19 positive cases with mild symptoms qualified for home-based care. Protocols
were also in place on how patients would be monitored for temperature, SpO2 level and development of
warning signs. With support from village level workers and BLOs, these protocols were followed. A tool
was developed for live monitoring and tracking of activities.
A MO would assess the condition of COVID-19 positive patients and ILI cases and would also check
whether they were eligible for home care. Medical kits were provided to COVID-19 positive patients and
ILI cases with an instruction leaflet for the patient and their families. During home isolation patients
were encouraged to do breathing exercises to increase lung capacity. Patients were advised to practice
‘Proning method’ to increase SpO2 levels. As a part of general IEC, messages on proning technique were
disseminated among communities.
Government doctors, as well as private doctors, provided home based care to patients. Depending on
availability, Oxygen concentrators were provided by the government to patients and some NGOs were also
involved in providing oxygen concentrators. If recommended by the treating physician, families were also
arranging oxygen concentrators for their patients.
Call centers worked round the clock to arrange ambulances to shift patients to COVID-19 health facilities
and district control rooms were in charge of providing information on availability of beds in facilities.
Adequate fire safety arrangements were made in the temporary and permanent COVID-19 health facilities
and adequate security arrangements were made available with the support of the police department.
Medical Support and Monitoring
Virtual- telemedicine/ helplines/ call center: 181 call centers were functional at the state
level to manage grievances. In addition to the state call centers, districts also established
call centers in their district control rooms to provide support at the local level. 52 |SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Deployment of Medical doctor supervision/ Nurse supervision/ Frontline workers frequency of check:
Medical officers and interns were deployed to call centers to resolve queries of patients. Medical Officers
in charge of Urban PHC and sector PHC were responsible for the daily monitoring of cases and referrals,
in case of requirement. | 53
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
India witnessed an unprecedented surge of COVID-19 positive cases and deaths during
second wave. In Sikkim, around 80 percent of the cases who had mild symptoms and
were asymptomatic were under home isolation. As per the guidelines from MoHFW, the
patients who were clinically assigned to be mild/ asymptomatic were recommended for
home isolation.
As the number of COVID-19 positive cases in home isolation surged, the department of Health & Family
Welfare with technical assistance from the development partner for Comprehensive Primary Health Care
(CPHC) USAID-NISHTHA/ Jhpiego organized a two-day virtual training for all the Primary Health Care
teams at the urban and rural primary health care facilities. The trainings were provided to the teams
from Urban Primary Health Centre-Health and Wellness Centre (UPHC-HWC) Gangtok and Ranipool, Sub
Centre-Health & Wellness Centers (SHC-HWC), Primary Health Centers (PHC) and also to the District
Medical Offi cers of all the four districts on Management of COVID-19 cases under home isolation. They
were also trained on the usage of oxygen concentrator and RAT for COVID-19 patients.
The state also launched an important initiative ‘Swasthya Sampark’ a post COVID-19 care initiative in
collaboration with USAID’s flagship health system strengthening project NISHTHA, implemented by
Jhpiego. The platform acts as an enabler for effective monitoring and tracking of post COVID-19 patients
and has functionalities for recording vitals of patients on a daily basis, provision of regular & need based
SOS telemedicine consultations with a pool of physicians, digital reporting with generation of system alerts
in case a patient develops symptoms and requires referral. Under this initiative, the patients recovered
from COVID-19 were monitored closely and were provided care at right time to prevent post COVID-19
complications. This post COVID-19 Platform was a remote help desk integrated with telemedicine
(teleconsultation & tele counselling) to support individuals recovered from COVID-19. The patients could
connect through a toll-free service care number wherein a trained health professional attended the
patients call and addressed their concerns. The platform could also provide services like mental health
counselling, dietary counselling through tele counselling services as well as treatment for any medical
ailment developed or worsened during post COVID-19 period through teleconsultation services.
Inclusion and Eligibility Criteria
Patients with mild symptoms or those who tested positive but were asymptomatic/
mildly symptomatic were advised home isolation. Psychologically fi t patients, who were
unwilling to go to hospitals but were co-operative on regular follow up protocols were also
provided the monitored home care services. It was mandatory for all the patients to have
the home facilities available as per the guidelines for home isolation.
SIKKIM 54 |SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Intervention Details
Awareness and communication played a vital role in containing the spread of
COVID-19 in the state. Awareness campaigns on home care protocols through
different Information, Education and Communication (IEC) Materials were rolled out
by the State Government. Home visit to COVID-19 positive patients were provided by
field staffs (MLHP, ANM & ASHAs). Regular communication was done through social
media platform (Facebook, twitter and other platforms). USAID-NISHTHA/ Jhpiego also supported
state by providing 170 banners on COVID-19 appropriate behaviors and the banners were distributed
to all the Districts to further disseminate at PHC & PHSC level.
ASHAs were also roped in for
generating awareness and to
distributing e home isolation kits.
Oxygen level assessments were done
by the healthcare teams every day.
Tele calling to the isolated individuals
were scheduled by the healthcare
teams on odd hours of need. The state
provided ambulance in each Gram
Panchayat Unit to ferry the patients to
the hospitals in need.
NISHTHA Swasthya Sampark was
launched by State of Sikkim with
support from USAID-NISHTHA/
Jhpiego in which COVID-19 recovered
patients were followed up by tele-
callers of the helpline. These patients were followed up actively for one month and passively for two
months. Line-listing of the COVID-19 recovered patients were shared with the tele-callers on a weekly
basis.
Further, oxygen concentrators were provided through PM-CARES, UNICEF and other private donors.
Total 447 oxygen concentrators were received by the State. This was distributed to all the facilities from
Secondary level to Tertiary level care. Ambulance services were provided at all the blocks for referral and
transport of home isolation cases. Safety arrangements were put in place by distribution of PPE kits,
sanitizers, masks to community workers as well as COVID-19 positive patients under home isolation.
Medical support and Monitoring
Virtual- telemedicine/ helplines/ call centers initiated the tele counselling activities, by
providing android mobiles to the respective psychologists and counsellors at the districts
and the PHCs. They were provided with dedicated handsets and an internet facility for
full one year. Deployment of Medical doctor supervision/ Nurse supervision/ Frontline
workers was done to check frequency of consultations. The senior level doctors working
in program management as state program officers were deputed for the clinical activities at different
COVID-19 Care Centers. Staffs from Urban PHCs were given temporary postings at STNM Hospital
(COVID-19 care Centre). Mid-Level Health Care Providers of East District were given postings at STNM
Distribution of the medical kits to the community members. | 55SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Hospital for COVID-19 duty. An integrated command center monitored (at patient end, doctor end and
centrally) patients through regular meetings and daily reporting. Surveillance and Contact Tracing of the
family members was done through dedicated teams under the Block Development Officers.
The state task force under the leadership of Hon’ble Chief Minister, formed a committee in rural and urban
areas, as COVID-19 task force and village COVID-19 management committee at urban and rural areas
respectively to fight and contain the disease in the area.
There are 155 Gram panchayat units in the state of which each GPU looks after 8 wards. The above-
mentioned teams were formed in such a way that 10 members team looked after a ward, provided all
the members in the team were trained and oriented on COVID-19 appropriate behaviors and counselling
techniques by health department, SIRD and Panchayati Raj department.
This team delivered COVID-19 care kits comprising of masks, hand sanitizers, essential medicines, vitamins
along with the prescription and printed COVID-19-care manual for home care for each COVID-19 positive
households. Positive patients and primary contacts with comorbidities were also provided with general
medicines such as antihypertensive and anti-diabetic drugs. Provision for free ration at the door steps was
made for the BPL family. All ASHA workers were provided with pulse oximeter for monitoring patients. The
state government provided a dedicated ambulance in all the blocks under the Block Development Officers
(BDOs) for referral and transport of patients in case of emergency. All the PRI members, BDOs and ADCs
were provided with financial assistance (funds) by the state government. Local NGOs were mobilized and
engaged for courtesy calls. IEC material distribution was done in the containment zones by the contact
tracing team.
Monitoring of patients under home isolation 56 |
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
The COVID-19 pandemic spread like wildfi re, across communities affecting everyone, but
mostly vulnerable populations. Due to the high number of cases, hospitals and health
facilities became overburdened. This led to a modifi cation in the states’ COVID-19 strategy
wherein asymptomatic / mildly symptomatic cases would be managed at home or in
institutional care at COVID-19 Care Centers.
Guidelines for COVID-19 home care management protocols & testing strategies were developed and
modifi ed (from time to time) accordingly, to ensure that all patients received appropriate care and
treatment, that they were able to identify and tackle complicated cases more effi ciently and refer to higher
facilities as per requirement.
Intervention Details
House-to-House surveys (fever survey) were conducted to identify patients with COVID-19
symptoms. They were handed ‘medicines kit’. COVID-19 clinics were established in all
health facilities to manage mild cases (on OP basis/ admission for observation). Similarly,
the number of testing centers were increased which resulted in decentralization of testing.
Continuous and periodic rounds of systematic door to door (fever) surveys were done
during the peak of the second wave to identify symptomatic patients and their contacts.
People with symptoms (identifi ed during fever surveys) were given treatment kits, advised home isolation
and given treatment kits (without waiting for COVID-19 test results). Needless to say, this helped in
identifying a large number of people suffering from non-COVID-19 fevers & similar minor illnesses and
providing appropriate treatment.
Regular follow ups were done by Accredited Social Health Activists (ASHAs) and Auxiliary Nursing
Midwives (ANMs) for people who were COVID-19 positive. They would also assess whether the patient
should continue in home isolation or be referred to COVID-19 Care Centers, according to their condition.
Medical Support and Monitoring
Home isolation treatment and monitoring protocol (HITAM): Patients diagnosed with
COVID-19 at testing centers / at home were clinically assessed to check whether they
would be suitable for home isolation. They were immediately provided with ‘medicines
kits’ that comprised of requisite medicines, as per doctor’s advice. This was followed by
monitoring the progression of symptoms and treatment compliance by trained tele-callers.
In case of clinical deterioration like continuous fever, breathlessness etc. (especially in high-risk groups /
co-morbid conditions), patients were immediately shifted to COVID-19 hospitals. Tele-callers were trained
to identify such cases to be escalated for expert opinion / hospitalization. They were made aware of
emergency ambulances and COVID-19 hospitals (mapped), for quick transportation and admission.
TELANGANA | 57SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
HITAM mobile application, software & call center: A mobile based application was developed during the
1
st
wave with features to capture patient demographics, symptoms, medications, and daily progress.
Doctors were employed to work from home during lockdowns (without physically attending call centers),
by installing the mobile app on their smart phones to facilitate their functions.
HITAM call center: Telemedicine
Based on the existing protocols, a kit containing Paracetamol, Cetirizine, Doxycycline, Vitamin B Complex, Vitamin C and Ranitidine (symptomatic & supportive treatment) along with other relevant IEC material was given to patients under home isolation.
As was the case in the rest of the country, the state of Telangana also faced a steep increase in the
number of COVID-19 cases during the second wave. This overwhelmed the testing and hospital treatment
capacities of the state. All hospitals were converted into COVID-19 clinics for evaluation of COVID-19
patients with mild symptoms (as OP) and for referring them, in case they were showcasing moderate
/ severe symptoms. Home isolation and treatment through telemedicine helped deal with the surge in
cases, especially in hospitals, during both the waves.
The above steps, i.e., home isolation, initiation of treatment without waiting for test results (with
sometimes long turnaround time / false negatives etc.) and identification for admission reduced the
spread of infection and prevented further deterioration of condition of several patients.
Hence, it can be concluded that home isolation with treatment kits (drug kits), proper integration of house-
to-house (fever) surveys, establishing COVID-19 clinics for monitoring and identifying cases, proved to be
an effective strategy to prevent overburdening of hospitals and reduce COVID-19 mortality in the state. 58 |
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
Home based care was permitted in the state of Uttar Pradesh only during the second wave
when over 80 percent of COVID-19 patients were asymptomatic and hospitals became
overburdened. Hospitalization also led to stigmatization of the disease, to the extent that
people started avoiding getting tested. To make the most of the limited resources and
ensure that everyone had access to quality healthcare, there was a need felt to introduce
home based care for treatment of asymptomatic / mildly symptomatic COVID-19 positive patients.
Inclusion and Eligibility Criteria
All COVID-19 positive cases identifi ed by any confi rmatory test were included and
asymptomatic and mildly symptomatic patients were permitted to stay and get treated in
home isolation. While there were no age criteria for inclusion and eligibility, all COVID-19
positive patients under home isolation had to have a separate room and bathroom that
would not be used by any other member of the household. Persons with more than one
comorbidity and vulnerable conditions were excluded from home treatment.
Intervention Details
Over 7,000 Rapid Response Teams (RRTs) were formed across the state and led by
Medical Offi cers (MOs). Each team was equipped with pulse oximeters, glucometer, BP
apparatus etc. All Standard treatment protocols and guidelines on home isolation were
assessed and followed. Persons under home isolation were regularly monitored and
provided facility-based care on escalation of symptoms. Approximately 60,595 home
isolated cases were shifted to facilities based on home caregivers’ feedback. These RRTs were connected
to the Nigrani Samitis at the village level.
UTTAR PRADESH | 59SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
More than 70,000 Nigrani Samitis (surveillance teams) were constituted across the state of Uttar Pradesh,
led by Gram Pradhans/ Ward members. Other members of these samitis included Front Line Workers
(FLWs)/ Volunteers. The experience gained from the Dastak campaigns over the 3 years was replicated
for COVID-19 home care. Almost all households were visited multiple times by trained surveillance teams
and sensitized on prevention and home care, ensuring adherence to quarantine protocols, keeping a
check on containment area activities, tracing and tracking suspect cases etc. Medicine kits for pediatric
age groups were also made available to Nigrani Samitis.
A massive rural outreach campaign was carried out by the Nigarini Samitis during the second wave. The
RRTs and Nigrani Samitis were connected, supervised and monitored digitally by the Integrated COVID-19
Command and Control Centers (ICCC) teams. Each district had the presence of one ICCC and this was
done across 75 districts. Senior district administrative and health officers were in charge of these centers.
At least 2 calls were made by trained staff on a daily basis to COVID-19 patients in the area and their
health was assessed. Temperature, oxygen saturation and other clinical symptoms were recorded, based
on which they were provided essential drugs and pulse oximeters and referred to higher facility care, if
required.
Several districts partnered with private organizations under their Corporate Social Responsibility (CSR)
initiatives to ensure delivery of quality healthcare services. For example, the Lucknow district administration
partnered with Flipkart for the delivery of free medical kits to COVID-19 positive patients under home
isolation. The ICCC that was set up was supported by HCL at Gautam Buddha Nagar.
Medical Support and Monitoring
A five-layer monitoring system was put in place for providing medical support and
monitoring:
Monitoring at CM UP helpline 60 |SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Medical Kit Distribution
Quick feedback sharing with Administrative and Senior Health officers through web-based meetings
0301 0204 05
Unit Mos
and
Zonal MOS
District level
health and
Administrative
Third party
independent
monitoring :
WHO, UNICEF
State control
room and CM
UP Control
room
Senior
Administrative
and Health
Officers for
high case
load districts,
Joint Director
level officers
from Health
Department for
all 75 Districts | 61
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
After experiencing an over-whelming number of COVID-19 patients requiring hospital
beds, the state of West Bengal viewed Home Care System as part of an effective treatment
plan for COVID-19 positive patients with mild symptoms. Treatment guidelines and
protocols were quickly designed and implemented. Intensive trainings, capacity building,
close supervision and monitoring, collaboratively, by both Government and Private Health
Facility Centers (HFCs), were conducted. This was implemented in urban as well as rural areas of the
state.
The prime objective of the Department of Health & Family Welfare, Govt of West Bengal was to quickly
and effectively manage the COVID-19 waves in the state. This was made possible through Telemedicine,
Integrated Call Centre System, COVID-19 Patient Management System (CPMS) and Integrated COVID-19
Management System (ICMS), which were all developed and implemented towards the beginning of the
fi rst wave of the pandemic and further enhanced on a periodic basis during the second wave.
The other supporting objectives included creating essential infrastructure like medical oxygen
infrastructure, using existing infrastructure like Safe Homes and Satellite Health Centers, and building the
capacities of all health workers in the healthcare ecosystem.
Inclusion and Eligibility Criteria
During the fi rst wave, both RT-PCR as well as Rapid Antigen Tests (RAT) were being used,
with a gradual increase of RAT tests to reduce the time taken to get the results. In addition,
CBNAAT, TrueNat, TrueNat RDRP Confi rmatory were used in small numbers. Towards the
latter half of 2020 and as the second wave started in early 2021, RT-PCR tests increased
in view of the test being known as the ‘gold-standard’.
For asymptomatic cases, 200 Safe Homes and Satellite Health Facilities were established and guidelines
and SOPs were developed for mild and asymptomatic patients for whom home isolation was not possible
or advisable. Safe Homes were set up in both cities and towns in West Bengal by the respective District
authorities. In the second wave, COVID-19 positive asymptomatic persons stayed under home care with
family or friends / care-givers, who were also counselled on the above guidelines.
Patients with comorbidities and other immune-compromised persons who were most vulnerable
received close supervision and monitoring. Frontline workers regularly visited households across
the state. With the help of the telemedicine platform, Accredited Social Health Activists (ASHAs)
Workers and Community Health Officers (CHOs), many other people with Non-Communicable
Diseases (NCDs) were identified. Family members and care-givers were counselled on how to take
care of patients with comorbidities and case management protocols were issued to handle patients
with comorbidities.
WEST BENGAL 62 |SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Psychologically fit and willing for Home isolation – The trained personnel at the Integrated Call Centre
would talk to patients’ family members / care-givers to understand if the patient fits the criteria for home
isolation and accordingly home isolation was advised.
Intervention Details
An initiative was launched to spread awareness on what a COVID-19 patient should do
while in home isolation to clear any misconceptions and make it easier for doctors to
handle such patients when / if rushed to hospital during an emergency situation. The
contents were divided into sections dealing with who can stay in home isolation, when
treatment is required and directions for caregivers.
The campaign was launched in parts of Bidhannagar, South Dum Dum, Baranagar, New Barrackpore and
Barrackpore - pockets that had seen a large number of COVID-19 cases. One lakh leaflets were distributed
with a list of seven telephone numbers of COVID-19 control rooms in North 24-Parganas district and two
WhatsApp numbers where people could send messages in case of emergencies.
During the second wave, ASHA worker counselled household members of families that had COVID-19
patients with mild symptoms. ASHA workers were provided with all the necessary information and
Community Health Officers (CHOs) at the Health & Wellness Centers, also known as Suswasthya Kendras,
were also provided with the protocols that were to be followed. The ASHA workers were responsible for
the collection of data on comorbidities in the Community Based Assessment Checklist. Doctors could
treat patients through telemedicine platforms and e-Prescription would be communicated by CHOs to the
patient / care-giver.
The state of West Bengal equipped block-level Primary Health Centers (PHCs) and hospitals with isolation
beds, medical oxygen and ambulances for better handling of COVID-19 cases. A fleet of 102 ambulances
was reserved for transporting COVID-19 patients.
Medical Support and Monitoring
Virtual – Telemedicine / Call Centre / Helplines: 96 doctors working in 3 shifts (24X7) for
providing tele-consultation to COVID-19 patients under home isolation. Till date 6,93,901
consultations have been done.
Tele Psychological Counselling Helpline: This began on August 1, 2020 with the help of
recent graduates from Kolkata university. These young counsellors provided psychological
counselling to 3,55,771 persons. Every COVID-19 positive patient was given a call on the basis of their
positive report and if required, hospital admissions were arranged. On an average 10,000 calls were made
per day.
Ambulance Service Helpline: Free ambulance service was provided for testing, admission and discharge
from hospitals. On an average 800 ambulances provided free service to COVID-19 patients per day.
During the first wave, there was an increased focus on creating health facility infrastructure as the demand
for beds, especially ICU beds, was more. Patients preferred staying for longer periods than necessary
because of which needy patients were not getting ICU beds. In general, there was a lot of fear and anxiety
among people and families preferred to send their COVID-19 positive family member to institutions
including Hospitals and Safe Homes. | 63SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
In the second wave, as individuals and family members became aware and a) received appropriate
Teleconsultation through Telemedicine, b) Prompt support through the Integrated Call Centre System
and c) Effective patient management from the COVID-19 Patient Management System (CPMS) and
Integrated COVID-19 Management System (ICMS), Safe Homes & Satellite Health Facilities helped reduce
the demand for hospital-beds.
Scalability and Replicability
All best practices are scalable, replicable and sustainable. Teams are continuously
upgrading and enhancing their skillsets and infrastructure Teams at the state Headquarters
and at the district level are finding innovative methods to tackle the inevitable 3rd wave. 64 |
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States | 65
SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
SECTION B
STATE PRACTICES
(information collected through secondary research) 66 |
SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States | 67
SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
In the state of Andhra Pradesh, a comprehensive home isolation system was set up for
asymptomatic or mildly symptomatic cases of COVID-19. Auxiliary nurse midwife (ANMs)
and village/ ward volunteers were engaged in creating awareness, monitoring patients
at home and educating patients on how to self-monitor their symptoms. Home care kits
(including medicines) were provided to patients. The state also set up home isolation help
desks and dedicated helpline numbers in case of emergencies.
Inclusion and Eligibility Criteria
Patients with mild symptoms or those who tested positive for COVID-19 but were
asymptomatic/ mildly symptomatic were advised home isolation. People who were feeling
unwell and had Influenza-Like Illness (ILI) symptoms of COVID-19 (fever, cold, running
nose, throat pain) were advised to get tested immediately, and isolate themselves. They
were advised to ensure that there was a separate room with an attached bathroom (if
possible) and a caretaker who could act as a messenger. Those acting as caretakers were advised to
take hydroxychloroquine to make sure they were healthy. People over the age of 60 with comorbidities
were allowed to isolate at home only upon treating doctors’ approval. Similarly, people with HIV, organ
transplant recipients, and cancer patients were advised to follow home isolation only if the treating doctor
recommended the same.
Intervention Details
The state ensured that the ANMs, village/ ward volunteers were notifi ed immediately of
the test results of the patients. Once notifi ed, ANMs, village/ ward volunteers contacted
patients to understand their health condition. Home isolation kits (including medicines
for fever and cold, and masks) were distributed by Mandal Special Offi cers and Municipal
Commissioners.
In order to reduce the burden on hospitals in East Godavari, the district administration adopted a novel
concept of setting up of isolation centers in villages. Many people in rural areas who had mild symptoms
were unable to isolate within the comfort of their homes, given the lack of space. To reduce the spread of
COVID-19, these patients were admitted to the isolation centers wherein they were provided home cooked
food by sarpanches or groups of volunteers. Village secretaries would monitor their health, offer fi rst-aid
kits, and arrange for medical assistance as per the need.
In Krishna district, where less than 10 percent of the 3,200 beds were occupied, mild and suspected
COVID-19 patients were given a cash incentive to opt for COVID-19 Care Centres (CCCs) instead of home
isolation. A lottery system was launched to boost occupancy at eight CCCs. The fi rst winner received
a cash reward of Rs. 15,000 while the second and third won Rs. 10,000 and Rs. 5,000 respectively. The
ANDHRA PRADESH 68 |SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
amount was drawn from the district administration funds, and was transferred directly to the winners’
bank accounts.
CCCs were makeshift facilities that had the required medical facilities, such as medicines, oxygen
concentrators and food provisions. At these facilities, doctor visits were conducted thrice a day and
ambulances were available in case of emergencies. Patients were encouraged to regularly monitor their
temperature and oxygen levels. In case SpO2 levels were below 94 and patients experienced trouble
breathing, doctors would be informed, and they would immediately be referred to a hospital.
Medical Support and Monitoring
A COVID-19 alert tracking system was set up to locate people who had been placed under
home isolation. This was done with technical assistance of the telecommunications
service provider platforms and mobile tower signals. The Rapid Response Teams
(RRTs) line-listed positive cases and mapped their contacts. This helped in deciding the
perimeters for action.
In case of emergencies, a Home Isolation Help Desk and dedicated helpline numbers were set up. As of
May 2021, 15,031 patients were in home isolation out of 17,770 active COVID-19 infection cases. | 69
SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
In September 2020, the State Government launched swaraksha.nic.in,a government-run
website where asymptomatic COVID-19 patients in Jharkhand could register and upload
necessary information to obtain permission for home isolation. The Swaraksha website,
designed by the state National Informatics Centre (NIC), allowed asymptomatic COVID-19
patients to download home isolation certifi cates to prove their eligibility to remain at
home. In addition to this, district-specifi c initiatives were observed in Ranchi, Singhbhum and Dumka.
Inclusion and Eligibility Criteria
In order to get the certifi cate, it was mandatory to register on the website with patients’
Specimen Referral Form (SRF) ID - a unique number which was given to every person who
underwent a test. Following registration, the patient was required to provide infrastructural
details on the website’s form such as the number of rooms and toilets in the patient’s
house. In addition, the patient was required to provide details of: family members older
than 60 years and younger than ten; details of all family members and their comorbidities, if any, details of
the patient’s swab collection date and the dates of the test results. In case the patient was suffering from
any other disease, they were required to mention it on the website irrespective of the nature of the disease.
Once the patient shared all the details on the website, the district administration decided whether or not
the patient could remain in home isolation.
Intervention Details
A dedicated Ranchi website was developed where people could access resource lists
for hospitals, oxygen, home delivery of medicines, COVID-19 consultations, ambulance,
home delivery of essential goods, COVID-19 testing centers, and vaccination along with
the other resources related to COVID-19 management. Also, through google forms,
patients could apply for video consultations of four types through the Swaraksha Portal:
allopathic, Ayurvedic, homeopathic, and Unani. Further, citizens could access location-based information
dissemination feeds, emergency services and hospital information, and other important information via
the Jaano Local COVID-19 emergency system application.
District-level initiatives aided in the fi ght against the virus. For example, in Singhbhum District, the
administration devised concepts such as the Phone Booth Sample Collection Center, which signifi cantly
reduced the need for already scarce and overpriced personal protective equipment (PPE) kits while also
ensuring the safety of the person collecting the sample.
Taking a step forward, the state developed a simple, fast and cost-effective solution, CO-Bot. Co-Bot, a low-
cost (Rs 26,000) remotely operated robotic device that delivered food, water, and medicines to patients.
This reduced interactions between health offi cials and patients, lowering their risk of infection. Co-Bot,
JHARKHAND 70 |SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
which was outfitted with an internet-enabled high definition 360-degree camera and a two-way speaker-
mic system, also allowed doctors and nurses to practice telemedicine. Other initiatives included isolation
beds (also known as i-beds) for positive patients, low-cost face shields, meals-on-wheels deliveries for
the stranded and poor, an ultraviolet note sanitization machine for banks and railway counters, and a
sanitization chamber in a newly established COVID-19 hospital.
Initiatives such as ‘Essentials on Wheels,’ Didi Kitchens, and physical and mental health awareness
campaigns were observed in Dumka District, making the lives of citizens living in home isolation easier.
The state also adopted integrated approach of automated Interactive Voice Response System (IVRS),
telephonic calling and web link response for regular monitoring and follow up of patients under home
isolation for early identification of symptomatic cases and their appropriate linkage to designated COVID-19
Care Centre routed through district health society. The intervention which was developed in partnership
with USAID-NISHTHA/ Jhpiego was targeted to reduce morbidity and mortality due to COVID-19 while
ensuring end-to-end follow-up, right from determining the patient’s status as home isolated, till the time
they complete their time in isolation.
Medical Support and Monitoring
In April 2021, Ranchi District Administration collaborated with an online medical portal
mDoc App to provide free consultations through voice and video calls to COVID-19 patients
in home isolation. The service also facilitated doctors’ visits to patients on request at a
minimal cost and provided free telemedicine. Pathological and physiotherapy services
were also offered; over 700 doctors were registered on the medical portal.
A group of 16 doctors with various specialties under the aegis of National Medicos Organisation (NMO)
also provided free medical consultations to patients in home isolation between 11 AM and 1 PM daily,
assisting them with admission and other assistance as and when required.
In August 2020, the state government announced a 24-hour helpline for COVID-19, non-COVID-19,
and mental health issues in collaboration with StepOne. Callers used the IVRS system to select their
symptoms, and then a registered healthcare expert advised the individual and the government on how to
proceed. Patients with mental health issues received counselling. StepOne is an authorised partner for
Aarogya Setu Mitr telemedicine consultations, an ancillary service on the Aarogya Setu app that provides
free teleconsultation for those with COVID19-like symptoms.
References
¾https:/<> /swaraksha.nic.in/public/index.php
¾https://www.telegraphindia.com/jharkhand/govt-launches-website-to-handle-home-isolation-
requests/cid/1792179
¾https://ranchi.nic.in/covid/
¾https://timesofindia.indiatimes.com/city/ranchi/free-e-consultation-for-ranchi-covid-patients-in-
home-isolation/articleshow/82186270.cms
¾https://theprint.in/opinion/districts-fight-covid/robots-delivering-meals-to-patients-low-cost-ppes-
west-singhbhums-innovative-covid-fight/447191/
¾https://theprint.in/opinion/districts-fight-covid/covid-talent-contests-and-didi-kitchens-how-
dumka-relied-on-community-to-survive-lockdown/462411/ | 71
SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
While the COVID-19 pandemic was spreading, the Karnataka government developed
innovative strategies through careful planning, innovative use of technology, effi cient
deployment of available resources, and community participation. The state government
partnered up with private entities including Swasth, Portea and StepOne to provide care
to home-quarantined/isolated patients as well as connect them to facility care, if needed.
The efforts included teleconsultation and triaging, training of health workers and providing ambulance
services and medicines.
Inclusion and Eligibility Criteria
As per the government guidelines, only asymptomatic or mildly symptomatic patients
were advised to be in home care. These patients were suggested to keep equipment such
as pulse oximeter, digital thermometer, facemasks, gloves, sanitizer, etc. Also, a caregiver
was to be available to provide 24x7 care with the patient. Elderly patients aged above 60
years and those with co-morbid conditions such as hypertension, diabetes, heart disease,
chronic lung/ liver/ kidney disease etc. and lactating mothers were allowed home care only after proper
clinical evaluation by the treating Medical Offi cer (MO)/ physician/ family doctor. Home care was not
applicable for pregnant women two weeks before expected date of delivery. For further daily follow-up of
the patient, tele-monitoring through government or private institution/agency was arranged.
Intervention Details
The state government ensured that health teams from the district health authority/
BBMP/ authorized private institution/ agency visited the patient’s home to ensure they
are isolated. Alternatively, an empaneled agency handled telephonic medical triage by
confi rming the person was isolating. A dedicated tele-monitoring link was established
for the patient’s daily follow-up during the entire period of home isolation/ home care. If
the person developed any warning symptoms during the period of home isolation/ home care, the doctor
evaluated the situation and advised the person to be transferred to COVID-19 hospital as per the need.
Ola Foundation (CSR arm of Ola) partnered with GiveIndia for ‘O2forIndia’ which provided free oxygen
concentrators to patients in quarantine with SpO2 levels less than 94 percent.
Initially, 500 oxygen concentrators were provided, and patients were offered door-to-door delivery and
pick-up of oxygen concentrators. Patients could request oxygen concentrators through the Ola mobile
application by providing a few basic details depositing Rs. 5000, a refundable deposit to use the service.
Ola arranged for the oxygen concentrators to be picked up after the patient recovered and no longer
required oxygen support, so that it could be ‘sterilized’ and made ready to be used by patients. In addition,
Flipkart donated 30 ICU ventilators to the Karnataka government in late June 2021.
KARNATAKA 72 |SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
Taking serious note of reports that many patients in home care routinely flouted rules, resulting in
infection spreading and fatalities, the government in May 2021 decided not to allow people to isolate at
home in urban slums and villages. They made it mandatory for asymptomatic patients and people with
mild symptoms to get admitted to COVID-19 Care Centers (CCCs), which also served as triage centers.
The decision was prompted by health department’s data showing 70 patients either died at home or were
brought dead to the hospital between May 14 and 22, 2021. Home care was limited to urban homes which
had separate rooms and attached bathrooms.
In a bid to ensure compliance with isolation rules, the government planned to affix red tape on houses with
infected people. However, officials claimed that due to lack of awareness about the upgraded facilities
at CCCs including a section with oxygenated beds, people who tested positive were reluctant to move to
those centers, with only about 30 percent of the 19,300 beds occupied in 289 newly set up CCCs in 227
Taluks in May. Of the 3,218 CCC beds in Bengaluru, 90 percent of them were left vacant in May, 2021.
To manage and distribute medical oxygen efficiently and transparently at all levels, the Government, in May
2021, decided to set up an oxygen cell in each district, which would function 24x7. The cell coordinated
with hospitals and meet their demand if there was any shortage. The State already had a 24x7 State
Oxygen Unit and a 24x7 State Oxygen Helpline at the Drug Controller Head Office in Bengaluru. The unit
monitored all re-fillers in their district as well as those from other districts who supplied oxygen to their
district. A database of all the hospitals in the district, as well as their oxygen needs and oxygen suppliers
were regularly maintained.
Medical Support and Monitoring
An algorithm was developed for telemonitoring by government or private entities to
determine home care and then connect patients to a facility when required.
In the first wave of the pandemic, the health department with help of SWASTH provided
teleconsultation to home isolated COVID-19 patients. A total of 5,204 patients were
monitored by the NGO (July to Sept 2020). Subsequently, from October 2020, the health
department partnered with Portea to provide home care including attendant support to COVID-19 patients.
Teleconsultation was made available to home isolated cases via StepOne and Portea Medical. For
medical and non-medical emergencies, patients were given an escalation number. When they received
such a call, they were connected to the zonal officer, who directed them to the quarantine teams. Digital
thermometer, pulse oximeter, a sufficient number of masks, two bedrooms and a caregiver were some of
the requirements to be eligible for home isolation. Portea was made responsible to do the physical triage
and the tele-triage. StepOne announced a 24x7 helpline for COVID-19, non-COVID-19 and patients with
mental health issues. Callers chose their symptoms via the Interactive Voice Response System (IVRS),
after which a registered healthcare expert guided the individual on how to proceed.
Counselling was provided to patients with mental health concerns. StepOne was an empanelled partner
for telemedicine consultations on Aarogya Setu Mitr, an ancillary service on the Aaroya Setu app that
enables free teleconsultation for those with COVID19-like symptoms.
Portea Medical partnered with the Government of Karnataka to support the recovery and care unit in
COVID-19-affected rural areas. Portea set up a 50-bed community health center in Konanur, Arkalgud
taluk, Hassan District, Karnataka. For this initiative, the company collaborated with an NGO called DFY.
Portea worked in 15 Primary Health Centers (PHCs) in the surrounding area. The centers could provide
24-hour oxygen support as well as HDU beds equipped with BiPAP machines and oxygen concentrators. | 73SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
As of May 2021, Rajiv Gandhi University of Health Sciences (RGUHS) trained over 7,000 final year MBBS
students to treat and monitor the home-isolated cases. The university registered and trained the students
through StepOne app. COVID-19 duty was mandatory for all the final year MBBS students studying at
colleges affiliated to RGUHS and as of May 2021, 4,000 students had registered and 2,500 of them had
been trained. According to the university officials, each student was assigned to make 40 calls/ contact 40
home-isolated patients every day. If the students discovered a patient who required additional treatment,
they contacted the team’s senior doctors and catered to their needs.
References
¾https:/<> /covid19.karnataka.gov.in/storage/pdf-files/HFWpercent20295percent20ACSpercent
202020percent20Homepercent20Isolationpercent20ver2.pdf
¾https://www.aninews.in/news/national/general-news/karnataka-ropes-in-medical-students-to-
provide-teleconsultation-to-covid-patients-in-home-isolation20210506221706/
¾https://www.deccanherald.com/state/top-karnataka-stories/karnataka-govt-appoints-private-
firm-to-offer-telemonitoring-services-to-covid-19-patients-under-home-isolation-892850.html
¾https://www.biospectrumindia.com/news/77/19046/portea-medical-collaborates-with-
karnataka-govt-for-covid-19-care.html
¾http://www.uniindia.com/flipkart-donates-icu-ventilators-to-karnataka/south/news/2434053.html
Shift to Covid hospital
(DCHC/DCH)
Isolate person at home/
home care
Shift the person to Covid
Care center(CCC)
Asymptomatic/mild symptomsModerate/severe
Not suitable for Home
isolation
Suitable for Home isolation/
Home care
Alogrithm for deciding Home isolation/Home care
Tele-monitoring team/Health team/medical officers/physician
perfrom medical triage of the person and assess suitability of house
A person tests positive for Covid-19 74 |SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
¾ht<> tps://www.honeywell.com/us/en/press/2021/05/honeywell-demonstrates-support-for-india-s-
covid-relief-effo
rts ¾https://projectstepone.org/
¾https://www.newindianexpress.com/states/karnataka/2021/may/13/247-oxygen-cell-to-be-set-
up-in-each-karnataka-district-2301952.html
¾https://timesofindia.indiatimes.com/city/bengaluru/home-care-scrapped-karnataka-government-
now-struggles-to-fill-covid-care-centres/articleshow/82897182.cms
¾https://www.hul.co.in/news/news-and-features/2020/committed-towards-combating-covid-19.
html
¾https://www.india.com/news/india/ola-to-begin-free-home-delivery-of-oxygen-in-bengaluru-other-
cities-amid-covid-19-crisis-4656368/ | 75
SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
Kerala is one of the few states in India with a strong pre-existing public health network to
support COVID-19 home-care without any help from private entities. Their efforts to reduce
burdens on hospitals were largely successful, and were also recognized by the WHO
(World Health Organization) in July 2020
4
. Active surveillance, setting up of district control
rooms for monitoring, strong community engagement and addressing the psychological
needs of the vulnerable population were some of the key strategic interventions implemented by the state
government that kept the disease in control.
Inclusion and Eligibility Criteria
The district
administration
decided when
to initiate
the Standard
Operating Procedure (SOPs)
for home-based management
of asymptomatic COVID-19
patients. The following clinical
criteria were used to determine
eligibility: COVID-19 positive by any
confi rmatory test, asymptomatic
(no symptoms), persons with no
major morbidities/ uncontrolled
comorbidity/ vulnerable
condition, persons who were
psychologically fi t and willing to
be isolated in a room. Children
under the age of 12 were allowed
to be placed in room isolation
with their parent/ caregiver, with
a third person acting as caretaker.
All these category patients were
assessed by Medical Offi cers
(MOs) from the local health
authorities and were provided
care under the breakthrough fi ve
tier COVID-19 care model.
KERALA
The Five Tier Covid 19 Care Pyramid - Ke rala
Cat B-CSL TC-COVID 2nd Line
Treatment Centre
Cat A-CFL TC-COVID 1st Line
Treatment Centre
Asymptomatic with no provision
for home care and isolation-DCC
(Domiciliary care centre)
Asymptomatic - Home care
and isolation
Cat C-Designated
COVID Hospital 76 |
SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
As determined by local self-government and health authorities, adequate access (road and communication),
separate rooms with attached bathrooms, provision for vulnerable people to be isolated/ separated, and
a healthy caretaker were the pre-requisites for home isolation. COVID-19 negative family members from
vulnerable groups were closely monitored by the local primary healthcare teams, either by extending
the three levels of daily monitoring or by having a Junior Public Health Nurse/ Accredited Social Health
Activist (ASHA) Volunteer visit every third day to monitor the vulnerable member using the checklist. All
exposed members of the household were quarantined for 14 days after their last contact with a confirmed
COVID-19 patient at home. The supply of basic commodities to such households was ensured by the
Local Self Government (LSG).
Intervention Details
The state government used innovative approaches to strengthen its health infrastructure.
Coordinated efforts were made between the state and district units to bring out treatment
and discharge protocols.
Test results were sent to the respective district program management and support units,
who handed over the same to Rapid Response Teams (RRTs) as well as the individuals.
The RRTs were responsible to get in touch with individuals, check their health conditions, and give
directions on the next step of care. Those without facilities for proper home isolation were accommodated
in domiciliary care centers arranged by the LSGs.
For the primary contacts at the individual’s home, all help, including food or medicines were ensured by
ward-level committees. Those under home care were moved quickly to the hospital if they experienced
shortness of breath or fall in oxygenation. The rapid response teams were contacted and were made in
charge of the next steps.
Self-Care guidelines and recommendations were laid out in detail by the authorities. Every day, patients were
contacted via phone by local health teams for symptoms in accordance with a prescribed checklist, which
was signed by a medical officer. These patients were monitored for symptoms, SpO2 levels, psychological
evaluation, and social issues. If patients developed symptoms such as hypoxia or tachycardia, they were
transported to the nearest COVID-19 First Line Treatment Centers/COVID-19 hospital, depending on the
severity. Specially designed double chambered vehicles were used for transportation.
Medical Support and Monitoring
Considering the increase in the number of cases, the state government rolled out a three-
level daily monitoring system for providing medical support.
Daily
telphoneic
monitoring
Self
monitoring
and reporting
of symptoms
Finger pulso
oximetry
123 | 77
SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
With an aim to minimize fatalities, Tele ICU Command Centers were established at district level which
were managed by experienced intensivists and nurses on a 24x7 basis. These Tele ICU infrastructures
included monitors, computers with headphones, speakers and high-speed internet connection. The
government also encouraged private hospitals with intensive care expertise to provide tele ICU facility to
small hospitals in Hub and Spoke model. District Medical Offi cer and Institutional medical boards were
made responsible to oversee the plan, establish systems and monitor activities.
Scalability and Replicability
The COVID-19 management and control in Kerala ensured commitment from the highest
administration with proactive timely interventions. In order to scale up and reduce the
chances of virus spread in future, fever clinics can be converted into COVID-19 clinics
across all Hospitals. Further oxygen beds can be arranged at Taluka Hospitals and
wherever possible. At Primary Health Center/ Family Health Center and all other hospitals
it is important to ensure regular stock of steroids and oral anticoagulants in accordance with home care
management advisory. Support mechanisms such as home care and oxygen concentrator arrangement
for home, along with other treatment support can be established for patients’ bed-ridden at home.
Telemedicine units and counsellors can be leveraged for regular assessment of health status.
Daily telephonic follow up by
PHC MO/designated person
Self assesment of symptoms
Daily pulse oximetry and
assesment of pulse rate by patient
YesYesYesNONONO
Shift to
Covid
hospital
Continue
Inform
PHC MO/
DISHA
Continue
home
care
Continue
home
care
Inform
PHC MO
and shift to
designated
Covid
Hospital
Altered sensorium, breathlessness, Chest pain, Drowsiness,
Haemoptysis, excessive fatiguability, syncope, palpitation
Red fl ag
signs
Assess for fever or any red fl ag
signs
Observe for devlopment of
fever or red fl ag sign
SpO2<94 on room air
PR>90/min
Home care of Asymotomatic Category A
Medical Support and Monitoring
Three Level Daily Monitoring System 78 |SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
Isolation wards can be set up at Community Health Care Centers and major hospitals across the state
including building isolation blocks in Kozhikode and Thiruvananthapuram Medical College Hospitals.
Scale up infrastructure for treatment of pregnant women and children is another important measure. The
state can also plan to maximize vaccination drives to reduce transmission. It is also important to focus
on post-COVID-19 care, particularly stress management and anxiety issues.
References
¾https:/<> /dhs.kerala.gov.in/wp-content/uploads/2020/08/Advisory-Home-care-Asymptomatic-
COVID19-Postive-patient.pdf
¾https://dhs.kerala.gov.in/wp-content/uploads/2021/04/Summary-Of-Covid-19-quarantine-and-
isolation-guidelines.pdf
¾nCorona – Guidelines Department of Health and Family Welfare Govt of Kerala
¾Responding to COVID-19 - Learnings from Kerala
¾Teams to monitor patients in home care
¾https://dhs.kerala.gov.in/wp-content/uploads/2020/10/Guidelines-Tele-ICU-and-Intensive-Care-
Servcies-1.pdf
¾https://dhs.kerala.gov.in/wp-content/uploads/2021/05/Guideline-Strengthening-Patient-Care.pdf
¾Kerala is preparing for a possible third wave of COVID-19: Here’s how | 79
SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
Around 24 municipal wards of Mumbai fall under the jurisdiction of the Brihna Mumbai
Municipal Corporation (BMC). Each of these ward offi ces have a disaster control room,
which were converted into COVID-19 response ‘war rooms’. A dedicated helpline number
(linked to 30 more lines) was set up for each war room to oversee cases arising in
municipal wards. Based on the condition of the patient, if they had been recommended
home isolation, staff members enquired whether patients were able to and had the required space to
isolate in their homes. If not, patients were provided with appropriate institutional quarantine facilities to
isolate. A dashboard was also created which provided real time updates to the BMC.
The state of Maharashtra partnered with the private sector to support in the fi ght against the COVID-19
pandemic. Hindustan Unilever Limited (HUL) provided RT-PCR testing kits and other supplies including
pulse oximeters, PPE kits, masks, oxygen concentrators and 29 ventilators to government hospitals in
Maharashtra. To augment the quarantine system instituted by the government, HUL tied up with Apollo
Hospitals, State Bank of India, Oyo, Lemon Tree and others to create isolation facilities equipped with
medical supervision to help reduce the burden on hospitals while providing acute care for patients in need.
They also donated over 74,000 testing kits for early detection of COVID-19. These kits were used to conduct
free testing of patients in government hospitals. Efforts were also made to upgrade medical infrastructure
in hospitals treating COVID-19 patients. Another private sector partner, Honeywell, along with its NGO
partners, in consultation with the state government of Maharashtra, established a COVID-19 critical care
center equipped with beds, oxygen, PPE kits and other basic medical infrastructure.
Intervention Details
In August 2020, StepOne, in partnership with the state government of Maharashtra set up
a 24x7 telemedicine helpline for COVID, non-COVID-19 and mental health related issues.
Callers could choose their symptoms via the Interactive Voice Response System. Following
this, a registered healthcare expert would guide the patient on when and where to seek
care. Patients with mental health issues were provided counselling services. StepOne
is also an empaneled partner for telemedicine consultations on Aarogya Setu Mitr, an ancillary service
on the Aargoya Setu app that enables free teleconsultation for people with COVID-19 like symptoms. In
May 2021, home quarantine was stopped in 18 districts that had a higher COVID-19 positivity rate than
the state’s average and COVID-19 care centers in these districts began functioning as isolation facilities.
Reference
¾https://www.downtoearth.org.in/news/health/bmc-s-24x7-decentralised-war-rooms-helping-
stem-covid-19-cases-in-mumbai-76801
¾https://www.news18.com/news/india/communication-is-key-mumbais-covid-19-model-gets-
govt-praise-maharashtra-coronavirus-mumbai-model-bmc-3727934.html
¾https://www.thehindu.com/news/cities/mumbai/covid-19-maharashtra-to-stop-home-
quarantine-in-18-districts/article34641134.ec
MAHARASHTRA 80 |
SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
To fi ght the COVID-19 pandemic, in June 2020, the government of Odisha announced
setting up of COVID-19 Care Homes (CCHs) in all 6,798 Gram Panchayats of the state.
Odisha also set up special COVID-19 hospitals for critical patients, equipped with
approximately 10,000 beds and ICU facilities and also trained health workers with the
right skills to fi ght this pandemic
In July 2020, the government released detailed guidelines on home isolation for asymptomatic/ mildly
symptomatic patients with no comorbidities. This was facilitated by the state’s Health and Family Welfare
department.
Inclusion and Eligibility
The criteria for inclusion and eligibility of persons to be placed under home isolation
included mild symptomatic/ pre-symptomatic/ asymptomatic cases, having the requisite
facility in their homes for self-isolation. Family members of the isolated patient, who
were in contact with them, were also required to have space for quarantine, along with
a separate toilet. Adult caregivers were required to provide care to patients at all times,
i.e. on a 24x7 basis and communication between the caregiver and state helpline was a requirement
throughout the duration of the home isolation period. Caregivers and all others that came in contact
with COVID-19 patients were asked to take all necessary precautions. Patients were asked to constantly
monitor their health and vitals and keep the Health Authorities informed for surveillance teams to follow
up accordingly. Patients were required to fi ll an undertaking on self-isolation, stating that they would follow
all home quarantine guidelines and other family members in home quarantine were also required to follow
the protocols. Stickers were put outside the homes of COVID-19 patients to caution others.
COVID-19 patients with comorbidities including those with Hypertension, Diabetes, Heart Disease,
Chronic Lung/ liver/ kidney disease, Cerebro-vascular disease etc., Immuno-compromised patients (HIV,
Transplant recipients, Cancer Therapy etc.) and elderly patients were not eligible for home quarantine.
Intervention Details
The COVID-19 Isolation Facilities, known as COVID-19 Care Centers (CCC) / COVID-19
Health Centers (CHC) that were created by the state government were primarily used as
isolation facilities for COVID-19 suspect / positive cases who did not have the required
infrastructure to isolate in their homes. Each of the CCHs set up in the state had facilities
to accommodate 10 to 20 persons, and all put together could accommodate about
70,000 people. Every institute that created isolation facilities - CCCs/ CCHs were required to nominate
a dedicated offi cer, who would maintain close and regular contact with the Chief District Medical Offi cer
ODISHA | 81SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
of the district. Further, a nodal officer was also specially notified by the District Collector/Municipal
Commissioner for home isolation. The state also issued specific SOPs for medical personnel, nursing
officers and security personnel at quarantine facilities. In order to decentralize its COVID-19 management,
the state government further announced the setting up of ward level committees in both urban and rural
areas to monitor the situation and extend help to anyone testing positive.
The ward level COVID-19 management committees in rural areas included ward members, Auxiliary
Nurse Midwives (ANM) and Accredited Social Health Activist (ASHA) workers, and members of local
women’s self-help groups. The village welfare committees overlooked the functioning of the COVID-19
management committees.
In urban areas, ward committees were managed by ward officers, local people and volunteers as members
to monitor the situation. These committees were also set up in CCHs in large slum clusters. The Health
and Family Welfare department developed a simple training module for COVID-19 positive patients and
caregivers in both Odia and English languages. The department also developed a brochures/ leaflets on
the subject which was shared with COVID-19 positive patients and their caregivers.
Medical Support and Monitoring
The District/ Municipal Administration/ Health Authorities were in charge of monitoring
all cases under home isolation. The health status of those under home isolation was
monitored by field staff/ surveillance teams through personal visits, along with a
dedicated call center to follow up with patients on a daily basis. The clinical status (body
temperature, pulse rate and oxygen saturation) was recorded by field staff/ call center.
Patients were guided on measuring their parameters and provided with instructions by field staff. The
details of patients were regularly updated on the COVID-19 portal and facility app and shared with the
District Surveillance Officer.
In case a patient needed to be moved to a COVID-19 facility, they were to be transferred only via dedicated
COVID-19 ambulances of the designated COVID-19 care facility. In case of the following serious signs /
symptoms wherein immediate medical attention was required, patients were to contact the 104 helpline
and not directly go to any hospital, these included: Difficulty breathing, Dip is SpO
2
(<95percent), Persistent
pain/ pressure in the chest, Mental confusion, Slurred speech/ seizures, Weakness or numbness in any
limb/face, Developing bluish discolorations.
In May 2021, the Odisha Transports department fixed hiring charges of various types of ambulances
operated by private hospitals and private operators in the state. Small categories of ambulances like
Maruti Omni, Tata Magic and Maruti Eco etc. could charge Rs 750 up to 10 kilometers of distance. Also,
small ambulances with basic life support facilities could charge Rs 1,000 up to the same distance.
These categories of ambulances could charge Rs 30 per additional kilometer exceeding 10 kilometers.
Further, medium category ambulances like Mahindra Bolero could charge Rs 1,000 up to the distance
of 10 kilometers. These ambulances with basic life support system facilities could charge Rs 1,500 up
to the same distance. Large categories of ambulances like Tata Winger, Force Traveller and Tata 407
etc. could charge Rs 1,250 up to 10 kilometers. These categories of ambulances with basic life support
system facilities could charge Rs 2,000 up to the same distance and ambulances could also charge Rs 30
per additional kilometer exceeding 10 kilometers. Also, large category of ambulances with advanced life
supporting system facilities could charge Rs 3,000 up to 10 kilometers and extra charges per additional
kilometers. 82 |SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
Tele-consultation services were rolled out by the state in partnership with StepOne. The 24x7 helpline was
issues covering COVID, non-COVID-19 and mental health. Callers could choose their symptoms via the
IVRS system. Following this, a registered healthcare expert would guide the patient on when and where
to seek care. Patients with mental health issues were provided counselling services. StepOne is also
an empaneled partner for telemedicine consultations on Aarogya Setu Mitr, an ancillary service on the
Aargoya Setu app that enables free teleconsultation for people with COVID-19 like symptoms.
Scalability and Replicability
During the first wave, the state government had set up 16,815 temporary medical centers
at the Gram Panchayat level across the state, with a total of 7,62,345 beds. Many of these
centers were shut down as the number of returnee migrant workers declined. A new role
can be envisaged for these centers.
References
¾ht<> tps://www.google.co.in/amp/s/www.thehindu.com/news/national/coronavirus-odisha-to-set-
up-covid-care-homes-in-all-gram-panchayats/article31855777.ece/amp/
¾https://nidm.gov.in/covid19/PDF/covid19/state/odisha/300.pdf
¾https://odishatv.in/news/covid-19/odisha-fixes-hiring-charges-for-ambulance-services-issues-
warning-46804
¾https://health.odisha.gov.in/pdf/Guidelines-for-Quarantine-facilities-COVID-19.pdf | 83
SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
Launched in August 2020, the state of Tamil Nadu’s key initiative was the Amma COVID-19
Homecare scheme, under which kits and teleconsultation was provided at home. The
state also made use of eSanjeevani OPD and launched Siddha-based treatment facilities.
Private players like StepOne and Ola also contributed to home based care in the state.
Inclusion and Eligibility Criteria
All patients with SpO2 level above 94 percent (if RT-PCR results were positive then
irrespective of symptoms, otherwise suspected cases with RT-PCR negative or untested
with symptoms) were advised home isolation by the government. This was prescribed
through testing/ screening/ triaging centers, health facilities, outreach camps and home
visits. Exceptions for this were pregnant/ lactating mothers or patients above the age of
65, who were referred to COVID-19 hospitals.
Intervention Details
Amma COVID-19 Homecare Scheme: Introduced in August 2020, through this scheme
people in home isolation could avail diagnostic services, medicines, and consultations.
The care package was offered for a period of 14 days, at a cost of Rs 2,500.
Patients who tested positive and were advised home isolation, and people with RT-
PCR negative results but suspected symptoms (as of August 2020) were provided with
homecare kits that contained pulse oximeters, digital thermometers, 14 face-masks, soaps, 14 zinc
and 14 multivitamin tablets and packs of herbal immunity boosters like ‘Athimathuram’ and ‘Kabasura
Kudineer’, among others. The kit also contained a COVID-19 booklet. The package included psychological
counselling, prescriptions and monitoring of oxygen levels and temperature by a team of doctors. If
patients showed signs of worsening condition, they were shifted to hospitals.
An exclusive facility with 350 beds for COVID-19 treatment was set up at the Pudukottai Medical College
Hospital. Among the 350 beds, 35 were allotted to intensive care units, 165 beds were equipped with
oxygen lines and separate rooms and advanced equipment were also made available at the facility.
In Chennai, patients were shifted from test and screening centers through GVK EMRI 108 Ambulance
Services based on calls received by the Emergency Response Centre of the organization. Transit of patients
from test centers to government and private hospitals was free of cost. Further, to ensure availability of
ambulances for everyone, private operators were permitted to shift COVID-19 patients. The government
fi xed rates for private ambulances and took strict action against defaulters.
The Ola Foundation (CSR arm of Ola), partnered with GiveIndia for ‘O2forIndia’ initiative. They provided free
oxygen concentrators to patients in quarantine in Chennai. Initially they supplied 500 oxygen concentrators
TAMIL NADU 84 |SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
to patients free of charge by offering doorstep delivery and pick-ups of oxygen concentrators. To avail this
service, patients had to place requests for oxygen concentrators through the Ola mobile app by providing
some basic details. Home delivery was done by specially trained personnel through taxis. After the patient
recovered and no longer required oxygen support, Ola would arrange pick-ups and sterilize the oxygen
concentrators and then deliver to other patients in need.
Medical Support and Monitoring
A citizen-centric initiative for uninterrupted services during pandemic: eSanjeevani
COVID-19 OPD provided integrated telemedicine solutions. Instructions were sent to
Government Health facilities including PHCs, HSCs to provide drugs for ePrescription
generated via the eSanjeevani OPD. Over 3,50,000 consultations were conducted through
this initiative (till December 2020). Symptomatic patients were identified and shifted to
higher facilities for further care.
Tele-consultation and counselling services were provided through StepOne, with a 24x7 helpline for
COVID, non-COVID-19 and mental health related issues. Callers could choose their symptoms via the
IVRS system. Following this, a registered healthcare expert would guide the patient on when and where
to seek care. Patients with mental health issues were provided counselling services. StepOne is also
an empaneled partner for telemedicine consultations on Aarogya Setu Mitr, an ancillary service on the
Aargoya Setu app that enables free teleconsultation for people with COVID-19 like symptoms.
00-bedded facilities were made available at the Government Polytechnic College in Cuddalore district
in June 2021. Patients were given only Siddha formulations i.e. traditional food items and herbal
concoctions. Besides this, breathing exercises for strengthening lungs, exercises for increasing oxygen
saturation, meditation, ‘aasanaas’, relaxation and counselling was done. Discharged patients were given
Siddha formulations to strengthen their physique.
Sustainability and Replicability
The Amma homecare scheme was sustainable, although its popularity was limited
to certain districts till November 2020.The state launched 2,000 Amma Mini-Clinics
in January 2021 and 1,645 doctors were recruited to run them. The Deputy Directors
of Health Services, under whose purview the mini-clinics fall, was instructed to divert
medical officers, on a need basis, as per requests to institutions that come under the
Directorate of Medical Services.
The Government COVID-19 Hospital, a 600-bed exclusive facility in King Institute Campus in Guindy, is
planning to open a comprehensive post-COVID-19 care center with an outpatient unit, testing facilities,
inpatient and rehab services. The state has also upgraded services of post COVID-19 clinics across
all medical colleges. These clinics will have senior pulmonologists, diabetologists, cardiologists and
neurologists posted, and also have rehab wards where physiotherapy and other treatments will be offered.
The state is ramping up infrastructure and human resources in its pediatric wards and sensitizing
pediatricians to COVID-19 treatment protocols and management while ensuring adequate supply of
steroids, IV immunoglobulin and other drugs needed. Additional NICU units are also being added. Medical
colleges and district HQ hospitals are working towards creating additional bed capacity, over and above
existing pediatric capacity, along with ICUs. Incentives have also been offered to manufacturers of oxygen
and COVID-19 related equipment. | 85SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
References
¾https:/<> /www.thehindu.com/news/national/tamil-nadu/home-care-of-patients-with-mild-covid-19-symptoms-
gains-traction/article32896607.ece
¾https://cms.tn.gov.in/sites/default/files/go/hfw_e_257_2021.pdf
¾https://cms.tn.gov.in/sites/default/files/go/hfw_e_240_2021.PDF
¾https://indianexpress.com/article/cities/chennai/covid-19-in-tamil-nadu-updates-6555009/
¾https://www.nhm.gov.in/New_Updates_2018/Innovation_summit/7th/HSS/HSSpercent20PPTspercent
20percent20percent285percent29/Tamilpercent20Nadu-percent20eSanjeevanipercent20Nationalpercent20
Summit.pptx
¾https://projectstepone.org/
¾https://timesofindia.indiatimes.com/city/chennai/tamil-nadu-govt-to-set-up-special-post-covid-care-clinics/
articleshow/83942346.cms
¾https://www.india.com/news/india/ola-to-begin-free-home-delivery-of-oxygen-in-bengaluru-other-cities-
amid-covid-19-crisis-4656368/
¾https://www.newindianexpress.com/states/tamil-nadu/2021/may/09/tamil-nadu-to-add-12-siddha-covid-
care-centres-for-mild-patients-health-ministerma-subramanian-2300371.html
¾https://www.thehindu.com/news/national/tamil-nadu/readying-for-a-third-wave-tamil-nadu-ramps-up-
infrastructure-in-paediatric-wards/article34862019.ece 86 |SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
Annexure 1: Summary of the guidelines on home isolation
I. P<> atients eligible for home isolation:
1. Clinically assigned mild/ asymptomatic case by the treating Medical Officer. S/he must be in
constant contact with a treating physician and promptly report in case of any deterioration.
2. Have the requisite facility at their residence for self-isolation and for quarantining family contacts.
3. A caregiver should be available to provide care on 24 x7 basis. A communication link between the
caregiver and healthcare facility is a prerequisite for the entire duration of home isolation.
II. Who is NOT eligible for home isolation
1. Elderly patients aged more than 60 years and those with co-morbid conditions shall only be allowed
home isolation after proper evaluation by the treating medical officer.
2. Patients suffering from immune compromised status are not recommended for home isolation
and shall only be allowed home isolation after proper evaluation by the treating medical officer/
Community Health Officer.
III. General precautions for the patients:
1. Hydration: To stay hydrated at all times and take adequate amounts of fluids in form of juices,
soups and water.
2. Diet: Healthy diet containing adequate energy, protein, vitamins and minerals, obtained through the
consumption of a variety of foods, including green and orange vegetables, meat, fish, beans, nuts, whole grains and fruit should be consumed.
3.
Toilet use: To flush after closing the lid of the toilet and disinfecting the items used with 1% sodium
hypochlorite spray solution/sanitizers/soap solution.
4. Avoid sharing personal items with anyone else like toothbrushes, eating utensils, dishes, drinks,
bath/hand towels, wash cloths or bed linen, etc.
5. Take adequate rest and sleep well.
6. Do not meet visitors till you are released from home isolation/ home care.
7. Self-monitoring: Check and record your body temperature using mercury/ digital thermometer
(shall be < 100.40 F) in armpit and oxygen saturation with a fingertip pulse oximeter (shall be >95%) thrice daily.
8.
Keep in contact with friends and family through messages, phone calls, or simply conversing with
them from a safe distance – viz. from the balcony/roof/window.
9. Prone ventilation can be practiced by all isolated patients’ multiple times in a day for up to 16 hours,
with 30 minutes in each position.
10. Medication advised during home/community-based isolation should be symptomatic. There is no
requirement of administering hydroxychloroquine, remdesivir, tenofovir, zinc, multivitamin, etc
11. Infection with COVID-19 predisposes people with compromised pulmonary function to developing
severe complications. Therefore, patients with cystic fibrosis, COPD, chronic asthma etc. should be especially careful. Smokers should also be strongly advised to quit smoking, at least for the period of active infection.
ANNEXURES | 87Home-based Management of COVID-19: Best Practices Adopted by States
IV.When to seek medical attention:
Immediate medical attention must be sought if warnings signs or symptoms develop. These could
include difficulty in breathing, dip in oxygen saturation (SpO2 < 94% on room air), failing to perform
the 6-minute walk test, persistent pain/pressure in the chest, extreme fatigue and mental confusion
or inability to arouse
V.Instructions for caregivers:
1.Mask: The caregiver should wear a triple layer medical mask or N95 mask when in the same
room with the isolated person. If the mask gets wet or dirty with secretions, it must be changed
immediately. Discard the mask after use and perform hand hygiene after disposal of the mask.
2.Hand hygiene: Hand hygiene must be ensured following contact with an ill person or his immediate
environment. Use soap and water for hand washing at least for 20 seconds. Alcohol-based hand
rub can be used, if hands are not visibly soiled.
3.Patient care: Avoid direct contact with body fluids of the patient, particularly oral or respiratory
secretions. Avoid exposure to potentially contaminated items in his immediate environment
4. Cleanliness:
a.Clean and disinfect frequently-touched surfaces like phones, remote controls, counters, table-
tops, doorknobs etc with 70% Lysol or 1% sodium hypochlorite solution.
b. Clean and disinfect bathroom, fixtures and toilet surfaces at least once daily. Regular household
soap or detergent shall be used first for cleaning, followed by 1% sodium hypochlorite solution
c.Gloves, masks, disposed tissue and other waste generated during home isolation/home care
shall be sprayed/ soaked in 1% sodium hypo-chlorite solution and disposed in a yellow bag in
separate bin.
5.Waste disposal: Effective waste disposal helps prevent further spread of infection within household.
The waste (masks, disposable items, food packets etc.) should be disposed of as per CPCB
guidelines.
Left-over food, empty juice bottles, disposable utensils, empty water bottles, waste generated from kitchen, packaging material, waste papers, waste plastics, any other items generated or used by family members and the positive person at home isolation/ home care should be collected along with other general solid waste in bags securely tied for handing over to waste collectors.
Masks and gloves used by caregiver and other family members shall be kept in paper bag for a minimum of 72 hours prior to disposal of the same as general waste after cutting, the same to prevent reuse.
When to discontinue home isolation: Patients under home isolation will stand discharged and
end isolation after at least 10 days have passed from onset of symptoms (or from date of
sampling for asymptomatic cases) and no fever for 3 days. There is no need for testing after
the home isolation period is over.
Given below are links to the guidelines issued by MoHFW, CGHS and ICMR
MoHFW:https://www.mohfw.gov.in/pdf/RevisedGuidelineshomeisolation4.pdf https://www.mohfw.
gov.in/pdf/RevisedguidelinesforHomeIsolationofmildasymptomaticCOVID19cases.pdf
CGHS:https://cghs.gov.in/WriteReadData/l892s/Guidelines%20for%20tele-homecare%20of%20
COVID-19%20patients%20(16%20June%202020).pdf
ICMR: https://www.icmr.gov.in/pdf/covid/techdoc/COVID_HOME_CARE_English_v2.pdf
ANNEXURES 88 | Home-based Management of COVID-19: Best Practices Adopted by States
ANNEXURES
Annexure 2: Best practices from partner organizations
USAID-NISHTHA/JHPIEGO
USAID’s flagship health system strengthening project NISHTHA, implemented by Jhpiego, is supporting
13 states in strengthening the delivery of comprehensive primary healthcare. NISHTHA is also working
closely with the states to strengthen their response towards COVID-19. NISHTHA is providing technical
assistance to the intervention states for improved provision of home-based isolation care across following
areas:
Capacitating states in line with GoI’s home isolation guidance – NISHTHA has been providing technical assistance to its intervention states for implementation of the home isolation care guidelines with local contextualization. These guidelines are also being modified into interactive and easy to understand flyers which acts as a job-aid/ checklist for field level functionaries. The project has supported capacity building efforts across five states (Tripura, Meghalaya, Sikkim, Mizoram and Arunachal Pradesh) and about 1900 frontline workers have been trained on home isolation care and management protocols.
Co-design and implementation of home-based care models – NISHTHA has co-designed a menu of home-based isolation care models based on the local needs of the intervention states. These models are being rolled out for enhanced remote monitoring, follow up and home-based care of COVID-19 patients. Following models have been rolled out across intervention states:
a.Integrated Tech Enabled Home-Based Care Model -Tele-Track – NISHTHA is leveraging technology to develop an end-to-end integrated technology enabled home-based care platform i.e. NISHTHA Tele-Track for monitoring, care and management of asymptomatic and mild COVID-19 cases under home isolation. The platform acts as an enabler for effective monitoring and tracking of COVID-19 patients and has functionalities for recording of vitals of home isolated cases on a daily basis, provision of regular & need based SOS telemedicine consultations with a pool of physicians and digital reporting and with generation of system alerts in case a patient develops symptoms and requires referral. The platform has been recently rolled out across five states i.e. Arunachal Pradesh, Mizoram, Meghalaya, Madhya Pradesh and Nagaland.
b.Assisted home care model through home visits by health workforce – The model envisages follow-up through home visits by health workforce of asymptomatic and mild COVID-19 cases under home isolation for early identification of complications and establishing referral linkages with higher facilities. This intervention is being rolled out across two states i.e. Meghalaya and Sikkim.
c.Hybrid model by Integrating IVR and Telephonic Follow up – To strengthen efforts in the management of COVID-19 cases, a solution has been designed for regular monitoring and follow up of patients under home isolation and post discharge patients to identify early symptomatic cases and link them with appropriate care. This is a hybrid model that has been deployed using the IVR technology, web-based google form, and tele-calling by trained human resources to ensure seamless follow-up of patients under home isolation. This initiative has been undertaken with an objective of augmenting state’s efforts towards COVID-19 and thereby, reducing overall morbidity and mortality due to the pandemic. This intervention has covered around 96,080 and 25,686 patients under home isolation in the states of Jharkhand and Chhattisgarh respectively. With the second surge of COVID-19, the platform has been rolled out in Assam also and around 2300 patients have been reached out through this platform till date (rolled out on June 7, 2021), of which 122 patients were found symptomatic and linked with appropriate care. | 89Home-based Management of COVID-19: Best Practices Adopted by States
Floating Home Isolation Kit Bank – Most of the states are struggling with availability of COVID-19
Home Isolation Kits comprising basic state approved medicine for COVID-19 management, self-
monitoring device like pulse oximeter, thermometer and personal hygiene products to provide quality
care for home isolated patients. To address this challenge, NISHTHA in collaboration with the state
government of Nagaland has developed an innovative model of Floating Home Isolation Kit Bank
across two high burden districts i.e. Dimapur and Kohima by creating a pool of CHIKs on a return after
use basis.
Development of differentiated home based care approaches for vulnerable groups – Building upon the ministry’s home isolation guidelines as the reference document, NISHTHA in collaboration with Indian Association of Preventive and Social Medicine (IAPSM) developed an operational guideline for differentiated home-based care approaches for various identifi ed vulnerable groups. The idea is to adapt ministry’s guidelines for home isolation to the current context of various vulnerable groups for use by local self-governments, PRIs, civil society organizations and NGO partners. These operational approaches will focus on differentiated home based care models for identifi ed vulnerable groups like urban poor, migrants, children, transgender, tribal population, people living with HIV, pregnant and lactating women, persons with disabilities, and mental health issues etc. These operational approaches will clearly spell out various kind of operational models for home-based care for these special groups based on their vulnerabilities and specifi c needs.
Risk communication materials for both patients and care givers – NISHTHA is providing support to its intervention states for developing and disseminating risk communication materials on COVID-19 messaging. This includes development of RCCE materials, job aids and protocols on COVID-19 Appropriate Behaviors, post COVID-19 care, care during home isolation, mental health, breastfeeding and COVID-19, wellness etc. A guidebook was also developed for parents on prevention and care of COVID-19 among children.
ANNEXURES
Identifi cation and line
listing of COVID
patients requiring
CHIKs by District
health authority
(DHA)
Sharing of contact
details and address of
the identifi ed patients
by DSO to the
dedicated health staff
for delivery of CHIK
Staff will call the
COVID patients and
brief them about CHIKs
and give necessary
instructions
NGO identifi ed by DHA
to deliver CHIKs to the
patients and obtain
written consent from
relatives of patient
NISHTHA Tele-Track will
monitor patients for10
days and generate alerts
to DHA for linkages for
emergency referral
After 10 days, District
Task Force (DTF) will issue
discharge certifi cates, as
per the existing SOP
NGO to collect CHIKs during
the next 3 days from the
patient and deposit it in
CMO offi ce for disinfection.
Patients will be advised to
sanitize CHIKs before it is
being handed over to NGO
Nagaland: Process fl ow of Floating Home Isolation Kit Bank 90 |Home-based Management of COVID-19: Best Practices Adopted by States
F<> urther, NISHTHA has developed a set of engaging audio visuals for risk communication messaging for
the community as well as training aids for health workers on areas such as care during home isolation,
post COVID-19 care, infection prevention practices, care of the mother and newborn, breastfeeding
and COVID-19, use of digital thermometer and pulse oximeter etc.
The AVs can be accessed through the following link:
https://drive.google.com/drive/folders/1kFM3hIX3DzFbF2TJOGLrQjAUsup4GWgP?usp=sharing
Project StepOne
Project StepOne is a non-profit startup on a mission to augment public health resources with technology,
people and processes to effectively fight against Covid. We work with state/district governments, as an
integral part of the government work flow and systems to fight Covid, bringing appropriate telemedicine
interventions to bring medical support to the COVID-19 affected - all services are not charged and pro-
bono to the governments.
We have a large volunteer network of 12000+ doctors, 15000+ medics/paramedics and 5000+ non-medical
volunteers working virtually connected via our technology framework. Our volunteers man helplines, call
vulnerable/positive citizens to get information & assist them, handle emergencies and solve other citizen
problems/grievances and in all cases connect the patients to doctors providing timely care. All services
were provided free to governments.
Background
Covid-19 pandemic has created a crisis for all countries around the world and it has stretched government
infrastructure and resources even in the most developed countries of the world. India being a developing
country with a high population is expected to be more stretched for resources - all government resources
and infrastructure are expected to be completely over burdened. This is expected to put millions of people
under tremendous danger and pose severe problems for citizens, governments alike. The unprecedented
scale of the pandemic is expected to stretch healthcare resources like hospitals beds, equipment like
ventialors and ICU equipment, healthcare workers like doctors and also other government resources to
perform normal citizen response activities.
The Problem
Governments faced the following problems in dealing with the pandemic:
1.
Severe shortage of staff to perform key functions - Doctors and other healthcare staff, Staff to take
calls, staff to obtain key citizen data, staff for guiding and helping citizens
2. Delays and inability to easily train and onboard new staff to augment the shortage of staff
3. Need for systems to help staff be quickly productive when onboarded
4. Systems to scale up and scale down the staff as the virus spread surges or flatten
The StepOne SolutionStepOne created a system that can quickly helps augment government resources with the necessary
people - people with required background/skills, use technology to connect these people to the government
systems enabling them to work remotely from where they are - which is a key in the COVID-19 world and
tying them via processes/workflows with government systems to seamlessly make the integration of
these people with the government system easy.
ANNEXURES | 91Home-based Management of COVID-19: Best Practices Adopted by States
Project StepOne therefore presents technology, people and processes required to solve the problems
faced by the government.
Operate on a Pro-bono Model
It’s not enough to support the governments with technology, people and processes but it’s very important
to also run the system for a significant timeframe. This is because most of the time, governments don’t
have the resources with the right expertise to run the system and therefore Project StepOne provides the
necessary infrastructure and expertise to operate the system. All services are pro-bono and not charged.
Project StepOne Solution Set
Every COVID-19 patient was contacted everyday via a tele-screening call and followed up by a doctor
consultation or trained professional counselling if required or requested by the patient - emergencies
and cases of deterioration were identified during the call and escalated thereby preventing mortality and
morbidity. All emergency handling was done in close coordination with the government and other on
ground agencies across all states.
Advantages of the Project StepOne Solution Set
Accessible: Project StepOne’s Citizen interface works via normal telephone call, a medium easily accessible
now to all parts of the society. It works on all types of phones and does not require data or smartphone, in
most cases does not even require any phone currency to be available as the helplines are toll free.
Inclusive: Citizens calling Project StepOne’s helplines don’t need to be educated or literate - most helplines support all local languages. The volunteer doctors on the platform can speak 33 languages including rarely spoken languages like Nagamese, Garo, Khasi, Jaintia, Beari Urdu etc ensuring anyone calling on the helplines are helped out.
Free or Affordable: All services by StepOne are provided free of charge and delivery of medical services including ambulance, hospitals and medication are channelized via the government healthcare system or NGO’s ensuring lowest affordable options to the citizens.
ANNEXURES
The Project StepOne Solution
Project Stepone
Technology Platform
Large volunteer network of
doctors, nurses and other
citizens to augment Govt
resources
Proven processes and
systems to quickly deploy
for specific areas where
governments need
7000+ Doctors, 2000+
citizen volunteers
Fully operated by team of
experienced and
independent professionals
Flexibility to scale up based
on surge or demand
Built to quickly scale
StepOne augments government resources with trained volunteers
StepOne helps govt go from problem to operational at scale in a few days 92 | Home-based Management of COVID-19: Best Practices Adopted by States
Annexure 3: List of partners supporting home-based care in
states
StatePrivate/NGO/Development Partners
Arunachal Pradesh NISHTHA/Jhpiego
AssamNISHTHA/Jhpiego, 104 Call Centre
BiharPrivate IVRS Agency
Chhattisgarh NISHTHA/Jhpiego, Indus Action, Samarthan, Piramal Swasthya
ChandigarhRed Cross
DelhiPoreta, Step-One, Prakriti-E-Mobility, Call Doc, Health Care at Home, CATS, CNCTD
GoaRotary Club, Lions Club, Jaycee, other CSRs
Jammu and Kashmir Norway India Partnership, HISP
JharkhandNISHTHA/Jhpiego Step-One, mDoc, National Medicos Organization
KarnalDeloitte, KCGMCH, Hindustan Wellness Lab
KarnatakaSwasth, Protea, Step-One, Ola Foundation, Give India, Doctors For You
Madhya Pradesh NISHTHA/Jhpiego
MaharashtraNISHTHA/Jhpiego, Step-One, HUL, Apollo Hopsital, SBI, Oyo, Lemon Tree
ManipurNISHTHA/Jhpiego, RIMJS, JNIMS, IMA, Medicine sans frontier
MeghalayaNISHTHA/Jhpiego
MizoramNISHTHA/Jhpiego, Young Mizo Association
NagalandNISHTHA/Jhpiego, Seva Bharti
OdishaNISHTHA/Jhpiego, Step-One
PuducherryStep-One, Sri Aurbindo Society
SikkimNISHTHA/Jhpiego, UNICEF
Tamil NaduStep-One, Ola Foundation, Give India
TelanganaHyderabad Institute of Technology and Management
Uttar Pradesh Hindustan Computers Limited (HCL)
ANNEXURES | 93SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
NOTES 94 |SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
NOTES | 95SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
NOTES | IIISECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
ANNEXURES Home-based Management of COVID-19: Best Practices Adopted by States
Health Vertical
National Institution for Transforming India
NITI Bhawan, Sansad Marg
New Delhi - 110001
healthdiv-pc@gov.in
011-23042547
Disclaimer: Every care has been taken to provide accurate information along with references thereof. Only validated data and photographs submitted
by competent authorities at the district and state levels have been used in the document. However, NITI Aayog shall not be liable for any loss
or damage whatsoever, including incidental or consequential loss or damage, arising out of, or in connection with any use of or reliance on the
information in this document.
Monograph design support by USAID-NISHTHA/Jhpiego
SIKKIM
Home-based Management of COVID-19: Best Practices Adopted by States
HOME-BASED MANAGEMENT OF COVID-19
BEST PRACTICES ADOPTED BY STATES SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States Innovative Approaches adopted by states for Home based management of COVID-19II |
Home-based Management of COVID-19:
Best Practices Adopted By States
Publishing Agency: NITI Aayog
Year of Publication: 2021
Disclaimer: Every care has been taken to provide accurate information along with references thereof. Only
validated data and photographs submitted by competent authorities at the district and state levels have been
used in the document. However, NITI Aayog shall not be liable for any loss or damage whatsoever, including
incidental or consequential loss or damage, arising out of, or in connection with any use of or reliance on the
information in this document. SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
GOVERNMENT OF INDIA
Innovative Approaches adopted by states for Home based management of COVID-19| i
HOME-BASED MANAGEMENT OF COVID-19
BEST PRACTICES ADOPTED BY STATES ii |
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States | iii
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Over the past two years, the country has been facing an unprecedented public
health crisis in the form of COVID-19. Since the onset of the pandemic, our state
governments have responded with various innovative measures to contain the
spread of the virus. The unprecedented challenges caused by COVID-19, was
managed collectively by both governmental and non-governmental support. The
changing dynamics of the COVID-19 infection called for an early identification,
remote monitoring and appropriate referral mechanism in order to reduce the
number of severe cases and deaths. This called for formulation of ‘Home-based
care model for COVID-19.’ During these testing times, the management models
adopted at the national and at the state level were recognized globally.
The innovative and reliable models of home-based care created ample
opportunities for provision of care and support needed for recuperation. These customized and state
specific models were successful due to the coordinated efforts between various state departments and
Community Based Organizations (CBOs). The intervention focused on setting up of district control rooms
for monitoring, enhancing community engagement, updating clinical guidelines, mobilizing appropriate
resources and addressing the psycho-social needs of vulnerable populations that kept the disease in
control. The COVID-19 response control rooms set up by various states were well equipped with the
tracking systems and digital facilities for providing real time situation analysis and imparting immediate
response to the critical patients. The home-based care models supplemented the government’s efforts in
monitoring the patients under home isolation.
This compendium aims to provide information focused on sustainability and scalability of home-based
care models adapted by various states of India. I am hopeful that this document will act as an essential
knowledge resource for the stakeholders from other Low- and Middle-Income Countries (LMICs) across
the globe and this will go a long way in strengthening our battle against COVID-19 and similar pandemics
in the future.
Dr Rajiv Kumar
Vice Chairperson
NITI Aayog
Government of India
New Delhi, India
Message, Vice Chairperson, NITI Aayog | vHome-based Management of COVID-19: Best Practices Adopted by States
The COVID-19 pandemic has highlighted the importance of public health
response during health emergencies. State governments responded quickly
and innovatively to face this unprecedented crisis despite structural limitations
imposed by limited resources. One such critical innovative practice was providing
home-based care to a large number of patients. In collaboration with Government
of India, home based care guidelines, SOPs for identifi cation, treatment and
referral were adapted by states to spread awareness and prepare innovative
home care models.
Home-based care can signifi cantly augment health systems capacity with the
help of digital tools. Treatment and care provided at home can signifi cantly reduce
complications, improve recovery, reduce spread of infection, and reduce hospital
admissions. There was seamless integration of digital tools with health system delivery in providing
care at home. In almost all states/UTs, Integrated control and command centres became the nerve
centre which connected patients at home with doctors and health care workers, through telemedicine
and connected them to ambulances and higher-level facilities when needed. eSanjeevani, the national
telemedicine helpline and eOPD, was a boon for many recovering at home. Patients and families felt
psychologically more stable at home.
This document presents various home-based care models adopted by states and summarizes basic
principles and practical recommendations. Several of these successful strategies can be replicated and
scaled. It is intended that adaptation of this resource material will be used for guidance by decision-
makers and strategic direction for sustainability at national and subnational levels.
Amitabh Kant
Chief Executive Offi cer
NITI Aayog
Government of India
New Delhi, India
Foreword, CEO, NITI Aayog | vii
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
The states in India were quick to recognize the threat of COVID-19 and introduced a
series of strategies to contain the virus transmission. They successfully implemented
the concept of home-based care as a viable and effective health care delivery
mechanism. In view of the changing needs of the pandemic and to curb the spread
of the virus, Government of India released telemedicine guidelines in March 2020,
which led to the implementation of telemedicine and home healthcare services in
India. Home healthcare, along with remote monitoring and telehealth technologies,
played a critical role in COVID-19 management.
Ministry of Health and Family Welfare (MoHFW), Government of India (GoI), issued
guidelines and released SOPs on medical and social eligibility criteria for home isolation. These SOPs
included self-monitoring and guidelines on when to seek medical care for patients under home isolation.
The states also came up with home care solutions managed through multidisciplinary teams assigned
for supervision, periodic assessments and linking the patients to medical/ nursing care in case of need.
Home based care became a safe and socially acceptable alternative to hospitalization for patients with
mild symptoms and asymptomatic cases. This in turn resulted in availability of beds for the severe and
critical patients. Thus, making more beds available for symptomatic/ more critical patients.
During fi rst wave of COVID-19, patients did not opt for home isolation due to the high fear factor among
family members and community. However, during the second wave, with the unprecedented surge in cases,
patients went to the hospital only when needed. Patients and families felt psychologically more stable and
safer at home and preferred monitored treatment at home or closer to home. Seeing the impact of fi rst
wave and second wave, home-based care under supervision of medical offi cers and health workers with
decentralized and digital management became a reliable solution. This provided timely and appropriate
healthcare and averted many deaths.
States developed various innovative models on home-based care. Many civil society organizations, SHGs
and private sector aided the government in these initiatives. They adopted a multipronged approach
covering an array of services, such as teleconsultation, IVRS helplines, various self-monitoring applications,
providing medicines, arranging ambulance services, arranging doctor visits and follow-ups, and IT and
logistical support to ensure prompt and smooth management of COVID-19.
NITI Aayog initiated the task of developing a comprehensive compendium that documents the various
decentralized models of home-based management of COVID-19 patients across the country with an aim to
promote cross-learning and sharing of valuable experiences. In July 2021, an email was issued to all states
and union territories (UTs) requesting them to share their COVID-19 management practices and models. A
format was shared within a pre-structured criteria/categorization to ensure uniformity in the documentation
of the models. The email was followed up with phone calls to the nodal offi cers from the health departments
in states and UTs. Thorough literature and web study review were conducted to strengthen this document.
This compendium provides information on the various practices and models implemented by Indian
states, districts, and cities to manage COVID-19 patients under home isolation and home quarantine.
Section A of this compendium highlights the states that formally provided the information, while Section
B highlights the states wherein information was obtained through a detailed literature review and data
collection from informal resources.
Case studies/reports/papers highlighting good practices/models implemented by state or in collaboration
with civil society, private sector, and international organizations and non-governmental groups that
assisted state and local governments have been annexed.
Dr Vinod K Paul
Member, NITI Aayog
Preface, Member, NITI Aayog | ixSECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
The compendium of state specific Home-Based Care models during COVID-19 has been prepared to
showcase the commendable work done by the states during the first and second wave of COVID-19, with
the inputs from respective states and development partners.
We would like to especially thank all the states’ health departments for sharing their interventions, success
stories and learnings to make this compendium a reality. We are deeply thankful to all those who reviewed
the compendium and shared inputs for improvisation.
The document was designed and conceptualised under the guidance of Dr Vinod K Paul, Member, NITI
Aayog and Mr Amitabh Kant, CEO, NITI Aayog.
We appreciate the support from USAID-NISHTHA/Jhpiego team in editing and designing the document.
We are hopeful that this document will aid in showcasing the various home-based care interventions
during these testing times and help in cross learning between states.
Acknowledgements | xiHome-based Management of COVID-19: Best Practices Adopted by States
CONTENTS
Message, Vice Chairperson, NITI Aayogiii
Foreword, CEO, NITI Aayogv
Preface, Member, NITI Aayogvii
Acknowledgementsix
Table of Contentsxi
List of Abbreviationsxii
Executive Summaryxvi
1. Section A: State Practices (information shared by the states) 1
1.Arunachal Pradesh3
2. Assam6
3. Bihar9
4. Chandigarh11
5. Chhattisgarh13
6. Delhi16
7. Goa19
8.Jammu and Kashmir22
9.Haryana (Karnal)23
10.Madhya Pradesh28
11. Manipur32
12. Meghalaya36
13. Mizoram39
14. Nagaland42
15. Puducherry44
16. Punjab47
17. Rajasthan50
18. Sikkim53
19. Telangana56
20.Uttar Pradesh58
21.West Bengal61
2. Section B – State Practices (information collected through
secondary research)65
22.Andhra Pradesh67
23. Jharkhand69
24. Karnataka71
25. Kerala75
26. Maharashtra79
27. Odisha80
28.Tamil Nadu83
3. Annexures86
CONTENTS xii |SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
HbA1CGlycated Hemoglobin
ACAssistant Commissioner
ALSAdvance Life Support
AMOAdministrative Medical Officer
ANMAuxiliary Nurse Midwife
ASHAAccredited Social Health Activist
AWWAnganwadi Workers
AYUSHAyurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy.
BBMPBruhat Bengaluru Mahanagara Palika
BDOBlock Development Officer
BiPAPBilevel Positive Airway Pressure
BLOBooth Level Officer
BLSBasic Life Support
BMCBrihnamumbai Municipal Corporation
BPBlood Pressure
BPLBelow Poverty Line
CABCOVID-19 Appropriate Behavior
CBACCommunity Based Assessment Checklist
CBCComplete Blood Count
CBNAATCartridge-Based Nucleic Acid Amplification Test
CBOCommunity Based Organization
CCCCOVID-19 Care Centers
CCCCCommunity COVID-19 Care Centers
CCHCOVID-19 Care Homes
CCMTCommunity COVID-19 Management Team
CDMOChief District Medical Officer
CFLTCCOVID-19 First Line Treatment Centers
CHCCommunity Health Centre
CHICCommunity Home Isolation Centre
CHIKCOVID-19 Home Isolation Kits
CHOCommunity Health Officer
CMOChief Medical Officer
COVID19 Coronavirus Disease 2019
CPHCComprehensive Primary Healthcare
CPMSCOVID-19 Patient Management System
CPTOCOVID-19 Patient Tracking Officers
CRPC-Reactive Protein
LIST OF ABBREVIATIONS | xiiiHome-based Management of COVID-19: Best Practices Adopted by States
LIST OF ABBREVIATIONS
CSRCorporate Social Responsibility
CTComputed Tomography
DCHDiploma in Child Health
DCHCDedicated COVID-19 Health Centre
DDPODistrict Development & Panchayat Officer.
DFYDoctors for Your
DHDistrict Hospital
DNODistrict Nodal Officer
DSODistrict Surveillance Officer
EDDExpected Date of Delivery
EMRIEmergency Management and Research Institute
ENTEar Nose and Throat
FBSFasting Blood Sugar
GDMOGeneral Duties Medical Officer
GISGeographic Information System
GNCTDGovernment of National Capital Territory of Delhi
GOIGovernment of India
GPGram Panchayat
GPSGlobal Positioning System
GPUGram Panchayat Units
HBCMHome Based Care Management
HCAHHealth Care at Home
HCLHindustan Computers Limited
HDUHigh Dependency Unit
HFCHealth Facility Centers
HFSVHand Wash- Facemask- Social Distance- Vaccine
HIHome Isolation
HISPHealth Information Service Provider
HITAMHome Isolation Treatment and Monitoring Protocol
HIVHuman Immunodeficiency Virus Infection
HMSHealth Management System
HQHeadquarters
HRHeart Rate
HSCHealth Sub Centre
HULHindustan Unilever Limited
HWCHealth and Wellness Centre
ICCCIntegrated Command and Control Centre
ICMRIndian Council of Medical Research
ICMSIntegrated COVID-19 Management System
ICUIntensive Care Unit
IDSPIntegrated Disease Surveillance Project
IECInformation Education and Communication xiv |Home-based Management of COVID-19: Best Practices Adopted by States
LIST OF ABBREVIATIONS
ILIInfluenza-Like Illness
IMAIndian Medical Education
IVRSInteractive Voice Response System
JNIMSJawaharlal Nehru Institute of Medical Sciences
JPHNUnion Public Health Nurses
KCGMCHKalpana Chawla Government Medical College
LDHLactate Dehydrogenase
LLTFLocal Level COVID-19 Task Force
LSGLocal Self Government
MBBSBachelor of Medicine and A Bachelor of Surgery
MDDoctor of Medicine
MHIMManipur Home Isolation Management
MISManagement Information System
MLHPMid-Level Healthcare Provider
MOMedical Officer
MoHFWMinistry of Health and Family Welfare.
MPMadhya Pradesh
MPHWMulti-Purpose Health Worker
MPWMulti-Purpose Worker
MSFMédecins Sans Frontières
NCCNational Cadet Corps
NCDNon-Communicable Disease
NGONon-Governmental Organization
NHMNational Health Mission
NICNational Informatics Centre
NICUNeonatal Intensive Care Unit
NIMHANS National Institute of Mental Health and Neuro Sciences
NIPINational Iron Plus Initiative
NITINational Institution for Transforming India
NMONational Medicos Organization
NONodal Officer
NSAIDNonsteroidal Anti-Inflammatory Drugs
OPDOut Patient Department
ORSOral Rehydration Solutions
PCRPolymerase Chain Reaction
PHCPrimary Health Centre
PHSMPublic Health & Social Measures
PM-CARES Prime Minister’s Citizen Assistance and Relief in Emergency Situation
PPEPersonal Protective Equipment
PR,Pulse Rate
PRIPanchayati Raj Institutions
PTAPatient Transport Ambulance | xvHome-based Management of COVID-19: Best Practices Adopted by States
RATRapid Antigen Test
RDRPRNA Dependent RNA Polymerase
RGUHSRajiv Gandhi University of Health Sciences
RIMJSRajendra Institute of Medical Sciences
RRTRapid Response Team
RTPCRReverse Transcription Polymerase Chain Reaction
SARISevere Acute Respiratory Infections
SARSSevere Acute Respiratory Syndrome
SDMSub-Divisional Magistrate
SHCSub Health Centre
SHGSelf Help Group
SIRDState Institute of Rural Development
SNOState Nodal Officer
SOPStand Operating Procedure
SPO2Oxygen Saturation
SRFIDSpecimen Referral Form Identification
STNMSir Thutob Namgyal Memorial Hospital
STOTShort-Term Oxygen Therapy
TBTuberculosis
TORTerms of Reference
TVTelevision
UNICEFUnited Nations Children’s Fund
UPHCUrban Primary Health Centre
USAIDU.S. Agency For International Development
UTUnion Territory
VICVillage Isolation Centers
VLTFVillage Level COVID-19 Task Force
WHOWorld Health Organization
YMAYoung Mizo Association
ZNOZonal Nodal Officers
LIST OF ABBREVIATIONS xvi |SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Awareness and Communication
The most important factor in preventing the spread of COVID-19 is to empower people with the right
information at the right time. With an aim to inform and educate communities on COVID-19 management,
multiple awareness-raising strategies, methods and tools have been adopted by state governments and
Union Territory administrations including use of job aids, posters, banners, videos on various aspects such
as home isolation, proning, use of pulse oximeter etc. Health departments organized many campaigns
and activities through Accredited Social Health Activists, Community Health Workers and Self-Help
Groups who worked with community members to raise community awareness on home care protocols.
Frontline workers including community health workers/ Accredited Social Health Activists/ Anganwadi
Workers/ Volunteers were enlisted to conduct house-to-house visits, identify and monitor cases, and
provide home based care. To ensure that Accredited Social Health Activists worked efficiently in the field,
they were trained and re-trained from time to time on Standard Operating Procedures and Guidelines that
were issued by the Government of India, The Indian Council of Medical Research, Central Government
Health Scheme and States.
To strengthen community surveillance, governments implemented a Community Surveillance Plan with
the goal of identifying potential cases of Severe Acute Respiratory Infections/ Influenza-Like Illness /
fever or other health conditions (malaria, diarrhea, dengue fever, etc.) with the support of local Accredited
Social Health Activists. Community monitoring groups like ‘Village Nigrani Samiti’ encouraged community
participation in managing COVID-19 positive and Influenza-Like Illness cases at home (in states of
Rajasthan Uttar Pradesh). The home isolation guidelines outlined who was eligible to remain under home
isolation, how to self-monitor and isolate at home. The patient’s and caregiver’s contact information were
shared with the helpline numbers.
EXECUTIVE SUMMARY
Home-based care has emerged as an important pillar of pandemic management. Various home
care best practices included in this document provided holistic support to patients and their
families. Home-based care is a low-cost model and can reach many people at the same time with
the help of digital tools such as telemedicine/call centres/apps etc. However, there could be some
limitations if all services are not connected and integrated at all levels and if there are delays in
referrals, transportation, and admissions. There is a risk of the spread of infection to family members
if protocols are not followed properly. Clear standard operating procedures and triaging are therefore
extremely critical for efficient home care. Hospitalization should be accessible at well-functioning
referral facilities. The integrated command and facilitation centres should be flexible, adaptable, and
resilient for use in COVID-19, and adaptable non-COVID-19 related services in a quiescent pandemic
situation. Community engagement and management have contributed to the large-scale take-up of
home-based care. Local efforts are essential for better case management and for reducing fear and
stigma. Community preparedness can help in ensuring that no one is left behind. The practices on
home-based care described in this compendium may be adopted, adapted, and replicated by the
states/UTs for scale-up in respective contexts, building on their experiences. | xviiHome-based Management of COVID-19: Best Practices Adopted by States
SUMMARY
These protocols were endorsed with the help of village employees and block level offi cials. Young Mizo
Association, medical personnel in the local level and volunteers created WhatsApp groups to track patients
under home isolation via chats and phone calls. In Punjab, a house-to-house survey known as Ghar-
ghar nigrani was conducted. In addition, the Panchayati Raj department in Sikkim provided advocacy and
counselling services.
Many states adopted the test-track-treat concept and identified cases early on. However, at times, the
test-track–treat protocol proved difficult to follow especially during the second wave. To combat this,
track-treat was adopted to help people to be treated through a home-based care system.
Doctors and Health workers’ visits and support
The COVID-19 pandemic and associated containment measures posed several challenges to medical
treatment and consultations. During this public health crisis, patients under home isolation needed
appropriate care and psychosocial support. In many cases, frontline workers and doctors visited rural
areas to reach vulnerable communities which were diffi cult to reach, maintaining all protocols (Assam,
Sikkim, Bihar, Chhattisgarh, Madhya Pradesh etc.). Frontline workers made visits to check patient’s
oxygen saturation level and enquire about other signs and symptoms for early identifi cation of symptoms
and referral. Dedicated ambulances were stationed near homes, facilities, block, districts and COVID-19
testing centers for immediate shifting of COVID-19 patients to Care Centers for providing intermediary
care and hospital admission.
For instance, ‘Doctors on Wheels’ in Puducherry and ‘Sanjivani van’ with ‘Doctors on call’ in Gujarat were
some initiatives that provided last mile delivery of healthcare. In Chandigarh, Rapid Response Teams
visited homes for referrals services and provision of medical supplies.
Awareness generation amongst community in Chhattisgarh xviii | Home-based Management of COVID-19: Best Practices Adopted by States
Monitoring of patients under home isolation in Sikkim
SUMMARY
Medical kits and Supplies
Almost all states proactively provided medicine kits to home isolated patients through front line
workers, free of cost. These kits contained basic medicines (Paracetamol, Vitamins, Antibiotic),
Ayush products (Arunachal, Assam, Chhattisgarh, Chandigarh, Goa, Jharkhand, Mizoram). Medical
kits were provided to COVID-19 positive and Influenza-Like illness cases with an instruction
leaflet for the patient and their family. Add-on facilities like COVID-19 kits containing Personal
Protective Equipment and masks were provided in most states (Arunachal, Punjab, Assam, Goa,
J&K, Chandigarh, Bihar, Manipur, Mizoram, Delhi, Nagaland, Meghalaya, Rajasthan, Tamil Nadu)
and thermometers and pulse-oximeters were also provided on returnable basis in a few states like
Nagaland and Assam. Nine different kits according to age, comorbidity and symptomatic condition
were prepared and distributed, for example in Punjab, food kits were also provided to home isolated
patients.
During the second wave, there was an unprecedented increase in demand for medicines and oxygen
concentrators. Many districts set up oxygen concentrator banks for the distribution of oxygen
concentrators to home isolated patients. The oxygen concentrators were made available to patients
on a temporary loan basis against a nominal security deposit which was refunded upon return (Delhi,
U.P, Nagaland, etc.). The Ola Foundation provided free oxygen concentrators to patients in quarantine
in Chennai and Tamil Nadu. | xixHome-based Management of COVID-19: Best Practices Adopted by States
SUMMARY
Community Health Offi cer of Seikhazou
HWC conducting teleconsultation in Nagaland
Medicine kits at HWC in Durg, Chhattisgarh
Telemedicine and Helplines
During the surge in COVID-19, telemedicine emerged as an innovative and safe interactive system for
patients and health workers. Many states and districts implemented call centers and telemedicine facilities
to manage COVID-19 patients under home isolation and recorded their vitals in a database. Facilities such
as assessing patients on call, daily monitoring by health workers, Doctor-on-call, COVID-19 Helpline, health
and psychosocial counselling and nutritionist-on-call etc. were offered. Some of the helplines also assisted
in facilitating visits of doctor/ nurses when required. States connected patients to doctors through dedicated
telemedicine platforms, Interactive Voice Response System and helpline numbers. xx |Home-based Management of COVID-19: Best Practices Adopted by States
A few state governments also deployed interns from medical colleges to aid in on-call medical consultation
in case of escalations (West Bengal, Punjab and Haryana). In Jharkhand, through the Swaraksha Portal,
patients got video consultations of 4 kinds: Allopathic, Ayurvedic, Homeopathic, and Unani. Various apps
were successfully implemented in many states such as CallDoc (Delhi), Swasthya Nidhi App (J&K), mDoc
(Jharkhand), ChatBot (Punjab), NISHTHA Tele-Track (Arunachal Pradesh, Nagaland, Mizoram), NISHTHA
COVID-19 Sanchar (Madhya Pradesh and Sikkim) and HIT App (Bihar).
A national level telemedicine platform called eSanjeevani was launched in April 2020 and was adopted
by all 36 States/ Union Territories. It has provided 1 crore consultations as on August 24, 2021. 60,000
doctors and paramedics have been trained and over 430 online eOPDs have been made operational.
The leading 10 States are Andhra Pradesh (2,751,271), Karnataka (19,39,444), Tamil Nadu (14,76,227),
Uttar Pradesh (12,32,627), Gujarat (4,16,221), Madhya Pradesh (3,69,175), Bihar (3,43,811), Maharashtra
(3,31,737), Kerala (2,37,973), Uttarakhand (2,26,436).
Home isolated patients were followed up through the 104-helpline number to take updates on their
physical condition. Psychological support was given to patient as well as family members, as and when
required. In Assam, all calls for home isolated patients were managed through the hub at the COVID-19
command room at the state HQ and were managed by Team SAMPARK doctors under the eSanjeevani
telemedicine platform.
Several states received support from non-governmental organizations and NIMHANS to expand
psychological counselling services to patients in home isolation by providing trained social workers and
mental health professionals (West Bengal, Arunachal, Puducherry, Odisha, Madhya Pradesh).
Community Participation
Community-based management and community engagement have been the key factors that have
contributed to the large-scale uptake of home based care. Local efforts are necessary and essential for
better case management and to ensure a reduction in mortality rates. The community-based management
of COVID-19 not only helped in reducing fear and stigma, but improved community preparedness for
future re-emergence of infectious diseases and to ensure that no one is left behind.
Governments of many states (J&K, Kerala, Punjab, M.P, Odisha, Rajasthan) established COVID-19 care
committees at all gram panchayats to monitor the overall operation of COVID-19 care homes (CCHs)/
Centers (CCCs). These gram panchayats were entrusted with the responsibility of isolating suspected
cases. Sarpanch, the elected representative of Gram Panchayats was empowered to take decisions that
worked best in their respective areas. Activities such as provision of medicine kits, food materials to home
isolated patients etc. and transport to CCHs when needed were managed under his/her supervision.
Integrated control and facilitation centers
As part of the efforts to curb the spread of COVID-19, integrated control and facilitation centers were set
up to provide all types of COVID-19 related data. Almost all states, including Assam, Delhi, Haryana, Kerala,
Punjab, Madhya Pradesh, Manipur, Meghalaya, Rajasthan, Sikkim and Uttar Pradesh set up a control
room, each with a team of doctors/ nurses/ volunteers and support staff. The team ensured that the
space provided to patients at home had all the basic requirements for home isolation, based on guidelines
issued by Ministry of Health and Family Welfare/ State Governments. These centers largely monitored
home isolated and COVID-19 care center patients through phone calls, based on which swift follow up
action was taken. These centers actively provided and arranged tele-consultations through eSanjeevani
or other such other telemedicine platforms. They monitored quarantine facilities, provided self-monitoring
app facilities to quarantined people and gave them support to track the health of suspected patients and
their contacts under home quarantine. In some states, apart from teleconsultations, these integrated
SUMMARY | xxiHome-based Management of COVID-19: Best Practices Adopted by States
centers also, provided real-time tracking of ambulances, disinfection services, and virtual training to
doctors and healthcare professionals etc.
These command centers acted as a bridge between the fi eld teams and district administrations and
coordinated the various apps and helplines. The control rooms worked in close coordination with the
ambulance management cell for timely provision of ambulance services. Bed availability was reflected on
a real time basis so that patients could be connected when required. These centers also managed calls
made to the 104 and 108 helpline numbers for ambulance, oxygen support and home quarantine facilities.
The technological features of the Integrated centers included an integrated technology platform,
Integrated Voice Response System, mobile based monitoring of vitals and symptoms, triaging by certifi ed
doctors for severity assessment, teleconsultations and emergency response. There were dedicated
tele-caller units with qualifi ed Medical/ AYUSH/ Nursing background trained professionals, a pool of
specialists with physicians, ENTs, mental counsellors, psychologists, nutrition counsellors and need-
based super specialists such as pulmonologists, cardiologists etc. Counselling for health and well-being
by trained counsellors was made available. Linkages with public health facilities were presented for drugs,
diagnostics, ambulance & hospitalization.
In Bengaluru, these integrated centers operated 24x7 and mapped each COVID-19 positive case using GIS,
and highlighted the containment plan using heat maps. The Tamil Nadu government launched a dedicated
Twitter handle – @104_GoTN, through the integrated center for people seeking beds for COVID-19 patients.
In Haryana, the integrated center proactively reached out to all the patients who tested positive for COVID-19
through various helplines/ chatbots/ apps. Patients could reach the district administration through the 1950
helpline number, specially created WhatsApp chatbot and the state government web portals.
In Bengaluru, these integrated centers operated 24x7 and mapped each COVID-19 positive case using GIS,
and highlighted the containment plan using heat maps. The Tamil Nadu government launched a dedicated
Twitter handle – @104_GoTN, through the integrated center for people seeking beds for COVID-19 patients.
Integrated Control and Command Center in Sikkim
SUMMARY xxii |Home-based Management of COVID-19: Best Practices Adopted by States
In Haryana, the integrated center proactively reached out to all the patients who tested positive for COVID-19
through various helplines/ chatbots/ apps. Patients could reach the district administration through the 1950
helpline number, specially created WhatsApp chatbot and the state government web portals.
Collaborations and Partnerships
During the pandemic, collaborations and partnerships were important as they strengthened government’s
efforts and provided a full range of services and expertise to patients. The multi-sectoral approach and
public-private partnerships, along with use of technology and robust monitoring systems was able to
provide holistic supervised home care to COVID-19 patients.
USAID-NISHTHA, implemented by Jhpiego partnered and supported 13 state governments, with
special focus on the North East region. StepOne, a volunteer network partnered and supported 16
state governments. Manipur involved Medicine Sans Frontier (MSF), state government of Haryana in
partnership with Deloitte in Karnal launched ‘Sanjeevani Pariyojana’. Norway India Partnership Initiative
(NIPI) in Jammu and Kashmir, Sri Aurbindo Society in Puducherry, and Prakriti E-mobility in Delhi, were
some of the prominent collaborations that supported states in rolling out home isolation models and
strategies.
WHO, UN agencies and USAID developed courses for various groups focusing on training on COVID-19
management, and psycho-social training, etc. More than 1,80,000 doctors, nurses, paramedics, AYUSH,
sanitary workers, police, frontline health workers, and volunteers were trained with the help of these
agencies.
SUMMARY | xxiiiHome-based Management of COVID-19: Best Practices Adopted by States| xxiiiHome-based Management of COVID-19: Best Practices Adopted by States
1
2
3
4
5
6
7
Doctor and
Health
worker visits
Medical kits
and supplies
Telemedicine
and Helplines
Community
Participation
Integrated
control and
facilitation
centres
Collaboration
and
Partnerships
Elements
of Home Care
Models
Awareness
and
Communication xxiv |
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States | 1
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
SECTION A
STATE PRACTICES
(Information shared by the states) 2 |
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States | 3
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
During the second wave, more than 80 percent of mild COVID-19 cases (either asymptomatic
or had mild symptoms) were treated at home. Given the rapid increase in the magnitude
of cases along with the shortage of facilities to manage the high caseload, mild and
asymptomatic patients were actively monitored at home. In view of the overwhelming
burden on the health systems and health care providers, Arunachal Pradesh partnered
with USAID’s flagship health system strengthening project NISHTHA, implemented by Jhpiego, to initiate
a comprehensive technology-based model for home isolation known as ‘NISHTHA Teletrack’ This model
was implemented in Itanagar Capital Complex and Papumpare Districts, which reported high caseloads.
The state followed a Tele-caller home-based isolation monitoring model wherein a team under the District
Surveillance Unit monitored, followed and responded to patients under home isolation.
The objective of this model was to regularly monitor patients under home isolation and identify early
symptoms to enable and provide the right care at the right time. The platform acted as an enabler for
effective monitoring and tracking of COVID-19 patients and also had functionalities for recording vitals of
home isolated cases on a daily basis, provide regular & need based SOS telemedicine consultations with
through a pool of physicians, digital reporting and with a generation of system alerts in case a patient
developed symptoms and required referral. This ensured that immediate action was taken in case of
worsening of patient’s symptoms Further, through this platform accurate and timely information was
disseminated and also addressed queries raised by the patients under home isolation.
Inclusion and Eligibility Criteria
Patients who tested positive for COVID-19 through any confi rmatory test (RT-PCR/
RAT/ TRUNAAT) based on the assessment by healthcare providers in Triage Centers/
Flu Clinics/ Checkpoints/ Gate of entry and were psychologically fi t, were advised home
isolation. In case of mild cases of COVID-19 with controlled comorbidities, availability of
a caregiver at home was a pre-requisite
Intervention Details
As a fi rst step, a series of awareness campaigns were conducted with all local leaders
and community leaders through video conferencing to spread awareness on home
isolation. Communication material, including posters and handouts on home isolation
and NISHTHA tele-track application were developed, displayed and distributed to patients
under home isolation. Given that this was a tech-enabled model, community workers like
the Accredited Social Health Activists (ASHAs) were leveraged for mobilizing the community for testing,
following up with NISHTHA tele-track patients under home isolation, reporting on Influenza-Like Illness
(ILI) cases and responding or directing calls from the community to the tele-track platform.
ARUNACHAL PRADESH 4 |
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Comprehensive Tech Enabled Home Based Care Model
States/ districts (EKH & WGH) share
information with NISHTHA on a daily basis
Onboarding activities on Day 1
»Inbound call by Tele-Track team for onboarding (remotely)
»Assisted registration of patient on the Mobile App
»Informed about daily vitals tracking and tele-helpline
»Linkages with 144100for teleconsultation and emergency care
»Counsellingon basic home isolation guideline
Features of NISHTHA Tele-Track Platform
Suspected PatientRT-PCR / Rapid
Antigen Test
Patient Tested
Positive
Asymptomatic /
Mild Symptomatic
Patients
Referred for Home
Isolation
Daily self / Assisted
reporting of vitals and
symptoms in the App
Doctor Tele
Consultation On
Day 1 and 5
Nutritionist Tele
Consult Day 2
Mental Health Tele
Consult On Day 10
Telecaller On Day 1
and SOS
Doctor/ Specialist
Tele Consult SoS
Alert mechanism
for state/ district
for critical patients
Reporting to
state/ district on a
regular basis
Access to live dashboard for
state/ districts for real time
monitoring of the patients
12
3
4
5
6
7
8
9
Day 1 – Patient Registration
on Tele-Track | 5
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
A district-wise protocol was devised and detailed information of individuals under home isolation was
shared regularly with NISHTHA, Jhpiego. Following this, the NISHTHA team reached out to the patient
and provided the scheduled services for ten days. Given below is a snapshot of the day-wise activities:
Day 0 - State to share daily data of both districts with NISHTHA
Day 1- Onboard COVID-19 cases through tele-caller from NISHTHA Tele-Track
Facilitate tele-consultation with Medical Offi cers (MOs) and counselling on basic home isolation guidelines
Day 2 to Day 10 – Self-tracking of vitals and symptoms by patients. Fixed tele-consultations organized as
below:
Day 2 - Nutritionist Tele Consult
Day 5 - Tele-consultation with Medical Offi cer
Day 10 - Tele-consultation with Mental Health Counsellor
Daily reports were shared with the district on a defi ned set of indicators, which includes the list of patients
who could not be reached for three consecutive days. This enabled timely response by the District Rapid
Response Teams (RRTs) to locate and contact them. In addition, alerts were raised on a WhatsApp group
and Emails for all state and district offi cials and RRT team leads. As soon as the alert was raised, the RRTs
of a respective ward/ block would respond and activate the team for physical assessment of the alerted
patient. Based on the assessment the patient would either be referred to a higher facility or advised to
continue home isolation. This was followed by distribution of home care kits containing a mask, oximeter,
thermometer, basic medicines and AYUSH products. BLS Ambulances were kept on standby for any cases
requiring referrals to higher facilities in case of emergencies.
Patients’ counselling in process by Community Health Offi cers on use of tech-based platform, NISHTHA Tele-Track, for
monitoring patients under home isolation in Arunachal Pradesh. 6 |
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
The COVID-19 pandemic has been a humungous healthcare challenge across the world
including India. The state of Assam took this challenge head-on and has been managing
the pandemic effectively through robust planning and quality implementation with a
focus on multi-pronged strategies of 3Ts (TEST, TRACE, TREAT), encouraging COVID-19
Appropriate Behaviors (CAB) and COVID-19 vaccination. The state ensured maximum
emphasis on promotion of healthy practices to strengthen preventive strategies against COVID-19. Assam
adopted a multi-pronged strategy including awareness generation, tele-consultation services, provision of
home isolation medical kits and Interactive Voice Response System (IVRS) based platforms for follow up
and monitoring of patients.
The state aimed to strengthen management of COVID-19 at home, community and facility level awareness
generation on Public Health and Social Measures (PHSM) for following CAB. The state ramped up
testing to isolate positive cases to curb the spread of COVID-19. Contact tracing of COVID-19 patients
using a snowball approach for early isolation and management of cases were done. The government
provided treatment based on the triaging of COVID-19 positive cases at appropriate COVID-19 health
facilities. Efforts were also made to increase uptake of COVID-19 vaccination by addressing myths and
misconceptions on vaccines.
Inclusion and Eligibility Criteria
Persons who tested positive for COVID-19 either by Rapid Antigen Test (RAT) or RT-PCR
test. In case the person tested negative for RAT, an RT-PCR test was done. For such
cases, isolation was advised till the results of the RT-PCR test were known. For persons
with comorbidities/ uncontrolled comorbidity/ vulnerable conditions, special care was
provided from the beginning and these groups were advised to remain at home. Persons
who were psychologically fi t and willing to be under home isolation were allowed to, provided they satisfi ed
the conditions based on the guidelines.
Intervention Details
Awareness generation and Community Engagement: The Assam Health Department
undertook a mega campaign under community awareness on Public Health & Social
Measures through Accredited Social Health Activists (ASHAs), who in turn had been
working with community members for generating awareness on home care protocols
with focus on CAB and voluntary testing of persons on a timely basis. ASHAs have played
a critical role in reaching the last mile by spreading awareness on health messages including on COVID-19.
To ensure that ASHAs were equipped with the right skills, the state government of Assam ensured that
ASHAs were trained on a timely basis. Further, the state had devised need-based protocols on COVID-19
management, including home isolation protocols, which were revised based on inputs from the fi eld and
changing needs of the pandemic.
ASSAM | 7SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Provision of Home-Based Medicine Kits: The state also ensured that medicines were provided free of
cost to all patients under home isolation. As part of this, frontline workers visited the homes of COVID-19
patients on a regular basis to check their oxygen saturation levels and other signs and symptoms to
ensure early and timely referral and treatment based on their symptoms. As part of these visits, the
frontline workers also distributed medical kits to patients. So far, more than 2.15 lakh COVID-19 positive
patients under home isolation were under constant monitoring and more than 1.75 lakh home isolation
patients were provided Medical Kits for COVID-19, since April, 2021.
Teleconsultation Services: To ensure availability of treatment and follow up while sitting at home, the
health department of Assam initiated eSanjeevani teleconsultation from December 17, 2020 as ‘SAMPARK’
teleconsultation services for populations with comorbidities. Under SAMPARK, healthcare providers
(specialists/ General Duty Medical Officers) were based at the hub and anyone in need of healthcare
services could connect to these providers through the eSanjeevani app, which is downloadable on any
android mobile phone. On contacting the hub, an e-prescription would be generated, which could be used
at Health and Wellness Centers (HWCs) or at pharmacies to avail medicines. This enabled people to
access healthcare from home except when a physical assessment was required. Assam was ranked 11th
in providing teleconsultation among all states in the country. The state is also in the process of increasing
the number of hubs to reach a wider population.
Interactive Voice Response System (IVRS) helplines and NISHTHA COVID-19 Sanchar: The state used the
104-call center to follow up with persons under home isolation wherein patients were checked on their
physical status, as well as psychological support was provided through the helpline. To further strengthen
the 104-call center initiative, the state partnered with USAID-NISHTHA/Jhpiego to launch an IVRS based
remote monitoring model called NISHTHA COVID-19 Sanchar in Kamrup Metro district. NISHTHA
COVID-19 Sanchar ensured regular monitoring and follow-up of patients under home isolation and ensures
early identification of symptomatic cases. This was a hybrid model deployed by using the IVR technology,
web-based google form, and tele-calling by trained human resources to ensure seamless follow-up of
home isolated patients, which aimed to increase recovery rates and thereby reduce overall morbidity and
mortality due to COVID-19.
Partnerships with private sector: Assam also partnered with private providers in addressing the
COVID-19 crisis for different aspects, including COVID-19 treatment, maintaining non COVID-19
healthcare services and COVID-19 vaccinations. The government collaborated with private providers
to reduce and standardize the rates of COVID-19 treatment across all facilities to ensure that everyone
had access to quality healthcare.
Medical Support and Monitoring
As part of the teleconsultation services, all calls for home isolated patients were managed
through the hub at the COVID-19 Command Room at the state headquarter, which was
managed by doctors under SAMPARK as part of eSanjeevani telemedicine services. The
performance of Team SAMPARK was monitored on a daily basis at the state headquarters
and necessary instructions were issued to the districts and the 104 call center staff.
The state also ensured that medicines were provided free of cost to all patients under home isolation. As
part of this, frontline workers visited the houses of COVID-19 patients on a regular basis to check their
oxygen saturation levels and other signs and symptoms to ensure early and timely referral and treatment
based on their symptoms. 8 |SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
The state prioritized testing and initiated
testing facilities at vaccination centers.
Further, people who went for vaccination
were also tested before getting vaccinated,
which helped in identifying many more cases
and deferring their vaccinations, as per
guidelines. The state also emphasized on
the need for surveillance at the community
level. The government rolled out the Assam
Community Surveillance Plan with an aim
to list out potential cases of Severe Acute
Respiratory Infections /Influenza-Like Illness/
fever or people with other health issues (malaria, diarrhea, dengue, MR, JE etc.) with help of the village
ASHAs.
Scalability and Replicability
Since the state adopted a multi-pronged approach, all the approaches can be replicated
and scaled based on the changing needs of the pandemic. The state also scaled up
some of the initiatives implemented in the first wave during the second wave. Assam had
implemented a scheme called ‘DHANWANTARI’, under which medicines were distributed
at home (free up to Rs. 200) for even Non COVID-19 patients. However, during the second
wave, with all medical shops open on a 24x7 basis, free COVID-19 medicines were provided only for
patients under home isolation, thereby adopting an ‘adaptive’ and need based approach based on the
changing needs of the pandemic for all home isolated COVID-19 patients only. So, the learning is that the
system needs to be more ‘adaptive’ with the situation around and necessary actions need to be taken.
COVID-19 screening in Assam | 9
SIKKIM
Home-based Management of COVID-19: Best Practices Adopted by States
BIHAR
Overview
Home isolation of COVID-19 patients, who are asymptomatic or have mild symptoms,
has been recognized as an important strategy as it reduces the burden on the healthcare
establishments and results in effi cient utilization of scarce resources for moderate and
severe COVID-19 patients. Home isolation with appropriate guidelines provide some
distinct benefi ts such as care in a familiar home environment, less stress on family,
reduced burden on healthcare services, lower risk of healthcare associated infections/ nosocomial infect
and reduced cost of care to the families.
Intervention Details
COVID-19 management in Bihar was handled by the Corona Control Team, which was
divided into fi ve sub-teams: containment, testing, isolation and medicine, training, and
coordination (by IDSP cell). COVID-19 positive patients were confi rmed using tests such
as RT-PCR, NAAT, and RAT. Personal details such as name, address, phone number were
noted for all COVID-19 positive patients and patients with mild symptoms were advised
to undergo home isolation. The Bihar government engaged StepOne for effective tracking and monitoring
of home isolated cases and the list of home isolated patients was shared with them on a regular basis.
Awareness generation was also done through Information Education Communication (IEC), campaigns,
Twitter and newspapers in the State. District-specifi c toll-free number for COVID-19 related information
was also widely circulated.
Medical Support and Monitoring
The agency used an IVR system with fi ve COVID-19 symptoms as IVRS options; if the
patient’s COVID-19 symptoms worsened, the IVRS server detected this fluctuation and
volunteers were notifi ed to conduct a tele-consultation session with the patient.
The agency shared lists of patients who may require hospitalization with the State control
room, which then notifi ed the respective district control rooms. If required the doctor from
respective PHC would visit the home isolated patient for a check-up. If the patients’ health deteriorated
further, an ambulance service was made available to them. On an average 100 to 200 such case referrals
were handled during the second wave.
Accredited Social Health Activists (ASHAs) provided medical aid through distribution of home isolation
kits to the COVID-19 patients as per the State protocol dated 21/4/2021. Medicine kits were also made
available for the home isolation patients. However, pulse oximeter or thermometer were not provided in
the kits.
The Home Isolation Tracking (HIT) application was launched in fi ve districts of Bihar initially and then
scaled up to all the districts. Auxiliary Nurse Midwives (ANMs) visited the patients’ homes and tracked 10 |SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
vitals such as temperature and oxygen saturation; the readings were entered into the HIT app on their
tablets, and the patients’ need for additional medical care/ hospitalization was reflected on the app.
Scalability and Replicability
Following successful implementation in pilot districts, all home-based care models used
in Bihar were scaled up. However, death cases were not adequately recorded in home-
isolated cases, resulting in skewed death case data for Bihar. If home-based care models
are to be used, a mechanism for accurate reporting of death cases must be devised. | 11SIKKIM
Home-based Management of COVID-19: Best Practices Adopted by States
CHANDIGARH
Overview
Home care system for COVID-19 mitigation in Chandigarh was successful due to strong
and coordinated activities among various departments of the Chandigarh Administration,
including Health, Municipal Corporation, Transport Department, Red Cross Society, and
others. The city was divided into five medical zones, each led by a Senior Medical Officer
for effective home care management of patients under home isolation.
Intervention Efforts
Five medical zones and Rapid Response Teams (RRTs), consisting of trained Doctors
and Paramedical staffs were constituted, who were responsible for screening and
transporting COVID-19 cases as per the need. The roster and phone numbers were shared
with the concerned persons who were seeking the services of the ambulances either for
examination or transporting suspected COVID-19 cases to the health facilities. RRTs were
made in charge of clinical assessment and further management of patients under home isolation, and all
dispensaries doctors and staff were involved in day-to-day monitoring, assessment and record keeping.
All COVID-19 positive cases were verified by the RRTs to ensure that they adhere to the criteria as per the
guidelines for home isolation. The SDM teams further ensured that home isolation was feasible for such
patients. Field teams also confirmed the availability of separate rooms with an attached washroom for
home isolation. In case of any limitations, field teams facilitated the transfer to the COVID-19 care centre.
Patients with comorbidities and the elderly who required intensive care were immediately transferred to
health facilities. Infants and younger children, as per MoHFW guidelines, were kept under supervision of
parents/ guardians.
Parents/ caregivers were advised to keep patients hydrated and provide them with a nutritious diet. Older
children and family members were encouraged to stay in touch via phone, video calls, etc. Wellness Kits
were provided to home isolated patients, which included information on the dos and don’ts, as well as
contact information for the Help Desk and relevant officials.
The Chandigarh Administration had also standardized rates for availing oxygen cylinders and refilling the
Type B Cylinder. A press release and information on web portals were used to raise public awareness.
The administration, in collaboration with the Red Cross, established an oxygen concentrator bank for
the general public. Chandigarh has 32 ambulances (provided by Health Department UT Chandigarh, RED
CROSS and NGOs) which were used for home visits by RRT, referral, distribution of medicines.
In addition to telephonic consultations, the Telemedicine Solution of eSanjeevani OPD was made
operational, allowing patients to avail online consultations through this platform. In the second wave,
mobile testing teams visited the doorsteps of positive case contacts to conduct testing. As a result, the
contacts were tested and isolated right away rather than being transported in ambulances.
During the second wave, patients were regularly monitored by home visits by the RRT teams, daily
telephonic/ video calls were done by dispensary medical officers and if the SpO2 of patient fell below
94, patients would be shifted to hospitals. The tele-consultation and help desks were expanded and a 12 |SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
greater number of telephone lines for tele-consultation were added for monitoring of home isolated and
quarantined patients. The COVID-19 wellness kits were refined and augmented with provision of pulse
oximeters (to all symptomatic, elderly and co-morbid patients), thermometers, triple layer masks, hand
sanitizers, and Ayush medicines. Special card board boxes were developed for the distribution of above
medicines. These boxes were used to provide IEC in the form of list of vaccination centres, COVID-19
appropriate behaviour, RRT zones Helpline numbers, and home monitoring instruction sheets. The RRT
team ensured that those whose vitals were stable were allowed to isolate at home.
Scalability and Replicability
In Chandigarh, the COVID-19 mitigation model, through an effective Home Care system,
was successful. The model is scalable as home care beds are an extension of hospital
beds if there is a dedicated team of physicians, nurses, lab technicians, and ward servants
available for home isolation.
It is critical to understand the management of patients under home isolation as the
existing hospital infrastructure may fall short in the event of a future surge. | 13
SIKKIM
Home-based Management of COVID-19: Best Practices Adopted by States
CHHATTISGARH
Overview
The state of Chhattisgarh has been fi ghting the pandemic head on with multiple on-
ground innovations and approaches. Owing to the rapid increase in the number of cases
in the state of Chhattisgarh and in-line with the Government of India’s strategy, the option
of home isolation was provided to asymptomatic and mildly symptomatic patients. The
state adopted a patient feedback mechanism for persons under home isolation to ensure
quality of care and adherence to home isolation guidelines. This feedback mechanism
was rolled out with support from USAID-NISHTHA/ Jhpiego in co-ordination with other partners such
as Indus Action, Samarthan and Piramal Health. The patient feedback mechanism was designed to
strengthen quality of care for COVID-19 patients under home isolation, ensure accountability and quick
decision making to improve patient responsiveness.
During the second wave, when physical verifi cation and follow up was not possible, the state-initiated
contact tracing telephonically. This initiative was also launched in partnership with USAID-NISHTHA/
Jhpiego. Under this, patients were remotely monitored to enable early identifi cation of symptoms and
were evaluated for 10 days based on a standardized checklist. On the seventeenth day, a fi nal evaluation
was done. Following this, feedback was collected from the patients through manual calls and web-link
provided to the home isolated patients. The data was then analyzed and used to rank districts on quality
of management of COVID-19.
The state highlighted Durg as a model district which was ranked highest in the feedback mechanism.
Durg also set up 40 fever clinics to fi rst monitor Influenza-Like Illness (ILI) patients.
Inclusion and Eligibility
Criteria
Patients with Rapid Antigen Test (RAT)
positive results were examined for
symptoms and further investigation,
while patients with negative RAT test
results had to undergo RT-PCR testd.
Decisions on allocation of asymptomatic or mildly
symptomatic patients with co-morbidities were taken
by a medical consultant.
Intervention Details
Under Durg’s home care model,
medicine kits were provided for
patients and prophylaxis kit for
family members at the fever clinics.
Nine different kits according to age, 14 |
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
comorbidity and symptomatic condition were prepared and distributed. Durg district was divided into
seven zones. In order to ensure that all zones had adequate staff, the district appointed one AYUSH
medical officer for each zone along with 5-6 assistant consultants (AYUSH and Dental Interns) and
four to five nursing staff in each zone. A dedicated round the clock ambulance service was made
available for shifting patients in and out of the district. 15 ambulances (108) were dedicated for this
service and five more private vehicles were recruited during the second wave.
Under the patient feedback mechanism, the model was developed in a robust and scientifi c manner
focusing on domains of quality of care, as defi ned by the World Health Organization (WHO), such as
- Safe, Effective, Patient-centered, Timely, Effi cient and Equitable. Feedback was collected through a
standardized questionnaire covering thirteen parameters. This helped in setting accountability systems,
ensuring quality of care and adherence to home isolation guidelines. Given below is a snapshot of the
process:
Home isolated patient details shared with telecallers
USAID-NISHTHA team receives details of home isolated patients
from portal developed by state containing daily entries of district-wise
patients and shares with tele caller
Tellecaller contacts home isolated patients for feedback
Tele caller calls patients under home isolation on Day 3 to collect
feedback on quality of care based on a list of 13 questions
Patient feedback reports collected and analyzed
Feedback from 10 districts were collected by NISHTHA/Jhpiego while
other 18 districts were covered through other partner organizations.
The feedback information collected is shared with NISHTHA team who
then analyze fi ndings and create district-wise daily and weekly reports
and rankings to share with State government.
Dissemination of reports by state government
The State government disseminates reports to public to ensure
transparency and accountability and issues directives to districts for
improvement
District level action based on state directives
Based on the directives and reports, districts make the required
changes which help improve services. District-wise rankings also
create a healthy competition between them | 15SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Medical Support and Monitoring
Daily telephonic monitoring was done by Assistant Medical Officers (AMO), interns and
nursing staff on key vitals. The contact tracing team visited people’s homes and conducted
physical verification based on a checklist. The team also ensures distribution of medicine
kits to COVID-19 positive patients after telephonic evaluation by medical consultant and
AMOs. During the second wave, the state conducted telephonic contact tracing due to
the surge in the cases. A few districts also adopted the telemedicine platform to reach patients. The
Dantewada administration expanded Danteshwari telemedicine facility not only to hospitals but also to
patients under home isolation. Patients were able to register themselves for the facility at their homes
through the link provided or through the district website with their mobile phones. After the registration,
the health consultation was given free of cost by doctors on the video link received on the patient’s mobile
phone.
Sustainability and Replicability
The feedback mechanism for strengthening the quality of care for patients under home isolation intervention has been a model example in managing the pandemic effectively. It has clearly demonstrated the justified use of feedback mechanism from the beneficiary perspective to improve quality of care. While comparing baseline data of week 1 (10-16 April 2021) with the endline data of week 13 (05-11 July 2021), it is evident that the
quality of care and adherence to home isolation protocols improved. The table below depicts domain wise improvement in the quality of care of home isolated patients. A total of 1,26,308 home isolation cases were followed up till July, 2021. Between September 5, 2020 and July 17, 2021, the state reported a total of 70,653 patients under home care of which 18 deaths were reported.
Teleconsultation at HWCs in Surguja, Chhattisgarh 16 |
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
The COVID-19 pandemic brought many challenges to the National Capital and the
government made multiple efforts to combat the pandemic. In the fi rst wave itself, Delhi
witnessed tie-ups with private entities to enable home care of patients in the state, by
providers such as Portea, StepOne, Prakriti E-mobility, CallDoc Application and Health
Care at Home (HCAH). Home isolation was a big part of the capitals fi ght against the
pandemic. The government also launched a dedicated website i.e.https://delhifi ghtscorona.in which
contained all COVID-19 related information collated in one place.
The emergency handling system for home isolation cases operated stage by stage in Delhi. It involved
control room doctors, nurses in dispensaries, primary health nursing offi cers in subdivisions, doctors
engaged by the government for home isolation and bureaucrats monitoring the system.
Inclusion and Eligibility Criteria
The patients who were clinically assigned as mildly symptomatic/ asymptomatic by
the treating Medical Offi cer (MO) were advised for home care. Such cases needed to
have the requisite facility at their residence for self-isolation and for quarantining family
members. A caregiver and communication link between the caregiver and hospital was a
prerequisite for the entire duration of home isolation. Elderly patients over the age of 60
and those with comorbidities such as Hypertension, Diabetes, Heart disease, Chronic lung/ liver/ kidney
disease, Cerebro-vascular disease etc. were allowed home isolation after proper evaluation by the treating
MO. Patients suffering with immunocompromised status (HIV, Transplant recipients, Cancer therapy etc.)
were not recommended for home isolation. The caregiver and all close contacts of such cases were
advised to take Hydroxychloroquine prophylaxis as per protocol and as prescribed by the treating MO.
Intervention Details
The Delhi model to fi ght the COVID-19 pandemic included digital and community level
interventions. A dedicated website (delhifi ghtscorona.in) was created and it provided
access to detailed lists of testing centers, beds, teleconsultation leads with contact
details of individual doctors, ambulance services etc. to citizens.
All patients were in regular communication with a treating physician and needed to inform in case of
any deterioration. Patients were expected to continue the medications for other co-morbid illness after
consulting the treating physician. In case of falling oxygen saturation or shortness of breath, patients would
be hospitalized or were advised to get immediate consultation of their treating physician/ surveillance
team. Patient’s care givers kept monitoring their health. Immediate medical attention was provided in
case of serious signs or symptoms such as diffi culty in breathing, dip in oxygen saturation (SpO2 < 94
percent on room air), persistent pain pressure in the chest and mental confusion.
DELHI | 17SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Centralized Accident and Trauma Services (CATS) an Autonomous body of Government of National
Capital Territory of Delhi, provided 24x7 free ambulance services through a single toll-free number i.e. 102.
Maximum rates for private PTA (Patient Transport Ambulance), Basic Life Support (BLS) and Advanced
Life Support (ALS) were set by the government and strict actions were taken against violators.
Distribution of home care kits containing masks, oximeters, thermometers, Ayush products and basic
medicines like paracetamol, Vitamin C and Zinc were done by the district teams.,
In the first wave, oxygen provision at home was not recommended for patients under home isolation.
However, during the second wave, Oxygen concentrator banks were created, with 200 oxygen concentrators
set up in each bank in every revenue district of Delhi. In case patients under home isolation required
oxygen, the Delhi government’s team ensured the oxygen concentrators would reach their homes within
two hours. A technician also accompanied the team who explained to the family members how to use
the oxygen concentrator. Patients who were not enrolled under home isolation could call 1031 and avail
the facility. Domiciliary oxygen support was provided to all patients categorized as moderate to severe
who recovered, were discharged from the COVID-19 designated facilities and were prescribed domiciliary
oxygen support/short-term oxygen therapy (STOT) at home. For this purpose, a portal, on delhi.gov.in was
launched in May 2021, through which patients requiring oxygen could apply with a valid photo ID, Aadhar
card details, COVID-19 positive report and other documents like CT scan/ report, if available.
The government partnered with Prakriti E-mobility in April 2021 to provide transportation of COVID-19
positive patients to nearby healthcare facility via a sanitized vehicle through the Jeevan Seva App.
Many hotels were attached to private hospitals, which admitted COVID-19 positive patients as per the
patient’s medical condition and in case the patient’s condition deteriorated during their stay in the hotel,
they would be immediately transferred/ admitted to the attached private hospital at reduced rates set by
the government.
Similarly, Honeywell established a COVID-19 critical center in the state that was equipped with beds,
oxygen, personal protective equipment kits, and basic medical infrastructure. It also funded the donation
of oxygen concentrators and N95 respirators to the facility.
Awareness campaign on home care protocols were done by districts through Munadi, Nukkad natak,
distribution of pamphlets and through electronic media. Incentives were provided on per case basis to
Accredited Social Health Activists (ASHAs) workers and Auxiliary Nurse Midwives (ANMs). The two-
member teams were given incentives at the rate of Rs. 200 per patient visited i.e. Rs.100 per team member.
Further, an additional Rs. 200 for two-member team was given for refreshments.
Medical Support and Monitoring
For teleconsultation purposes, list of doctors apart from private agencies were made
available. Health officials posted in government dispensaries were part of the lowest rung
of a multi-layered monitoring system that monitored home isolated patients. Emergency
contact numbers were shared with each patient in home isolation. They had to either call
up their nearest dispensary from where they received health check calls or call up the
district control room. Dispensaries operated from 9am to 5pm. Beyond these hours, the control room was
the only contact point in case of an emergency.
Round the clock teleconsultation was made available through doctors of Government of N.C.T of Delhi
via the 1031 COVID-19 help line number. Medical support was provided to COVID-19 patients under home 18 |SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
isolation through District Surveillance Officer, Medical Officer in-charge of facility, ANM, ASHA. Patients
were contacted at least once a day. A widespread network of government testing centers providing free
testing was established in the State. The surveillance and contact tracing of family members was done
by districts under supervision of DSO and was reported to state Integrated Disease Surveillance Project
(IDSP).
Home Isolation Services were provided by Portea in partnership with Delhi government: Started in June
2020 by Government of Delhi, patients were monitored remotely through a comprehensive tracking
system involving government doctors and experts from Portea for the entire mandated isolation period of
17 days. Portea also submitted regular reports on their condition flagging off any health complications. If
required, the company arranged for a teleconsultation with Delhi Government doctors using its technology
platform. For cases where hospitalization was needed, Portea notified the appropriate government agency
for action on the ground. This arrangement was discontinued within a month due to unsustainable cost
to the Government.
Monitoring: Health Care at Home (HCAH) and StepOne: This organization was engaged by Delhi
government to provide remote monitoring services and was instrumental in reducing the burden on
hospitals that were overcrowded. StepOne was another partnership which provided tele-consultation and
counselling services to the patients.
StepOne is an empaneled partner for telemedicine consultations on Aarogya Setu Mitr, an ancillary service
on the Aarogya Setu app that enables free teleconsultation for those with COVID19-like symptoms. A
plasma bank initiative was also piloted in Delhi in partnership with StepOne. The government partnered
with them for 24x7 free online medical consultation services through the CallDoc app for non-emergency
medical needs. This was an alternative to in-person OPD. They had 100 doctors on board for this purpose.
Sustainability and Replicability
As per its home isolation policy during the first wave, the Delhi government monitored the
condition of patients through teleconsultation facilities and also distributed oximeters
to help them keep a tab on their oxygen levels. The timely testing, isolation and early
institution of treatment of COVID-19 positive cases were followed. COVID-19 appropriate
behaviors were ensured among the population, which played a vital role in prevention of
the next wave. An Integrated Command and Control Centre (ICCC) to manage COVID-19 on a real-time
basis in the city was established which integrated all the above services. | 19
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
In Goa, health services were delivered at community level and to home isolated patients by
community health workers including Multi-Purpose Health Workers (MPHW), Anganwadi
Workers (AWWs), traditional medicine practitioners (AYUSH), social care workers (NGOs
– Rotary club, Lion’s Club, Jaycees), and a variety of formal and informal community-
based providers (Churches, Temples, prominent citizens, trusts, CSR).
StepOne helped in telemonitoring of patients under home care during the second wave. (StepOne, is a
non-profi t volunteer driven collective of 7,000 doctors. The organization launched a National COVID-19
Telemedicine Helpline, offering 24x7 access to healthcare experts, free of cost).
Inclusion and Eligibility Criteria
Home care was only considered for adults with confi rmed or suspected COVID-19
symptoms. Psychologically fi t patients with mild or asymptomatic cases were advised
for home isolation. Also, the presence of a willing caretaker and appropriate home
environment were prerequisites. Patients were excluded from home care if abnormal self-
monitoring parameters were observed, including SpO
2
< 95 percent, Pulse rate > 100/ min
and temperature > 100F. Patients with uncontrolled or severe comorbidities, pregnant women, patients
without caretakers and children with moderate COVID-19 symptoms were restricted from home care.
Intervention Details
The state government rolled out innovative and engaging communication messages to
educate communities on COVID-19 management. For awareness generation, information
education communication van with pictographs, billboards and pamphlets were sent
across the state. Village wise posters and banners were installed at public places which
explained the concepts of hand-wash, social distance, importance of facemask and
vaccination. Door to door surveys and campaigns by MPHWs, AWWs, local governing bodies (Panchayat
members) were initiated to explain home isolation protocols.
Home based testing was provided for disabled and elderly. Telemedicine facilities were started at hubs
staffed by Medical Offi cers (MOs) and counsellors. Transfer protocol was prepared to transfer patients to
COVID-19 Care Centers (CCC) through a designated ambulance in case of moderate or severe symptoms.
Medicine kits were distributed at home by MPHWs. These kits included instructions on use of medicines
by the health department of Goa. Medicines were provided free of cost to patients at the Primary Health
Care (PHC) level. In addition, pulse oximeters and thermometers were provided with batteries. Personal
Protective Equipment (PPE) for 10 days home isolation (N95 face mask, 3 ply face mask, gloves, sanitary
wipes, sanitizers) were made available for all home isolated patients.
GOA 20 |SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Oxygen saturation through self-monitoring was supervised by MOs through telemedicine. The portal was
also used to triage and transfer patients to CCCs. Dedicated ambulance with Basic Life Support (BLS) was
arranged for home pickup and drop to CCC. MOs-initiated referral and supervised transfer for all patients
who developed severe and moderate symptoms. Many private providers helped in this initiative. Private
companies like Syngenta Indian Limited, Deccan Chemicals provided vehicles for patients transfer. Jindal
Steel Works provided a BLS equipped ambulance for COVID-19 patients under their Corporate Social
Responsibility (CSR) initiative. Rotary Club provided two RT-PCR testing machines worth Rs. 80 lakhs at
North Goa District Hospital facilitating decentralized processing of test results.
Medical Support and Monitoring
A district wise call center was set up. PHC MOs supervised home isolated patients through
telephone and maintained their records (Pulse, temperature, oxygen saturation) on a daily
basis. Every patient was contacted daily until their home isolation period was completed.
Auxiliary Nursing Midwives (ANMs) were tasked with Sub Centre based vaccination and
supervising home-based isolation by phone. Home isolation monitoring services were
offered through StepOne. Day 1-10 schedule was maintained to monitor patients. Automated Int calls
from Day 2 till Day 9 were done to monitor patients’ symptoms. Patients were called on Day 10 to check
their discharge from home isolation. Automated Interactive Voice Response (IVR) calls were done from
Day 11 to Day 17 for case of symptomatic patients.
The Government of Goa partnered with StepOne to create a Goa Online Portal with a Home isolation
monitoring channel, which helped track and monitor home isolated persons and proved to be a better
model than the one where calls were made by persons.
Medical kit | 21
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
During the fi rst wave, transmission was mostly reported through tourists coming into the state followed
by the local transmission. However, in the second wave there was a sudden increase in local transmission
with an increase in asymptomatic cases being reported. As hospitals were burdened with the surge in
cases, COVID-19 Care Centers (CCCs) were made functional with oxygen transport and storage facilities.
Decentralized oxygen therapy was commenced at the CCC. Further, efforts were made to provide care to
home isolated patients and large-scale vaccination drives were conducted in old age homes.
Scalability and Replicability
Going forward, the state aims to focus on testing patients through Mobile Vans in schools,
factories, housing localities as per localized outbreaks. Further steps have been taken
towards empowerment and integration of AYUSH doctors for preventive and primary care
for mild COVID-19 infections.
Step One System
Cloud
Day 1, Day 10
Telephonic screen-
ing of patients - to
check patient health
and symptoms
Queue of
patients to call
Calls
Updated
health
status
of Home
Isolated
patients
available
List of Covid Positive Patients
under Home Isolation
Doctors call out Covid Positive patients
and monitor symptoms, help identify
patients needing help
Doctor callout
Impact
Ensure Home Isolation patients get
medical and mental health care
Faster response to emergencies
Have full visibility on Home based patients
Ensure Home Isolated patients have full access to doctors via Telemedicine!
Home Isolation Monitoring
Doctor callout 22 |
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
The Government of Jammu and Kashmir (J&K) adopted an innovative approach to manage
and contain the pandemic. There were local district level triage centers to ensure proper
patient examination and referral, reducing unnecessary burden on tertiary and referral
hospitals. COVID-19 kits were given to patients and Interactive Voice Response System
(IVRS) was made available on round-the-clock helpline 104. The state partnered with Norway
India Partnership Initiative (NIPI) and Health Information Service Provider (HISP) India to create a COVID-19
dashboard for the state. 20,000 COVID-19 Care Center (CCC) beds were activated across the state close
to rural areas in all the 20 districts with 1,000 beds each. Patients requiring isolation were identifi ed by the
Panchayats/ concerned Medical Staff and Accredited Social Health Activist (ASHA) workers.
Intervention Details
Over 20,000 CCC beds were made available across J&K for COVID-19 positive patients
with no or moderate symptoms who did not have the necessary facilities in their homes
for home isolation. Districts established local district level triage centers to ensure proper
examination of patients and correct referral, reducing unnecessary burden on tertiary
and referral hospitals. Further, COVID-19 kits containing an oximeter, basic medicines,
vitamins, cough syrup, and pamphlets of dos and don’ts were distributed to COVID-19 positive patients in
home isolation.
State government’s outreach measures included consultation services over the IVRS and a round-the-
clock helpline number 104. At a glance, COVID-19 dashboard provided real time information about
confi rmed, active, recovered cases, deaths, positivity rate, recovery rate, fatality rate, test per million at
a single glance, geotagging and clustering of cases, health system preparedness, ICU availability and
isolation beds available to facilitate and generate appropriate and timely response, etc.
In addition to this, Swasthya Nidhi App provided real-time information on the various surveillance activities
conducted by the state.
Monitoring and Medical Support
Over 300 Anganwadi Workers (AWWs) were tasked to carry out door-to-door visits to
check on the health status of patients on a daily basis. In addition to this, ASHA volunteers
visited patients’ homes daily as part of surveillance measures.
Further, the government established a fi ve-bedded CCC in every panchayat, with one
oxygen supported bed (equipped with an oxygen concentrator) and other basic facilities in
collaboration with the local Panchayat Raj Institutions (PRIs), Departments of Health & Medical Education,
Social Welfare and Education. These centers were equipped with necessary medical kits and mapped to
nearby health facilities with provision of medical consultation, testing, ambulance services and isolation
of positive patients.
JAMMU AND KASHMIR | 23
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
The Government of Haryana, with support from Deloitte, launched ‘Sanjeevani Pariyojana’
(or ‘the life project’), a supervised, virtual home care initiative to provide individuals with
support and resources to manage their care at home, including access to virtual triage, as
well as links to COVID-19 hospitals and inpatient facilities when deemed appropriate by
state-trained medical staff.
The program addressed immediate and intermediate needs while establishing a foundation for long-
term needs in order to reduce the burden on India’s healthcare infrastructure. The main aim was to
augment home care support to enable recovery and treatment while in home isolation. It began with
identifying cases at early stages and ensure early recovery. The model was executed through seven key
interventions carried out in a Public Private Partnership (PPP) mode by the state government, Karnal
district administration, and Deloitte. In just 3.5 weeks, the Karnal district launched and implemented an
end-to-end support system.
This model also served as a guide for other State/District Administration in India for replicating in other
regions. The fi ve key interventions included the following:
Karnal district launched and executed end to end support system in merely 3.5 weeks
HARYANA (KARNAL)
01
STEP
02
STEP
03
STEP
04
STEP
05
STEP
5
Key Interventions
Command Center
Virtual Healthj
Tiered Medical Infrastructure
Outreach, Education and Communicatoins
Scale and Replicate 24 |SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Inclusion and Eligibility Criteria
When a patient was tested positive, a doctor would performed medical triage in accordance
with government guidelines, classifying the case as mild, moderate, or severe. Home
isolation was recommended for mild cases, and ASHA workers delivered home care
kits. In addition, these cases were monitored on a regular basis. Patients with moderate
symptoms were transferred to a field hospital/ isolation ward and were monitored on
a regular basis. In the most serious cases, patients were hospitalized, and community health centers
arranged ambulances and shifted them.
Intervention Details
ASHA workers used Information, Education and Communication (IEC) materials to
generate awareness on COVID-19 appropriate behaviors, helpline, home isolation
protocols and isolation facilities. They were also responsible to conduct early detection/
referrals of suspected cases, assessed health status inquiry of all individuals, monitored
adherence to home-isolation protocols, followed-up with individuals who were referred for
testing and sent updates on the status of the individuals. They also alerted Primary Health Care Medical
Officer (PHC-MO) MO/ helpline if a suspect individual had not gone for testing. Priority health status
check-ins were done for vulnerable populations, including those with a history of contact with positive/
suspected cases. ASHA workers engaged with MOs at PHCs to update their details on the Sanjeevani
app. This information was assessed and monitored by the ICCC at the District level for all home isolation
cases. | 25SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Field-Hospitals were set up and equipped with supplies such as oxygen beds, oxygen concentrators, 24x7
medical teams with dedicated doctors & staff nurses to accommodate a potential surge in COVID-19
patients. Field hospitals had dedicated ALS ambulances stationed round the clock with the idea that
any patient in need of critical care can be shifted to the nearest tertiary facility in the shortest span of
time. Isolation wards were created in 50 villages in the district, wherein patients who were positive and
asymptomatic and were not in need for hospitalization were given support in isolation away from their
families.
Home isolated patients were provided home care kits with basic medical aid equipment and medicines
to effectively monitor home isolation cases or to detect early symptoms. Nodal officers were deputed for
this purpose to ensure last reach through ASHA, ANMs, patwari, gram sachiv (secretary) to ensure every
patient received kits at their doorstep. A home care kit generally included: thermometers, pulse oximeters,
oxygen concentrator, steamer, triple layered masks, ORS packet, medicines (paracetamol, vitamins, etc.)
6,500 home care kits were prepared and distributed which contained 6,500 pulse oximeters, digital
thermometers along with other medical essentials. 200 Oxygen Concentrators were also supplied. In
addition to this, interns from the medical college in the State were roped in to provide medical consultations.
Distribution of medical kits to the community members
Medical Support and Monitoring
A team of 200 final and pre-final medical students (from KCGMCH) were selected to monitor patients in home care. Each member of the team was assigned 25 patients and was responsible for calling them every morning and evening to check their vitals. These readings were entered into a designed proforma tabulated in an excel sheet. If the parameters of any patient on any given day indicated that he or she might require
hospitalization and admission in a field hospital/ tertiary hospital, the issue was escalated to the consultant 26 |SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
(a senior doctor at KCGMCH), who then notified the district administration. Each student received an
honorarium of Rs.5000 per month, as well as extra marks in their internal assessment. In case the patient’s
condition deteriorated, the team coordinated with ICCC to shift the patient to appropriate facilities.
A COVID-19 hotline was set up for citizens. This hotline responded to citizen queries, directed them to
the right medical channel and proactively monitored health status of active / suspect COVID-19 positive
cases. Mobile testing was an important feature of this model. Testing was done on 5
th
/ 6
th
day of all home
isolation cases for Complete Blood Count (CBC), Blood Sugar, C-Reactive Protein (CRP) test (Quantitative)
and results were provided within 24 hours.
The ICCC which was set up as a Smart City initiative was activated for monitoring and management
of COVID-19 care. The ICCC was made responsible for capacity monitoring and management of
medical facilities. Data on healthcare capacity was collected at each hospital, and was entered by the
administrator into Sanjeevani portal. It tracked available capacity across district for beds, ICUs, ventilators
and availability of other infrastructure.
The center also played a major role in inventory management. It tracked inventory within the facility and
provided alerts when stocks dropped below a set minimum level. It showed data on the no. of Personal
Protective Equipment (PPE) kits or other items used in any isolation ward/ healthcare facility and
showcased total consumption and stock remaining for the district. It was also used to capture details
regarding oxygen availability and usage.
The ICCC had a capacity dashboard to aggregate number and real time availability status of all beds
across categories, like normal beds, individual rooms, ICUs, Ventilators, etc. Oxygen Dashboard showed
availability of oxygen, burn rate as well as the time left for the stock to empty. Patient dashboards showed
the numbers of patients in various kinds of admission within various facilities.
The ICCC also supported centralized decision support systems and capacity management by bringing
together patients, doctors, hospitals, labs, specialized treatment centers, hospital administrators, tele-
health professionals, etc., throughout the patients journey to enable a single view of the healthcare
system for the district administration (bed capacity, health care personnel, oxygen, ambulances,
current patient count, status, etc.). It enabled integrated tele-medicine, real-time bed-allocation,
patient shifting and war room dashboards driving efficiencies in field-operational processes at
district/ panchayat/ ward level.
The ICCC was also linked to ambulances, testing and mobile pharmacies. Advanced Life Support (ALS)
ambulances and mobile pharmacies were deployed. Since Basic Life Support (BLS) ambulances cannot
administer medicine, and critical COVID-19 emergencies required advanced care, 8 ALS ambulances were
stationed at Community Health Centers (CHCs) to ensure that any patient in need of care and attention
could be transported to the nearest tertiary care facility. The ambulance association was leveraged
to source ambulances for deployment in a very short time. The administration tied up with a private
agency, Hindustan Wellness Lab for home-based Lab Blood Tests of 3 types (CBC, CRP & Blood Sugar)
at subsidized rates (Rs. 460 per test) that helped district administration identify COVID-19 positive home
isolated patients who were in a need to shift from home to field hospitals/ tertiary hospital. Home
collection of test samples were done through Sanjeevani app.
Dedicated Village Isolation Centers (VICs) were established with the help of Development & Panchayat
Department, Haryana, near the villages Schools / Panchayat Bhavans / Chaupals etc. and had the facilities
of well-ventilated rooms, separate toilet facilities, adequate staff and logistics. DDPOs were designated
as Nodal Officer and also assigned the responsibility of providing logistics & maintaining VIC for patients. | 27SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Gramin Swasth Suraksha App – an application for online and real time screening of village population
through ASHA workers was developed.
Scalability and Replicability
To replicate the model and scale it up to larger geographical units, a playbook has been
created. The book proposes a three-tiered model that could leverage the existing state
administrative structure and allow for the establishment of an ICCC at the state level.
As Medical Colleges were not present in every district and each Medical College served
three to four districts on average, tele-consultation were envisioned at the Division level.
Similarly, Division Level ALS Ambulances were provided to connect CHCs/ District Hospitals to Medical
Colleges.
This model is planned to be replicated in other districts of Haryana and is further planned to be
implemented in few districts of Gujarat and Karnataka (in partnership with Deloitte). However, the model’s
long-term sustainability is yet to be determined; however, it can improve disease surveillance capabilities
by analyzing geo-tagged data to identify potential hotspots and vaccination priorities – and it can be
extended to other primary healthcare priorities (e.g., NCD). 28 |
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
The Government of India has endorsed Home Based Care (HBC) for asymptomatic
and mildly symptomatic COVID-19 patients. HBC if left unmonitored, poses the risk of
inappropriate care, and increased familial transmission. In view of this, Government of
Madhya Pradesh (GoMP), in cognizance with the guidelines from the Government of
India devised a ‘Monitored Care Strategy’ and public health measures for ‘Home care for
patients with COVID-19 presenting with mild symptoms and management of their contacts’.
The key objectives of HBC were to identify and support COVID-19 patients who could receive care at home.
Homes create an opportunity for emotional care and support needed for recuperation. Clinical monitoring
and treatment of COVID-19 patients at home and protocol for referrals of suspects/ symptomatic and
isolation of symptomatic cases leads to decongestion of health facilities and makes room for health
workers to focus on critically ill persons who require face to face examination and treatment.
An integrated tech-enabled HBC model through the ‘NISHTHA Tele-Track’ was launched in two districts,
Khandwa and Rajgarh as an enabler for effective monitoring and tracking of COVID-19 patients with
support from USAID-NISHTHA/ Jhpiego. The platform acts as an enabler for effective monitoring and
tracking of COVID-19 patients and has functionalities for recording vitals of home isolated cases on a
daily basis, provision of regular & need based SOS telemedicine consultations with a pool of physicians,
digital reporting and with generation of system alerts in case a patient develops symptoms and requires
referral.
Inclusion and Eligibility Criteria
Patients who tested positive for COVID-19 either through Rapid Antigen Test (RAT) or RT-
PCR and have mild symptoms or are asymptomatic are eligible for home isolation.
Intervention Details
The Kill Corona Initiative of the state was launched during the fi rst wave of COVID-19 and
was further revamped and re-launched during the second wave. The initiative had put
forth an elaborate plan that effi ciently aided in identifying, testing and treating COVID-19
suspects. The surveillance strategy for the Kill Corona Initiative included house to house
visits for population-based screening at rural and Nagar panchayat areas and setting up
COVID-19 Sahaytha Kendra at urban areas.
Community Health workers and Accredited Social Health Activist (ASHA) workers prepared a line list of
all people who travelled to other countries or other states of India in last 14 days and counselled them
MADHYA PRADESH | 29SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
on COVID-19 appropriate behaviors and home isolation protocols. This line list was then shared with the
Medical Officer (MO) at the Primary Health Center (PHC).
Once tested positive, patients were tracked through the NISHTHA Tele track for 10 days. The team comprised
of Medical Doctors, Nutritionists, Nurses, and counselors. During the 10 days, if there were symptomatic
patients with danger signs, the team immediately initiated referral linkages with the tertiary hospital for
early initiation of treatment. This helped in preventing delays in hospital admission which is considered as
one of the contributing factors for high mortality. Till date, a total of 86 cases have been registered, out
of which 17 cases successfully completed 10 days of home isolation without any complication and were
discharged from home isolation. No case has been referred to a higher facility and no mortality has been
reported till date.
Counselling of COVID-19 positive patients’ family members under home isolation by Community
Health Officer and ASHA workers
Medical Support and Monitoring
A medical team comprised of certified Doctors, Nurses, Nutritionists, and counsellors to do regular follow up on all the positive cases for a period of 10 days for patients who were enrolled in the NISHTHA Tele track platform. The certified doctors consulted with the patients on the first, third and seventh day. The nutritionist followed up on day 2 for nutrition counselling and on the fifth day mental health counselling was provided
by experienced clinical psychologists or counsellors. The nurses followed up for all 10 days to assist patients regularly. There was also a provision for live teleconsultation with a specialist doctor in case of any emergency.
The state also leveraged teleconsultation and helpline through Interactive Voice Response (IVR)
technology which helped in reaching out to patients round-the-clock, improving data quality, reducing
costs by automating communication processes. Primary healthcare workers, Anganwadi workers
(AWWs) and doctors, Auxiliary Nursing Midwives (ANMs) in Primary Health Centers (PHCs)/
Community Health Centers (CHCs)/ District hospitals were deployed to cover 50 households each
where they would keep track of the patient’s vitals on a daily basis. Further Medical Officers (MOs)/
doctors visited the households on first and last day of the home isolation period to determine them
as physically fit. 30 |SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
All the above interventions were connected and
monitored by an integrated command center. The list
of asymptomatic positive patients was provided to the
central command center and patients were monitored
twice a day to assess vital parameters and clinical
condition of patients on a pre-designed questionnaire. In
case the team identified moderate to severe symptoms,
the call would be forwarded to the on-board MOs/ MBBS
doctor to ascertain the condition and provide solution for
the same.
Mobile testing booth and teams were formed to
collect samples of the suspected cases with the
help of the list provided by the central command
center. This was done through the SOS calls received
which were verified by the MO where the details of
the address were forwarded to the ground team to
collect the sample. These results were forwarded to
the respective facilities to determine home isolation or
referral to higher facilities. State and district Rapid Respond Team (RRT) roles were to identify, isolate
and track the contacts of the positive cases with the help of information and lists provided and
submit the report/ data to the control room.
Distribution of medicines to patients by Community Health Officer
Health workers' visit to patients in home isolation. | 31SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Scalability and Replicability
The COVID-19 pandemic is here to stay and the sudden surge of cases in the second
wave highlighted that there is a need to be better prepared to curb the pandemic. With
the third wave approaching, the state has initiated a few models including large COVID-19
vaccination drives, sanitization of market areas, promoting self-hygiene practices,
establishing control room for monitoring and feedback of COVID-19 and other scalable
and replicable models. Other measures include setting of buffer stock of medicines, oxygen cylinders and
concentrators by creating a pandemic/ communicable disease fund, creating Information, Education and
Communication (IEC) materials, building hospitals or scaling up of capacity of hospitals in terms of ICU
beds and oxygen supported beds, earmarking and creation of separate blocks for communicable diseases,
creation of control room for monitoring and feedback of communicable diseases e.g. COVID-19 ,TB etc.
on regular basis for continuum of care and using of GPS facility of mobile for monitoring, surveillance and
contact tracing activities for current and future times. These measures are used for other programs and
can be replicated for COVID-19 as well.
The state has also launched an important initiative called ‘Swasthya Sampark’, a post COVID-19 care initiative
in collaboration with USAID’s flagship health system strengthening project NISHTHA, implemented by
Jhpiego. The platform acts as an enabler for effective monitoring and tracking of post COVID-19 patients
and has functionalities for recording vitals of patients on a daily basis, provision of regular & need based
SOS telemedicine consultations with a pool of physicians, digital reporting with generation of system alerts
in case a patient develops symptoms and requires referral. This post COVID-19 platform is a remote help
desk integrated with telemedicine (teleconsultation & tele counselling) to support individuals recovered
from COVID-19. The patients can connect through a toll-free service care number wherein a trained health
professional will attend to patients calls and address their concerns. Further, patients requiring advanced
care will be connected to a medical doctor through telemedicine, thereby providing timely and right home
care. The platform would also provide services like mental health counselling, dietary counselling through
tele counselling services as well as treatment for any medical ailment developed or worsened during post
COVID-19 period through teleconsultation services. 32 |
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
The state of Manipur adopted ‘Home Isolation’ (HI) for patients who were either
asymptomatic/ mildly symptomatic and willing, fi t or wish to stay under HI to reduce the
burden on the health system. Under this initiative, the state created a HI team at the state
and district levels. The team at the state level was led by the Joint Director whereas at
district level it was led by the Chief Medical Offi cer (CMO). Home isolation team activities
included enrolment, line-listing, drug distribution, tele monitoring, home visits and referral and discharge
of HI patients.
The state adopted a comprehensive home-based care system which included triaging of patients, regular
monitoring through teleconsultation or visits (if required), delivery of home isolation kits (medicines,
mask, pulse oximeter, sanitizer, etc.) and referral services. In case of a surge in COVID-19 cases in the
state, hospitals and services of healthcare professionals need to remain available for treatment of severe
symptomatic COVID-19 patients or other non-COVID-19 ailments, medical procedures, emergency cases,
etc. The adoption of HI will therefore go a long way in curbing the spread, through early containment and
reducing the overall burden on health facilities.
Inclusion and Eligibility Criteria
The CMO designated a medical team to examine and identify the COVID-19 positive
cases eligible for home isolation based on the following criteria: Minors (below 10 years
of age) or babies who were asymptomatic; pregnant women where the Expected Date of
Delivery is at least one month and were asymptomatic; patients with mild symptoms who
did not have any other co-morbid conditions and had the availability of being supervised
by trained health staff; asymptomatic elderly patients (60 years and above) and persons with any of
the following ailments: hypertension, diabetes, heart diseases, chronic lung/ liver/ kidney diseases and
patients who were immuno-compromised could be allowed to remain under HI after proper evaluation by
the medical team.
Intervention Details
Awareness campaigns on home care protocols: Information, Education and
Communication (IEC) materials (posters, leaflets and stickers) on COVID-19 Appropriate
Behaviors and COVID-19 were developed and distributed. The state also developed
videos on home isolation, pulse oximeter, use of masks, mental health etc. to educate
the community which were telecast on electronic media and social media. Videos on
proning and home isolation were developed by USAID-NISHTHA/ Jhpiego which were shared with all the
Community Health Offi cers (CHOs), who further disseminated it to persons under HI under their Health
and Wellness Centers (HWCs). In addition, awareness sessions were conducted by CHOs and Accredited
Social Health Activists (ASHAs) for persons under HI.
MANIPUR | 33SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Co-ordinated efforts at village level: There were coordinated efforts by Civil Society Organizations,
Panchayati Raj Institutions (PRIs), Local Club Volunteer, Teachers, Anganwadi Workers (AWWs), ASHAs,
National Cadet Corps, in manning isolation of mild/ asymptomatic cases at identified Community
COVID-19 Care Centers (CCC) and Community Home Isolation Centre (CHIC). These centers were run
by the concerned assembly constituency of the COVID-19 management team. The district isolation team
including CHOs visited the CHIC from time to time to ascertain the status of the patients.
Distribution of HI Kits: ASHAs supported in identification of houses suitable for HI, distribution of HI kits,
demonstration of pulse oximeter and contact tracing. As on August 3, 2021, 67,978 drug and HI kits were
distributed through ASHAs. Following discharge, pulse oximeters were collected by ASHAs and reused
after sanitization. ASHAs were also given special incentive for recollection of the pulse oximeters. In case
of difficult terrains, special mobile teams and volunteers were deployed.
Referral and helpline support: In case any HI patients required oxygen, they were referred on an immediate
basis to CCC or COVD Hospitals. For patients with moderate/ severe symptoms, the district nodal officer
was informed and these patients were referred using state ambulances deployed at all districts. Currently
the state has 41 Ambulances meant for COVID-19 (12 Advanced Life Support and 29 Basic Life Support).
Partnering with other organizations: The state partnered with Medicine Sans Fontier (MSF) NGO for
conducting home visits for physical examination of patients in Imphal west, Imphal East district and
Thoubal District which had high number of COVID-19 cases. The state was also supported by USAID-
NISHTHA/ Jhpiego for strengthening home based care at the HWC level.
Medical Support and Monitoring
Virtual telemedicine/ helplines/ call centers were set up wherein the State Home Isolation
Control room routinely followed up with HI patients to check their vitals and counsel them
on the home isolation guidelines. Follow up calls were made on the fifth day for early
identification of moderate severe signs and symptoms. Follow up calls were also made to
patients with co-morbidities to check their BP and blood sugar status. In case of patients
who developed moderate or severe symptoms, hourly follow up was done until they were admitted to
COVID-19 Care Centers/ Hospitals. Separate eSanjeevani OPD for HI patients and eSanjeevani helpline
number was also initiated. Two state HI helpline numbers were made operational on a 24x7 basis. In
HI KitsDemonstration by Asha WorkersDelivery by HWC staffs 34 |SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
case of high case load districts, viz Imphal East and Imphal West -10 landlines were made operational in
each control room for daily monitoring. Further, each patient was assigned a Medical Officer (MO) and a
monitoring Team (Nurse/ CHO).
The State Home Isolation Team led by State Nodal Officer HI and assisted by Deputy Director (Public
Health) and Specialist (Public Health) of different division conduct daily supervision of HI line listing, HI
kits and drug distribution.
The medical response team led by Deputy Director (PH) and Clinical Pharmacologist conducted home
visits for examining patients developing symptoms/ patients with comorbid conditions. For such patients
a team of doctors and nurses visited on a regular basis to ensure IV administration, blood glucose test, BP
check-up and other necessary minor procedures.
The State Medical Resource treatment group led by Senior
Specialist doctor were available for immediate online
consultation for all the doctors and nurses in the field. This
team included faculties of RIMJS, JNIMS, IMA and state
Doctors who were available through WhatsApp or telephone
calls.
At the district level, a team including District nodal officer and
Medical officer (CHC/ PHC) in charge, Assembly constituency
level doctor (in-charge of Home isolation), CHO /ANM in charge
of Home Isolation at DH, PHC, HWC, PHSC level visited the
patients on a regular basis. The vitals and symptoms of the HI
patients were recorded in a monitoring sheet maintained by the
health worker. This was also uploaded in the MHIM app.
Weekly Zoom meeting with the districts followed by weekly field visits by the state and zonal doctors to
different PHC /HWC of Imphal East and Imphal West | 35
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Linkages were also established with an integrated command centers, where relevant data was shared
with District Contact Tracing Team. The data was also shared with the Integrated Disease Surveillance
Project (IDSP) team and tracing was done by each team of the districts. The HWC staff also conducted
physical contact tracing in their HWC jurisdiction.
Grievance Cells for HI were also opened at the office of the Chief Minister in the month of May 2021 to
sort out issues/ complaints raised by HI patients through a dedicated Grievance Cell number.
Scalability and Replicability
The state plans to scale up the home-based physical assessment visits for patients
across all districts. This is currently operational in three districts which have the highest
case load. This structure can be integrated with the existing public health system and can
be made sustainable for future emergencies.
The State Model of Home Isolation of Manipur is defined and guided by structured SOPs,
flowcharts and guidelines. The state has clearly defined roles and responsibilities across various levels
which ensures accountability at all levels and an integrated continuum of care. The system can be well
replicated and scaled up to other districts/ state with some adaptations.
Weekly field visits by DNO HI and AC doctors to PHC /PHSC /Community Home Isolation centres and supervisory visits
for any urgent case 36 |
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
During the fi rst wave, 98 percent of the cases in the state of Meghalaya were asymptomatic
and during the second wave in the month of April, 2021 (before starting Home based care
management) 83 percent of the active cases were asymptomatic. Due to the exponential
rise of cases during the second wave there was a need to reduce the burden on hospitals.
The bi-phasic nature of COVID-19 called for an early intervention and monitoring
mechanism in order to reduce the number of severe cases and deaths. This called for a Home Based
COVID-19 Management - a psychological and medical support for the COVID-19 infected patients in
Meghalaya particularly in Shillong, which reported the highest cases in the state with signifi cant mortality
rates.
The urban area of East Khasi Hills, which is divided into 10 zones are manned by two zonal Nodal Offi cers
(ZNOs). Each zone has a mobile team which includes 1-2 Medical Offi cers (MOs) and 5-10 Staff Nurses.
Intensive training by specialists was provided to MOs and Staff Nurses on home-based management
of mild and moderate COVID-19 cases, infection prevention practices, oxygen therapy, non-invasive
ventilation, nebulization, metered dose inhalers etc. These trainings were conducted in partnership with
development partners including USAID-NISHTHA/ Jhpiego, UNICEF, WHO etc. Each team was equipped
with required essentials at fi eld level such as medicine kits for adults/ children, home isolation kits for
COVID-19 positive patients and monitoring formats.
The objective was (i) to provide home Based basic care to mild to moderately affected COVID-19 persons
who did not require in-hospital care (ii) to ensure continuous monitoring of COVID-19 symptomatic
persons (iii) to ensure timely identifi cation of disease prognosis and early referral by understanding the
bi-phasic nature of the disease (iv) to reduce the burden on hospitals (v) to strengthen the knowledge of
caregivers regarding protocols to follow while taking care of COVID-19 positive persons and (vi) to provide
psychological and moral support during times of pandemic.
Inclusion and Eligibility Criteria
Initially home isolation was mandated for COVID-19 patients who were 45 years and
above of age. However, this was later expanded to all age groups. Asymptomatic cases
and mild symptomatic case, persons who were psychologically fi t and willing for home
isolation were mandated for home isolation. Further, home was practiced initially only in
the urban areas of Shillong agglomeration and was later extended to peri urban areas of
Shillong. Over time this was extended to other districts as well.
MEGHALAYA | 37SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Intervention Details
Awareness campaigns were conducted on home care protocols through the state
COVID-19 helpline, innovative IEC messaging including home isolation diaries, COVID-
19-Home Care Hand-Book, posters, banners, advertisements on newspaper and
through field level staff. Front line workers including Accredited Social Health Activists
(ASHAs) / Auxiliary Nursing Midwives (ANMs), Urban Primary Health Center (PHC)
staff were leveraged to create awareness and follow up with patients under home isolation. Community
COVID-19 Management team (CCMT) and Block war Rooms - a one stop center was established at every
Development Block (rural areas) and Zones (urban area). These centers were functioning 24x7 on all
COVID-19 related matters.
The Integrated Disease Surveillance Project (IDSP) team shared the list of all the positive cases from
urban and peri urban areas of East Khasi Hills with respective Zonal Nodal Officers for follow up visits
on a daily basis. The home-based care management team confirmed the same by calling each and every
patient. Confirmed patients and follow-up patients are visited by the team. All asymptomatic and mildly
symptomatic patients were treated and severe patients were referred to hospitals. The onset date of
symptoms was captured by the team and the team regularly followed up from Day 6 to 10 to identify any
biphasic cases. Follow up visits of such patients were also regularly done. Specialists were also engaged
on a need basis under home based care management.
Home care kits including pulse oximeter, thermometer, masks and medicines as per the government’s
guidelines were distributed free of cost at the doorstep of patients. Oxygen concentrator were made
available free of cost to patients. Ambulance services were provided in case of emergency. Block war
rooms also coordinated in deployment of community ambulances.
Medical support and Monitoring
Virtual telemedicine/ helplines/ call centers: 14410 - COVID19 State Helpline number
played an important role in reaching out to people who were both inside and outside
home-based care management areas. The executives were trained on COVID-19 and the
changing needs of the pandemic. They helped the district administration in identifying the
cases where medical assistance was required. Nodal Officer/ MO contact details of each
zone were shared with patients.
All patient’s details were uploaded on Health Management System software on a regular basis, the same
was monitored by the backend team. A home-based care management team consisting of nurses and
supervised by doctors visited the patients on a regular basis. Daily cumulative reports were also submitted
to the Mission Director, NHM. An integrated command center was linked through regular meetings, daily
reports and through HMS software
High risk contacts of the patients were referred to nearest testing centers and whenever the need arose,
testing arrangements were done at door-step. Surveillance teams were headed by a District Surveillance
Officer. 38 |SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Scalability and Replicability
Scalability plan is to scale up this model and cover other urban areas of the state. The
distribution of the population in the state is such that a relatively dense population is found
only in certain pockets and rest are sparsely spread across the entire state. The terrain
is tough but COVID-19 has reached even the remotest region of the state. Keeping this
in mind, home based tele consultation of the COVID-19 patients through NISHTHA Tele-
Track was initiated in collaboration with USAID’s flagship health system strengthening project NISHTHA.
This has been rolled out recently on a pilot basis in the districts of Ri-bhoi and West Garo Hills districts.
This model will complement the home-based care management model of the state.
Meghalaya training pediatric covid-19 care-3 | 39
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
Mizoram being the second least populous state with a population of 11.9 lakhs was also
badly affected by COVID-19. The state somehow managed the fi rst wave of COVID-19
without the need of home isolation for COVID-19 patients. However, with the surge in
cases during the second wave, the state was unable to accommodate all COVID-19
patients in hospitals, thereby necessitating the need for home isolation strategy. Following
the MoHFW’s recommendation, the state government decided to keep patients who were eligible for self-
care under home isolation which comprised of at least 30 percent of the total cases in the state.
One of the main objectives of home-based care for COVID-19 positive patients in Mizoram was to minimize
the burden of health care facilities due to rapid rise of COVID-19 positive patients. The state adopted the
approach of supervised home-based care with an aim to prevent and reduce the severity of the illness by
providing care as per the need of the patient. Further, other approaches included monitoring and tracking
of patient conditions using digital and non-digital interventions, identifying patients with severe illnesses
and ensuring timely referrals.
Inclusion and Eligibility Criteria
Eligible COVID-19 positive patients who were willing to undergo home isolation signed
an undertaking on self-isolation. Patients with no clinical symptoms or very mild cases/
pre-symptomatic cases were cleared by the treating Medical Offi cer (MO) and advised
home isolation. Those who had the requisite facility at their residence for self-isolation
and for quarantining the family contacts were also advised home isolation. It was
necessary that a care-giver was available for 24x7 with a communication link between the caregiver and
the hospital. Patients were also required to monitor their health and regularly inform their status to the
District Surveillance Offi cer for further follow up
Intervention Details
Awareness campaigns on home care protocols was done digitally and through various
other media including local newspapers, local channels, Television scrolls, YouTube
channels, WhatsApp and display of Information, Education and Communication (IEC)
materials related to COVID-19 care on Health Department website.
State level and district level IDSP teams conducted active case fi nding in containment
zones on a regular basis. The active case fi nding team comprised of MOs in charge and healthcare team
in the particular locality or village including Multi-Purpose Workers and Accredited Social Health Activists
(ASHAs). The team was responsible for contact tracing and testing of suspected cases. The state also
leveraged frontline workers in containment zones for contact tracing and active case fi nding.
MIZORAM 40 |SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Medicines were distributed to patients in co-ordination with the Village/ Local level COVID-19 task (VLTF/
LLTF) force who purchased and delivered for purchasing and delivered the medicines to home isolated
patients at their door steps. Patients could also purchase their own medicines through VLTF/ VLTF. Free
medicines were distributed to Community COVID-19 Care Centers (CCCC) for poor patients under home
isolation in their own village/ locality by VLTF/ LLTF. Pulse oximeters were distributed to each Village/
Local Level Task force which was to be loaned to home-isolated patients. AYUSH medicines were also
widely distributed to home isolated patients through local level COVID-19 task force.
Oxygen Concentrators were not provided directly to home isolated patients since provision of oxygen
availability was ensured by the state in each community CCC for each locality. At least 50 percent of the
Oxygen Concentrators received from foreign aid were mainly distributed/ loaned to Community CCC.
Since every villages/ locality where COVID-19 cases were detected established CCCC in their own locality,
patients who needed oxygen were referred to Community CCCs for immediate treatment.
Ambulance service arrangement was made available by the state for referring patients under home
isolation. When a patient under home isolation was referred to the facility by an attending doctor, the
local level task force notified the CMO and ambulance was sent to the patient and transported via the
ambulance to hospital.
Medical Support and Monitoring
NISHTHA Tele-track, a home-based care model for monitoring, care and management
of asymptomatic and mild COVID-19 cases under home isolation was implemented
with support from USAID-NISHTHA/ Jhpiego in two districts - Aizawl East and Aizawl
West. The platform acts as an enabler for effective monitoring and tracking of COVID-19
patients and has functionalities for recording vitals of home isolated cases on a daily
basis, provision of regular & need based SOS telemedicine consultations with a pool of physicians, digital
reporting and with generation of system alerts in case a patient develops symptoms and requires referral.
The service is available 24x7 wherein newly home isolated patients were called for a period of ten days.
On day one, patients were called for doctor consultation, nutritionist counselling on day two, follow-
Health worker examining community members | 41SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
up teleconsultation on day five according to patient’s need and mental health counselling on day ten.
NISHTHA Tele-track mobile App users could fill their daily vitals which is then monitored by tele-callers. An
option for SOS call service was also provided for patients in case of any emergencies.
In addition to tele-consultation, 102 COVID-19 helpline was made available for any patient for COVID-19
related calls. The state has a strong community engagement mechanism for COVID-19 management.
NGOs and Village/ Local Level COVID-19 Task force (VLTF/ LLTF) closely monitor and manage COVID-19
patients at the community level. WhatsApp groups were formed where patients under home isolation
were also group members of and monitoring was done locally via chats and phone calls at the local
level. Referral linkages between the NISHTHA Tele-track callers, local level task force and Chief Medical
Officer (CMO) were created in such a way that patients who needed referral were informed at the CMO
level through the local task force for transportation of patients and admission at hospital.
11 tele-callers and 10 MBBS doctors were appointed for teleconsultation under NISHTHA Tele-track service
from the existing staff. District level home isolation doctor in charge who appointed from to manage the
home isolation patients and necessary co-ordination for referral. The IDSP cell in co-ordination with the
Village/ Local Level task force were involved in the final testing for COVID-19 patients after completion of
10 days of home isolation.
Surveillance for COVID-19 at the community level was done for persons with travel history and contacts
of COVID-19 positive patients. State also mandated for home quarantine for 10 days for those who had
primary and secondary contact with COVID-19 positive patients. IDSP sample collection team collected
the samples from quarantined family through door to door facility once the home quarantine period was
completed. Containment teams were created to conduct active case finding in COVID-19 containment
zones where all the individuals with COVID-19 like symptoms were tested.
Scalability and Replicability
The state needs to strengthen infrastructure and increase human resources to reduce
home isolation cases. However, technology-based interventions such as NISHTHA
Tele-Track and tele-consultation can be scaled across the state. Further, fixed day tele
consultation services can be introduced on existing platforms like eSanjeevani OPD for
COVID-19 patients under home isolation. 42 |
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
With the surge of the COVID-19 pandemic in the second wave, the entire country came
to a standstill. Like any other state, Nagaland too witnessed an alarming statistic with
a positivity rate of about 20 percent. Out of the total cases, 90 percent preferred Home
Isolation as most people with the COVID-19 disease experienced mild to moderate illness
and recovered without requiring special treatment. Therefore, in concurrence with the
MoHFW guidelines on home isolation, the Department of Health & Family Welfare Govt. of Nagaland in
partnership with USAID-NISHTHA/ Jhpiego rolled out a Comprehensive Tech-Enabled Home-Based Care
Model called NISHTHA Tele track (Web-based and mobile application) and an innovative model of floating
COVID-19 home isolation kits (CHIKs) in Kohima and Dimapur.
Inclusion and Eligibility Criteria
The Tele-Track model was rolled out in
two districts of Nagaland-Kohima and
Dimapur. Therefore, all the positive cases
were monitored daily by the NISHTHA
Tele track team. However, for availing of
Home Isolation kits, the following criteria were followed:
(i) COVID-19 positive cases by RTPCT/ RAT who were
65 Years and above with or without symptoms.
(ii) COVID-19 positive cases by RTPCR/RAT who were
64 years and below with co-morbidities or with
COVID-19 symptoms
Intervention Details
Floating Home Isolation Kits: Nagaland had limited resources and provisions for supply
of CHIKs (COVID-19 Home Isolation Kits) for monitoring home isolated COVID-19 cases
resulting in issues around quality of care. To address this challenge, NISHTHA with
the state NHM, District Task Force and local NGO partners (Sewa Bharti in Dimapur)
developed an innovative model - Floating Home Isolation Kit Bank. This involved creating
a rotating pool of home isolation kits at district level on a return after use basis. The home isolation kit
included basic state approved medicine for COVID-19 management, Self-monitoring devices like pulse
oximeter and digital thermometer and personal hygiene products. Given below is the process flow of the
CHIK
NAGALAND
Health worker taking Tele-consultation session | 43SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Medical Support and Monitoring
Leveraging digital technology, the COVID-19 positive patients were monitored through
NISHTHA Tele-track for a period of 10 days. The team comprised of Medical Doctors,
Nutritionists, Nurses, and Counsellors. The certified doctors did a consultation with the
patients on the first, days. The Nutritionist would call up on the 2nd day for nutrition
counselling and on the 5th Day for mental health counselling by experienced clinical
psychologists or counsellors. The Nurses followed up for all 10 days to assist the patients and there
was also a provision for live teleconsultation with a specialist doctor for any emergency. During the 10
days, if there were symptomatic patients with danger signs, the team would immediately initiate referral
linkages with the tertiary hospital for early initiation of treatment and further investigation and treatment.
This helps in preventing delays in hospital admission which was considered as one of the contributing
factors for high mortality. Till date, the team has referred such 6 cases and it has prevented from getting
complications. Once the patient completed 10 days of home isolation, they were linked with the district
hospital for a discharge certificate.
Scalability and Replicability
This model has been rolled out only in two high caseload districts - Kohima and Dimapur
and the state is planning to scale up this model even to the rural districts of Nagaland.
This model has enabled the patients to get in touch with the expert medical team which
brings in an element of trust and also a system for referral linkages for hospitalization if
any complication arises. On the other hand, the system is also able to track and monitor
severe cases for referral linkages with ambulances for hospitalization to avoid late admission and thereby
preventing death due to late admission to the hospital. 44 |
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
As part of the Union Territories (UTs) efforts to prevent the transmission of COVID-19
from infected to healthy individuals, a COVID-19 Triage Team was constituted. The aim of
the COVID-19 triage team was to bring services to patient’s doorsteps and link COVID-19
positive patients with appropriate healthcare services, as per their needs. The outreach
measures also included consultation services over Interactive Voice Response System
(IVRS) and a 104 round-the-clock helpline. In August 2021, the government partnered up with StepOne
and COVID-19 Response team and conducted free of cost triaging and regular monitoring of patients.
Initiatives like “Doctor on Wheels” was also launched to support the home quarantine system.
Inclusion and Eligibility
Patients who tested positive for COVID-19 and were stable were recommended for home
isolation if SpO2 > 92percent, respiratory rate ranged from 12-24 bpm and temperature
ranged from 97-100�.
Intervention Details
The COVID-19 Triage Team consisted of fi nal year MBBS students from various private
medical colleges who volunteered to work together with their respective medical offi cers,
Auxiliary Nurse Midwives (ANMs), Accredited Social Health Activists (ASHAs) workers in
the Primary Health Center (PHC) they were allotted. Each PHC had its own triage team
and conducted home-triaging on a daily basis. The list of patients who were COVID-19
positive was updated daily, which helped the triage team in planning the number of home visits for each
day. Based on symptoms exhibited by patients and other vital questions asked by the triage team, each
patient was segregated and placed either under home isolation or was hospitalized.
A team of over 300 Anganwadi Workers (AWWs) were tasked with carrying out door-to-door visits to
check on the health status of patients on a daily basis. In addition to this, ASHA volunteers conducted daily
home visits as part of surveillance measures. Patients under home isolation were provided medicines and
medical guidance. If the patient required hospitalization, they were transported to the referred hospital via
an ambulance with the help of the triage team. The activities of the team were monitored locally by the
PHC Medical offi cers (MOs) and centrally by the COVID-19 war room. Patients received support from the
triaging team, home isolation medical team, IVRS team and tele screening team.
Doctors on Wheels Initiative: When home quarantined patients made stress calls to the 104-helpline
number, instead of giving medical advice over the phone, a medical team would be sent to their door
step and the patient would receive immediate treatment and care. If the team felt the patient needed
PUDUCHERRY | 45
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
hospitalization, an ambulance would be arranged and the patient would be shifted. This initiative began
in May 2021.
Partnership with StepOne and COVID-19 Response Team: In August 2020, the government launched
an interactive technology platform for operating a remote Home Isolation Monitoring and Counselling
System. The platform offered free of cost help to safely manage mildly symptomatic and asymptomatic
patients under home isolation. The government partnered with two non-profi ts, Project StepOne and
COVID-19 Response, to form a group of volunteer counsellors to support in remote monitoring.
Under this initiative, the list of individuals under home isolation would be uploaded in the system and
day to day monitoring would be done. On day 1, patients would receive a call from the counsellors who
would brief them on the dos and don’ts, generic counselling would be provided and both patient and the
caregiver would be sensitized on safety measures and monitoring symptoms. Patients would receive
IVRS calls at 11 a.m. for 13 days (duration of isolation) and would be expected to report their symptoms
without fail. In case of a missed call, an automated message would go to their mobile number where
they could call and register it. Two reminders would be sent at 4 p.m. and 7 p.m, after which the numbers
would be transferred to the health team and they would call to enquire about the patient’s symptoms. If
during the IVRS call, any symptom got registered, the system would generate a token which would be
shared immediately with the home isolation team to schedule a door-step visit, after a round of tele-
Covid War Room
Covid Triage Team
IDSP
Line LIst
Step one dashboard for
tele-screening
Perfroms
Triaging at home
andsegregates the
patients - Homeisolation
or hospital Admission
Home
isolation List
generated
Home isolation team - follow up people
under home isolation. IVRS calls for all
HI Patients
Flowchart
of Activities 46 |SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
counselling. In case of an emergency, citizens could dial 104, which operated round-the-clock. Online
trainings were conducted for practitioners that had signed-up to support this service.
This initiative helped ease the burden of having to travel to hospitals for triaging. Triaging at home helped
reduce further transmission and workload in hospitals. It also helped in optimally utilizing beds that were
allotted for COVID-19.
Medical Support and Monitoring
Following the visit of the triaging team, a list of people under home isolation would be
generated and transferred to the home isolation team. This team comprised of MOs
who regularly visited homes of patients under home isolation to monitor their health
and progress. Any deterioration in health informed through the 104-helpline was also
addressed by this team of Home-isolation in-charge doctors and further referred to
hospitals. A COVID-19 triaging SOP was followed as below: | 47
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
The Department of Health and Family Welfare, Government of Punjab, began home
based care for COVID-19 positive patients under Home Isolation (HI) during the fi rst wave
of COVID-19. For this purpose, a dedicated agency was selected by the Department to
provide tele consultation services to monitor the health of HI persons across districts.
This was done through a tendering process.
The aim of this system was to ensure that regular contact be maintained with HI and home quarantined
persons so that any medical emergency could be resolved on an immediate basis.
Intervention Details
The department hired a tele monitoring company through tendering process for daily
monitoring of COVID-19 patients under HI. A chat bot was created for self-registration
of patient’s vitals. Dedicated call centers were set up at the district level and they were
responsible to make call and record vitals of patients under HI. They would also provide
support in case of medical escalations through Health Teams. Tele monitoring was being
provided to all COVID-19 positive HI patients (symptomatic or asymptomatic).
To generate awareness among the public regarding the tele monitoring system, IEC activities
through social media, short fi lms, pamphlets, brochures, education material inside Fateh Kit and booklets
on HI were disseminated and published in newspapers. Accredited Social Health Activists (ASHAs) and
the Rapid Response Teams (RRTs) teams were used to shift patients from their homes to the hospital
or testing centers, as required. Fateh Kits which contained face masks, sanitizers, essential medicines,
oximeter, thermometer, Ayush products etc. were given to all HI patients.
The state government also provided food kits
containing essential food items to needy HI
patients. Standard Operating Procedures (SOPs)
were developed to carry out HI monitoring in a more
systematic way.
Mobile based app - ‘Ghar Ghar Nigrani’ was
launched in June 2021 to undertake house to house
surveillance in Punjab until the elimination of the
pandemic. The Health Department’s initiative which
included ASHA workers/ Community volunteers
supported in the early detection and testing of
COVID-19 cases, and preventing its further spread
in the community.
PUNJAB
Medical Kit 48 |SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
The entire rural and urban population of Punjab, above the age of 30 was surveyed as part of the drive. It
also included persons under the age of 30 with co-morbidity or Influenza-Like Illness (ILI)/ Severe Acute
Respiratory Illness (SARI). This was an an-ongoing process that lasted till the virus was contained.
The survey captured the full medical history of a person including the past week and complete details of
their current medical condition, as well as comorbidities (if any). This helped the state to build a database
for evidence-based planning for COVID-19 containment and necessary targeted interventions at the
community level.
The app had been developed and designed in-house by the Health Department and was field tested in
Patiala and Mansa. Around 20,628 persons were surveyed, of which 9,045 were found to be asymptomatic
and 1,583 with symptoms of cough/ fever/ sore throat/ breathlessness etc.
A supervisor would oversee the work of ASHAs/ community volunteers and was engaged on a voluntary
basis (paid Rs. 5,000/ month. The supervisor was responsible for quality check of data that was
uploaded by volunteers, monitoring their daily progress and ensuring COVID-19 testing of those found
to be symptomatic. Community volunteers were mainly engaged in areas where ASHA workers were not
available, for instance in urban areas, or where ASHAs were unable to use the mobile app. A community
volunteer could be any female over the age of 18, with 10+2 or more as educational qualification and a
resident of the same village or ward.
District authorities set up Oxygen Concentrator (OC) Banks for the distribution of OCs to HI patients
across the districts. OCs with flow capacity of 5 L per minute delivering oxygen with concentration of 90
percent or more were recommended by the Health Ministry for management of COVID-19 patients under
HI. The allocation of these 5 L OCs to HI patients was done only with a prescription from the treating
Medical Officer. The OCs were made available to HI patients on a temporary loan basis against a nominal
security deposit which was refundable upon returning the OCs once the patient recovered. This exercise
was undertaken in collaboration with the Red Cross Society.
Deployment of ambulances (Standard/ Advanced Life Support (ALS)) and mobile pharmacies - Ambulance
services were provided to both confirmed and suspected COVID patients on a free-of-cost basis. The
deployment of 108 ambulances was prioritized in zones with high concentration of COVID-19 positive
patients. During the telemonitoring services, in case a HI case was escalated on medical advice of the
specialist, the HI-patient would be transferred to an L2 / L3 facility nearby, based on their condition. ALS
ambulances were used to shift critical patients with rapidly deteriorating vitals to higher facilities. Basic
Life Support ambulances with Oxygen facilities were equally beneficial in transferring COVID patients to
the nearest COVID-19 health facility.
Deployment of Medical Interns: Deputing interns can help in strengthening the monitoring and follow-
up of HI patients, thereby improving home-care quality, reducing COVID-19 mortality and strengthening
people’s faith in the health system. This initiative could also help in improving cooperation between the
patient and the RRTs.
Further teleconsultation services were provided to patients referred to district headquarters by tele-callers
through IDSP Cell / District Call Centre / Control Room | 49SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Medical Support and Monitoring
Regular monitoring was done by the assigned tele-caller agency. Call centers supported
doctors on duty and helped in maintaining health details through patient records.
COVID-19 Patient Tracking officers (CPTOs) in each district were appointed as Nodal
Officers for HI. They were responsible for providing home care to COVID positive patients
in their respective district through tele consultations. The District Administration set up
dedicated call centers for patients under HI to record their vitals and enter them into a database. The
state government deployed medical interns from medical colleges who helped in providing medical
consultations in case of escalations. 50 |
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
The home-based care system proved to be a critical approach in management of
COVID-19 positive patients. Rajasthan moved one step ahead and provided home based
care to Influenza-like illness (ILI) cases as well. Remote consultation by doctors using
technology not only helped in managing cases but also in limiting virus transmission.
Community monitoring groups such as the ‘Village Nigrani Samiti’ encouraged community
participation in managing COVID-19 positive patients and ILI cases at home. Under the supervision of the
Village Nigrani Samiti, door to door surveys were conducted by village level health workers/ Block Level
Offi cers in urban areas to identify ILI cases. Medicine kits were provided to all ILI and COVID-19 positive
cases and follow up was done on a daily basis. Symptoms were monitored and cases were referred higher
facilities, as per the condition of patients.
The overwhelming number of cases in the second wave made it diffi cult to follow the test-track-treat
concept as the virus was spreading rapidly and there were also delays in results. The state took a conscious
decision to follow track-treat concept and identify cases at the early stage and treat them through home
bases care system. To identify cases in early stages, ‘Door to Door’ teams were deployed. This deployment
was under the direct supervision of ‘Village Nigrani Samiti’ at the village and ward level. It was important
to provide medical support to all COVID-19 positive patients and ILI cases without compromising on
quality of care. Cases that did not need direct medical intervention in terms of oxygen support, injectable
medication, were effectively managed at home under the supervision of a medical offi cer. The concept
of management of patients through home-based care was also very useful, especially in the context of
Rajasthan, which has a huge geographical area and many hard to reach areas.
A system of home care was established under the supervision of Medical Offi cers (MOs) from urban and
rural Primary Health Centers (PHCs). COVID-19 positive and ILI cases were assessed by MOs to check
eligibility for home-based care. A medical kit and an instruction manual were provided to all COVID-19
positive patients. The monitoring system was established using WhatsApp, physical daily visits by local
BLO/Accredited Social Health Activists (ASHAs) to monitor temperature, SPO2 level, development of
warning signs and symptoms.
Inclusion and Eligibility criteria
COVID-19 positive cases that were tested by Rapid Antigen Test (RAT) or RT-PCR tests were
included. Other criteria for eligibility included asymptomatic or mildly symptomatic cases,
psychologically fi t and willing for room isolation, adequate space at home for isolation
and not in high-risk category of diseases like comorbid conditions, people over 60 years
of age, pregnant women and young aged children. During the second wave, ILI cases with
mild symptoms also qualifi ed for home-based care.
RAJASTHAN | 51SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Intervention Details
To generate awareness, different Information, Education and Communication (IEC)
methods (banners, leaflets, video) were adopted for wider communication to the
community. Panchayati Raj Department was actively engaged in disseminating messages,
as well as providing support to village level ASHAs and Anganwadi workers to conduct
Door-to-Door surveys and monitoring of cases under home care.
ASHA workers were oriented on home care management and steps needed to be taken by them for
management of COVID-19 positive patients and ILI cases. They were all well oriented and trained to
identify early warning signs and refer cases to higher facilities. ‘Village Nigrani Samiti’ was used effectively
to provide support to ASHAs to limit the movement of COVID-19 positive and ILI cases. ‘Swasthya Mitra’
were present in all villages and supported the ASHAs in daily monitoring of positive cases.
A protocol was developed and finalized for COVID-19 positive cases under home isolation. As per the
protocol, all ILI and COVID-19 positive cases with mild symptoms qualified for home-based care. Protocols
were also in place on how patients would be monitored for temperature, SpO2 level and development of
warning signs. With support from village level workers and BLOs, these protocols were followed. A tool
was developed for live monitoring and tracking of activities.
A MO would assess the condition of COVID-19 positive patients and ILI cases and would also check
whether they were eligible for home care. Medical kits were provided to COVID-19 positive patients and
ILI cases with an instruction leaflet for the patient and their families. During home isolation patients
were encouraged to do breathing exercises to increase lung capacity. Patients were advised to practice
‘Proning method’ to increase SpO2 levels. As a part of general IEC, messages on proning technique were
disseminated among communities.
Government doctors, as well as private doctors, provided home based care to patients. Depending on
availability, Oxygen concentrators were provided by the government to patients and some NGOs were also
involved in providing oxygen concentrators. If recommended by the treating physician, families were also
arranging oxygen concentrators for their patients.
Call centers worked round the clock to arrange ambulances to shift patients to COVID-19 health facilities
and district control rooms were in charge of providing information on availability of beds in facilities.
Adequate fire safety arrangements were made in the temporary and permanent COVID-19 health facilities
and adequate security arrangements were made available with the support of the police department.
Medical Support and Monitoring
Virtual- telemedicine/ helplines/ call center: 181 call centers were functional at the state
level to manage grievances. In addition to the state call centers, districts also established
call centers in their district control rooms to provide support at the local level. 52 |SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Deployment of Medical doctor supervision/ Nurse supervision/ Frontline workers frequency of check:
Medical officers and interns were deployed to call centers to resolve queries of patients. Medical Officers
in charge of Urban PHC and sector PHC were responsible for the daily monitoring of cases and referrals,
in case of requirement. | 53
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
India witnessed an unprecedented surge of COVID-19 positive cases and deaths during
second wave. In Sikkim, around 80 percent of the cases who had mild symptoms and
were asymptomatic were under home isolation. As per the guidelines from MoHFW, the
patients who were clinically assigned to be mild/ asymptomatic were recommended for
home isolation.
As the number of COVID-19 positive cases in home isolation surged, the department of Health & Family
Welfare with technical assistance from the development partner for Comprehensive Primary Health Care
(CPHC) USAID-NISHTHA/ Jhpiego organized a two-day virtual training for all the Primary Health Care
teams at the urban and rural primary health care facilities. The trainings were provided to the teams
from Urban Primary Health Centre-Health and Wellness Centre (UPHC-HWC) Gangtok and Ranipool, Sub
Centre-Health & Wellness Centers (SHC-HWC), Primary Health Centers (PHC) and also to the District
Medical Offi cers of all the four districts on Management of COVID-19 cases under home isolation. They
were also trained on the usage of oxygen concentrator and RAT for COVID-19 patients.
The state also launched an important initiative ‘Swasthya Sampark’ a post COVID-19 care initiative in
collaboration with USAID’s flagship health system strengthening project NISHTHA, implemented by
Jhpiego. The platform acts as an enabler for effective monitoring and tracking of post COVID-19 patients
and has functionalities for recording vitals of patients on a daily basis, provision of regular & need based
SOS telemedicine consultations with a pool of physicians, digital reporting with generation of system alerts
in case a patient develops symptoms and requires referral. Under this initiative, the patients recovered
from COVID-19 were monitored closely and were provided care at right time to prevent post COVID-19
complications. This post COVID-19 Platform was a remote help desk integrated with telemedicine
(teleconsultation & tele counselling) to support individuals recovered from COVID-19. The patients could
connect through a toll-free service care number wherein a trained health professional attended the
patients call and addressed their concerns. The platform could also provide services like mental health
counselling, dietary counselling through tele counselling services as well as treatment for any medical
ailment developed or worsened during post COVID-19 period through teleconsultation services.
Inclusion and Eligibility Criteria
Patients with mild symptoms or those who tested positive but were asymptomatic/
mildly symptomatic were advised home isolation. Psychologically fi t patients, who were
unwilling to go to hospitals but were co-operative on regular follow up protocols were also
provided the monitored home care services. It was mandatory for all the patients to have
the home facilities available as per the guidelines for home isolation.
SIKKIM 54 |SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Intervention Details
Awareness and communication played a vital role in containing the spread of
COVID-19 in the state. Awareness campaigns on home care protocols through
different Information, Education and Communication (IEC) Materials were rolled out
by the State Government. Home visit to COVID-19 positive patients were provided by
field staffs (MLHP, ANM & ASHAs). Regular communication was done through social
media platform (Facebook, twitter and other platforms). USAID-NISHTHA/ Jhpiego also supported
state by providing 170 banners on COVID-19 appropriate behaviors and the banners were distributed
to all the Districts to further disseminate at PHC & PHSC level.
ASHAs were also roped in for
generating awareness and to
distributing e home isolation kits.
Oxygen level assessments were done
by the healthcare teams every day.
Tele calling to the isolated individuals
were scheduled by the healthcare
teams on odd hours of need. The state
provided ambulance in each Gram
Panchayat Unit to ferry the patients to
the hospitals in need.
NISHTHA Swasthya Sampark was
launched by State of Sikkim with
support from USAID-NISHTHA/
Jhpiego in which COVID-19 recovered
patients were followed up by tele-
callers of the helpline. These patients were followed up actively for one month and passively for two
months. Line-listing of the COVID-19 recovered patients were shared with the tele-callers on a weekly
basis.
Further, oxygen concentrators were provided through PM-CARES, UNICEF and other private donors.
Total 447 oxygen concentrators were received by the State. This was distributed to all the facilities from
Secondary level to Tertiary level care. Ambulance services were provided at all the blocks for referral and
transport of home isolation cases. Safety arrangements were put in place by distribution of PPE kits,
sanitizers, masks to community workers as well as COVID-19 positive patients under home isolation.
Medical support and Monitoring
Virtual- telemedicine/ helplines/ call centers initiated the tele counselling activities, by
providing android mobiles to the respective psychologists and counsellors at the districts
and the PHCs. They were provided with dedicated handsets and an internet facility for
full one year. Deployment of Medical doctor supervision/ Nurse supervision/ Frontline
workers was done to check frequency of consultations. The senior level doctors working
in program management as state program officers were deputed for the clinical activities at different
COVID-19 Care Centers. Staffs from Urban PHCs were given temporary postings at STNM Hospital
(COVID-19 care Centre). Mid-Level Health Care Providers of East District were given postings at STNM
Distribution of the medical kits to the community members. | 55SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Hospital for COVID-19 duty. An integrated command center monitored (at patient end, doctor end and
centrally) patients through regular meetings and daily reporting. Surveillance and Contact Tracing of the
family members was done through dedicated teams under the Block Development Officers.
The state task force under the leadership of Hon’ble Chief Minister, formed a committee in rural and urban
areas, as COVID-19 task force and village COVID-19 management committee at urban and rural areas
respectively to fight and contain the disease in the area.
There are 155 Gram panchayat units in the state of which each GPU looks after 8 wards. The above-
mentioned teams were formed in such a way that 10 members team looked after a ward, provided all
the members in the team were trained and oriented on COVID-19 appropriate behaviors and counselling
techniques by health department, SIRD and Panchayati Raj department.
This team delivered COVID-19 care kits comprising of masks, hand sanitizers, essential medicines, vitamins
along with the prescription and printed COVID-19-care manual for home care for each COVID-19 positive
households. Positive patients and primary contacts with comorbidities were also provided with general
medicines such as antihypertensive and anti-diabetic drugs. Provision for free ration at the door steps was
made for the BPL family. All ASHA workers were provided with pulse oximeter for monitoring patients. The
state government provided a dedicated ambulance in all the blocks under the Block Development Officers
(BDOs) for referral and transport of patients in case of emergency. All the PRI members, BDOs and ADCs
were provided with financial assistance (funds) by the state government. Local NGOs were mobilized and
engaged for courtesy calls. IEC material distribution was done in the containment zones by the contact
tracing team.
Monitoring of patients under home isolation 56 |
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
The COVID-19 pandemic spread like wildfi re, across communities affecting everyone, but
mostly vulnerable populations. Due to the high number of cases, hospitals and health
facilities became overburdened. This led to a modifi cation in the states’ COVID-19 strategy
wherein asymptomatic / mildly symptomatic cases would be managed at home or in
institutional care at COVID-19 Care Centers.
Guidelines for COVID-19 home care management protocols & testing strategies were developed and
modifi ed (from time to time) accordingly, to ensure that all patients received appropriate care and
treatment, that they were able to identify and tackle complicated cases more effi ciently and refer to higher
facilities as per requirement.
Intervention Details
House-to-House surveys (fever survey) were conducted to identify patients with COVID-19
symptoms. They were handed ‘medicines kit’. COVID-19 clinics were established in all
health facilities to manage mild cases (on OP basis/ admission for observation). Similarly,
the number of testing centers were increased which resulted in decentralization of testing.
Continuous and periodic rounds of systematic door to door (fever) surveys were done
during the peak of the second wave to identify symptomatic patients and their contacts.
People with symptoms (identifi ed during fever surveys) were given treatment kits, advised home isolation
and given treatment kits (without waiting for COVID-19 test results). Needless to say, this helped in
identifying a large number of people suffering from non-COVID-19 fevers & similar minor illnesses and
providing appropriate treatment.
Regular follow ups were done by Accredited Social Health Activists (ASHAs) and Auxiliary Nursing
Midwives (ANMs) for people who were COVID-19 positive. They would also assess whether the patient
should continue in home isolation or be referred to COVID-19 Care Centers, according to their condition.
Medical Support and Monitoring
Home isolation treatment and monitoring protocol (HITAM): Patients diagnosed with
COVID-19 at testing centers / at home were clinically assessed to check whether they
would be suitable for home isolation. They were immediately provided with ‘medicines
kits’ that comprised of requisite medicines, as per doctor’s advice. This was followed by
monitoring the progression of symptoms and treatment compliance by trained tele-callers.
In case of clinical deterioration like continuous fever, breathlessness etc. (especially in high-risk groups /
co-morbid conditions), patients were immediately shifted to COVID-19 hospitals. Tele-callers were trained
to identify such cases to be escalated for expert opinion / hospitalization. They were made aware of
emergency ambulances and COVID-19 hospitals (mapped), for quick transportation and admission.
TELANGANA | 57SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
HITAM mobile application, software & call center: A mobile based application was developed during the
1
st
wave with features to capture patient demographics, symptoms, medications, and daily progress.
Doctors were employed to work from home during lockdowns (without physically attending call centers),
by installing the mobile app on their smart phones to facilitate their functions.
HITAM call center: Telemedicine
Based on the existing protocols, a kit containing Paracetamol, Cetirizine, Doxycycline, Vitamin B Complex, Vitamin C and Ranitidine (symptomatic & supportive treatment) along with other relevant IEC material was given to patients under home isolation.
As was the case in the rest of the country, the state of Telangana also faced a steep increase in the
number of COVID-19 cases during the second wave. This overwhelmed the testing and hospital treatment
capacities of the state. All hospitals were converted into COVID-19 clinics for evaluation of COVID-19
patients with mild symptoms (as OP) and for referring them, in case they were showcasing moderate
/ severe symptoms. Home isolation and treatment through telemedicine helped deal with the surge in
cases, especially in hospitals, during both the waves.
The above steps, i.e., home isolation, initiation of treatment without waiting for test results (with
sometimes long turnaround time / false negatives etc.) and identification for admission reduced the
spread of infection and prevented further deterioration of condition of several patients.
Hence, it can be concluded that home isolation with treatment kits (drug kits), proper integration of house-
to-house (fever) surveys, establishing COVID-19 clinics for monitoring and identifying cases, proved to be
an effective strategy to prevent overburdening of hospitals and reduce COVID-19 mortality in the state. 58 |
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
Home based care was permitted in the state of Uttar Pradesh only during the second wave
when over 80 percent of COVID-19 patients were asymptomatic and hospitals became
overburdened. Hospitalization also led to stigmatization of the disease, to the extent that
people started avoiding getting tested. To make the most of the limited resources and
ensure that everyone had access to quality healthcare, there was a need felt to introduce
home based care for treatment of asymptomatic / mildly symptomatic COVID-19 positive patients.
Inclusion and Eligibility Criteria
All COVID-19 positive cases identifi ed by any confi rmatory test were included and
asymptomatic and mildly symptomatic patients were permitted to stay and get treated in
home isolation. While there were no age criteria for inclusion and eligibility, all COVID-19
positive patients under home isolation had to have a separate room and bathroom that
would not be used by any other member of the household. Persons with more than one
comorbidity and vulnerable conditions were excluded from home treatment.
Intervention Details
Over 7,000 Rapid Response Teams (RRTs) were formed across the state and led by
Medical Offi cers (MOs). Each team was equipped with pulse oximeters, glucometer, BP
apparatus etc. All Standard treatment protocols and guidelines on home isolation were
assessed and followed. Persons under home isolation were regularly monitored and
provided facility-based care on escalation of symptoms. Approximately 60,595 home
isolated cases were shifted to facilities based on home caregivers’ feedback. These RRTs were connected
to the Nigrani Samitis at the village level.
UTTAR PRADESH | 59SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
More than 70,000 Nigrani Samitis (surveillance teams) were constituted across the state of Uttar Pradesh,
led by Gram Pradhans/ Ward members. Other members of these samitis included Front Line Workers
(FLWs)/ Volunteers. The experience gained from the Dastak campaigns over the 3 years was replicated
for COVID-19 home care. Almost all households were visited multiple times by trained surveillance teams
and sensitized on prevention and home care, ensuring adherence to quarantine protocols, keeping a
check on containment area activities, tracing and tracking suspect cases etc. Medicine kits for pediatric
age groups were also made available to Nigrani Samitis.
A massive rural outreach campaign was carried out by the Nigarini Samitis during the second wave. The
RRTs and Nigrani Samitis were connected, supervised and monitored digitally by the Integrated COVID-19
Command and Control Centers (ICCC) teams. Each district had the presence of one ICCC and this was
done across 75 districts. Senior district administrative and health officers were in charge of these centers.
At least 2 calls were made by trained staff on a daily basis to COVID-19 patients in the area and their
health was assessed. Temperature, oxygen saturation and other clinical symptoms were recorded, based
on which they were provided essential drugs and pulse oximeters and referred to higher facility care, if
required.
Several districts partnered with private organizations under their Corporate Social Responsibility (CSR)
initiatives to ensure delivery of quality healthcare services. For example, the Lucknow district administration
partnered with Flipkart for the delivery of free medical kits to COVID-19 positive patients under home
isolation. The ICCC that was set up was supported by HCL at Gautam Buddha Nagar.
Medical Support and Monitoring
A five-layer monitoring system was put in place for providing medical support and
monitoring:
Monitoring at CM UP helpline 60 |SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Medical Kit Distribution
Quick feedback sharing with Administrative and Senior Health officers through web-based meetings
0301 0204 05
Unit Mos
and
Zonal MOS
District level
health and
Administrative
Third party
independent
monitoring :
WHO, UNICEF
State control
room and CM
UP Control
room
Senior
Administrative
and Health
Officers for
high case
load districts,
Joint Director
level officers
from Health
Department for
all 75 Districts | 61
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
After experiencing an over-whelming number of COVID-19 patients requiring hospital
beds, the state of West Bengal viewed Home Care System as part of an effective treatment
plan for COVID-19 positive patients with mild symptoms. Treatment guidelines and
protocols were quickly designed and implemented. Intensive trainings, capacity building,
close supervision and monitoring, collaboratively, by both Government and Private Health
Facility Centers (HFCs), were conducted. This was implemented in urban as well as rural areas of the
state.
The prime objective of the Department of Health & Family Welfare, Govt of West Bengal was to quickly
and effectively manage the COVID-19 waves in the state. This was made possible through Telemedicine,
Integrated Call Centre System, COVID-19 Patient Management System (CPMS) and Integrated COVID-19
Management System (ICMS), which were all developed and implemented towards the beginning of the
fi rst wave of the pandemic and further enhanced on a periodic basis during the second wave.
The other supporting objectives included creating essential infrastructure like medical oxygen
infrastructure, using existing infrastructure like Safe Homes and Satellite Health Centers, and building the
capacities of all health workers in the healthcare ecosystem.
Inclusion and Eligibility Criteria
During the fi rst wave, both RT-PCR as well as Rapid Antigen Tests (RAT) were being used,
with a gradual increase of RAT tests to reduce the time taken to get the results. In addition,
CBNAAT, TrueNat, TrueNat RDRP Confi rmatory were used in small numbers. Towards the
latter half of 2020 and as the second wave started in early 2021, RT-PCR tests increased
in view of the test being known as the ‘gold-standard’.
For asymptomatic cases, 200 Safe Homes and Satellite Health Facilities were established and guidelines
and SOPs were developed for mild and asymptomatic patients for whom home isolation was not possible
or advisable. Safe Homes were set up in both cities and towns in West Bengal by the respective District
authorities. In the second wave, COVID-19 positive asymptomatic persons stayed under home care with
family or friends / care-givers, who were also counselled on the above guidelines.
Patients with comorbidities and other immune-compromised persons who were most vulnerable
received close supervision and monitoring. Frontline workers regularly visited households across
the state. With the help of the telemedicine platform, Accredited Social Health Activists (ASHAs)
Workers and Community Health Officers (CHOs), many other people with Non-Communicable
Diseases (NCDs) were identified. Family members and care-givers were counselled on how to take
care of patients with comorbidities and case management protocols were issued to handle patients
with comorbidities.
WEST BENGAL 62 |SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
Psychologically fit and willing for Home isolation – The trained personnel at the Integrated Call Centre
would talk to patients’ family members / care-givers to understand if the patient fits the criteria for home
isolation and accordingly home isolation was advised.
Intervention Details
An initiative was launched to spread awareness on what a COVID-19 patient should do
while in home isolation to clear any misconceptions and make it easier for doctors to
handle such patients when / if rushed to hospital during an emergency situation. The
contents were divided into sections dealing with who can stay in home isolation, when
treatment is required and directions for caregivers.
The campaign was launched in parts of Bidhannagar, South Dum Dum, Baranagar, New Barrackpore and
Barrackpore - pockets that had seen a large number of COVID-19 cases. One lakh leaflets were distributed
with a list of seven telephone numbers of COVID-19 control rooms in North 24-Parganas district and two
WhatsApp numbers where people could send messages in case of emergencies.
During the second wave, ASHA worker counselled household members of families that had COVID-19
patients with mild symptoms. ASHA workers were provided with all the necessary information and
Community Health Officers (CHOs) at the Health & Wellness Centers, also known as Suswasthya Kendras,
were also provided with the protocols that were to be followed. The ASHA workers were responsible for
the collection of data on comorbidities in the Community Based Assessment Checklist. Doctors could
treat patients through telemedicine platforms and e-Prescription would be communicated by CHOs to the
patient / care-giver.
The state of West Bengal equipped block-level Primary Health Centers (PHCs) and hospitals with isolation
beds, medical oxygen and ambulances for better handling of COVID-19 cases. A fleet of 102 ambulances
was reserved for transporting COVID-19 patients.
Medical Support and Monitoring
Virtual – Telemedicine / Call Centre / Helplines: 96 doctors working in 3 shifts (24X7) for
providing tele-consultation to COVID-19 patients under home isolation. Till date 6,93,901
consultations have been done.
Tele Psychological Counselling Helpline: This began on August 1, 2020 with the help of
recent graduates from Kolkata university. These young counsellors provided psychological
counselling to 3,55,771 persons. Every COVID-19 positive patient was given a call on the basis of their
positive report and if required, hospital admissions were arranged. On an average 10,000 calls were made
per day.
Ambulance Service Helpline: Free ambulance service was provided for testing, admission and discharge
from hospitals. On an average 800 ambulances provided free service to COVID-19 patients per day.
During the first wave, there was an increased focus on creating health facility infrastructure as the demand
for beds, especially ICU beds, was more. Patients preferred staying for longer periods than necessary
because of which needy patients were not getting ICU beds. In general, there was a lot of fear and anxiety
among people and families preferred to send their COVID-19 positive family member to institutions
including Hospitals and Safe Homes. | 63SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States
In the second wave, as individuals and family members became aware and a) received appropriate
Teleconsultation through Telemedicine, b) Prompt support through the Integrated Call Centre System
and c) Effective patient management from the COVID-19 Patient Management System (CPMS) and
Integrated COVID-19 Management System (ICMS), Safe Homes & Satellite Health Facilities helped reduce
the demand for hospital-beds.
Scalability and Replicability
All best practices are scalable, replicable and sustainable. Teams are continuously
upgrading and enhancing their skillsets and infrastructure Teams at the state Headquarters
and at the district level are finding innovative methods to tackle the inevitable 3rd wave. 64 |
SECTION A : STATE PRACTICES (Information shared by the States)
Home-based Management of COVID-19: Best Practices Adopted by States | 65
SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
SECTION B
STATE PRACTICES
(information collected through secondary research) 66 |
SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States | 67
SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
In the state of Andhra Pradesh, a comprehensive home isolation system was set up for
asymptomatic or mildly symptomatic cases of COVID-19. Auxiliary nurse midwife (ANMs)
and village/ ward volunteers were engaged in creating awareness, monitoring patients
at home and educating patients on how to self-monitor their symptoms. Home care kits
(including medicines) were provided to patients. The state also set up home isolation help
desks and dedicated helpline numbers in case of emergencies.
Inclusion and Eligibility Criteria
Patients with mild symptoms or those who tested positive for COVID-19 but were
asymptomatic/ mildly symptomatic were advised home isolation. People who were feeling
unwell and had Influenza-Like Illness (ILI) symptoms of COVID-19 (fever, cold, running
nose, throat pain) were advised to get tested immediately, and isolate themselves. They
were advised to ensure that there was a separate room with an attached bathroom (if
possible) and a caretaker who could act as a messenger. Those acting as caretakers were advised to
take hydroxychloroquine to make sure they were healthy. People over the age of 60 with comorbidities
were allowed to isolate at home only upon treating doctors’ approval. Similarly, people with HIV, organ
transplant recipients, and cancer patients were advised to follow home isolation only if the treating doctor
recommended the same.
Intervention Details
The state ensured that the ANMs, village/ ward volunteers were notifi ed immediately of
the test results of the patients. Once notifi ed, ANMs, village/ ward volunteers contacted
patients to understand their health condition. Home isolation kits (including medicines
for fever and cold, and masks) were distributed by Mandal Special Offi cers and Municipal
Commissioners.
In order to reduce the burden on hospitals in East Godavari, the district administration adopted a novel
concept of setting up of isolation centers in villages. Many people in rural areas who had mild symptoms
were unable to isolate within the comfort of their homes, given the lack of space. To reduce the spread of
COVID-19, these patients were admitted to the isolation centers wherein they were provided home cooked
food by sarpanches or groups of volunteers. Village secretaries would monitor their health, offer fi rst-aid
kits, and arrange for medical assistance as per the need.
In Krishna district, where less than 10 percent of the 3,200 beds were occupied, mild and suspected
COVID-19 patients were given a cash incentive to opt for COVID-19 Care Centres (CCCs) instead of home
isolation. A lottery system was launched to boost occupancy at eight CCCs. The fi rst winner received
a cash reward of Rs. 15,000 while the second and third won Rs. 10,000 and Rs. 5,000 respectively. The
ANDHRA PRADESH 68 |SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
amount was drawn from the district administration funds, and was transferred directly to the winners’
bank accounts.
CCCs were makeshift facilities that had the required medical facilities, such as medicines, oxygen
concentrators and food provisions. At these facilities, doctor visits were conducted thrice a day and
ambulances were available in case of emergencies. Patients were encouraged to regularly monitor their
temperature and oxygen levels. In case SpO2 levels were below 94 and patients experienced trouble
breathing, doctors would be informed, and they would immediately be referred to a hospital.
Medical Support and Monitoring
A COVID-19 alert tracking system was set up to locate people who had been placed under
home isolation. This was done with technical assistance of the telecommunications
service provider platforms and mobile tower signals. The Rapid Response Teams
(RRTs) line-listed positive cases and mapped their contacts. This helped in deciding the
perimeters for action.
In case of emergencies, a Home Isolation Help Desk and dedicated helpline numbers were set up. As of
May 2021, 15,031 patients were in home isolation out of 17,770 active COVID-19 infection cases. | 69
SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
In September 2020, the State Government launched swaraksha.nic.in,a government-run
website where asymptomatic COVID-19 patients in Jharkhand could register and upload
necessary information to obtain permission for home isolation. The Swaraksha website,
designed by the state National Informatics Centre (NIC), allowed asymptomatic COVID-19
patients to download home isolation certifi cates to prove their eligibility to remain at
home. In addition to this, district-specifi c initiatives were observed in Ranchi, Singhbhum and Dumka.
Inclusion and Eligibility Criteria
In order to get the certifi cate, it was mandatory to register on the website with patients’
Specimen Referral Form (SRF) ID - a unique number which was given to every person who
underwent a test. Following registration, the patient was required to provide infrastructural
details on the website’s form such as the number of rooms and toilets in the patient’s
house. In addition, the patient was required to provide details of: family members older
than 60 years and younger than ten; details of all family members and their comorbidities, if any, details of
the patient’s swab collection date and the dates of the test results. In case the patient was suffering from
any other disease, they were required to mention it on the website irrespective of the nature of the disease.
Once the patient shared all the details on the website, the district administration decided whether or not
the patient could remain in home isolation.
Intervention Details
A dedicated Ranchi website was developed where people could access resource lists
for hospitals, oxygen, home delivery of medicines, COVID-19 consultations, ambulance,
home delivery of essential goods, COVID-19 testing centers, and vaccination along with
the other resources related to COVID-19 management. Also, through google forms,
patients could apply for video consultations of four types through the Swaraksha Portal:
allopathic, Ayurvedic, homeopathic, and Unani. Further, citizens could access location-based information
dissemination feeds, emergency services and hospital information, and other important information via
the Jaano Local COVID-19 emergency system application.
District-level initiatives aided in the fi ght against the virus. For example, in Singhbhum District, the
administration devised concepts such as the Phone Booth Sample Collection Center, which signifi cantly
reduced the need for already scarce and overpriced personal protective equipment (PPE) kits while also
ensuring the safety of the person collecting the sample.
Taking a step forward, the state developed a simple, fast and cost-effective solution, CO-Bot. Co-Bot, a low-
cost (Rs 26,000) remotely operated robotic device that delivered food, water, and medicines to patients.
This reduced interactions between health offi cials and patients, lowering their risk of infection. Co-Bot,
JHARKHAND 70 |SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
which was outfitted with an internet-enabled high definition 360-degree camera and a two-way speaker-
mic system, also allowed doctors and nurses to practice telemedicine. Other initiatives included isolation
beds (also known as i-beds) for positive patients, low-cost face shields, meals-on-wheels deliveries for
the stranded and poor, an ultraviolet note sanitization machine for banks and railway counters, and a
sanitization chamber in a newly established COVID-19 hospital.
Initiatives such as ‘Essentials on Wheels,’ Didi Kitchens, and physical and mental health awareness
campaigns were observed in Dumka District, making the lives of citizens living in home isolation easier.
The state also adopted integrated approach of automated Interactive Voice Response System (IVRS),
telephonic calling and web link response for regular monitoring and follow up of patients under home
isolation for early identification of symptomatic cases and their appropriate linkage to designated COVID-19
Care Centre routed through district health society. The intervention which was developed in partnership
with USAID-NISHTHA/ Jhpiego was targeted to reduce morbidity and mortality due to COVID-19 while
ensuring end-to-end follow-up, right from determining the patient’s status as home isolated, till the time
they complete their time in isolation.
Medical Support and Monitoring
In April 2021, Ranchi District Administration collaborated with an online medical portal
mDoc App to provide free consultations through voice and video calls to COVID-19 patients
in home isolation. The service also facilitated doctors’ visits to patients on request at a
minimal cost and provided free telemedicine. Pathological and physiotherapy services
were also offered; over 700 doctors were registered on the medical portal.
A group of 16 doctors with various specialties under the aegis of National Medicos Organisation (NMO)
also provided free medical consultations to patients in home isolation between 11 AM and 1 PM daily,
assisting them with admission and other assistance as and when required.
In August 2020, the state government announced a 24-hour helpline for COVID-19, non-COVID-19,
and mental health issues in collaboration with StepOne. Callers used the IVRS system to select their
symptoms, and then a registered healthcare expert advised the individual and the government on how to
proceed. Patients with mental health issues received counselling. StepOne is an authorised partner for
Aarogya Setu Mitr telemedicine consultations, an ancillary service on the Aarogya Setu app that provides
free teleconsultation for those with COVID19-like symptoms.
References
¾https:/<> /swaraksha.nic.in/public/index.php
¾https://www.telegraphindia.com/jharkhand/govt-launches-website-to-handle-home-isolation-
requests/cid/1792179
¾https://ranchi.nic.in/covid/
¾https://timesofindia.indiatimes.com/city/ranchi/free-e-consultation-for-ranchi-covid-patients-in-
home-isolation/articleshow/82186270.cms
¾https://theprint.in/opinion/districts-fight-covid/robots-delivering-meals-to-patients-low-cost-ppes-
west-singhbhums-innovative-covid-fight/447191/
¾https://theprint.in/opinion/districts-fight-covid/covid-talent-contests-and-didi-kitchens-how-
dumka-relied-on-community-to-survive-lockdown/462411/ | 71
SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
While the COVID-19 pandemic was spreading, the Karnataka government developed
innovative strategies through careful planning, innovative use of technology, effi cient
deployment of available resources, and community participation. The state government
partnered up with private entities including Swasth, Portea and StepOne to provide care
to home-quarantined/isolated patients as well as connect them to facility care, if needed.
The efforts included teleconsultation and triaging, training of health workers and providing ambulance
services and medicines.
Inclusion and Eligibility Criteria
As per the government guidelines, only asymptomatic or mildly symptomatic patients
were advised to be in home care. These patients were suggested to keep equipment such
as pulse oximeter, digital thermometer, facemasks, gloves, sanitizer, etc. Also, a caregiver
was to be available to provide 24x7 care with the patient. Elderly patients aged above 60
years and those with co-morbid conditions such as hypertension, diabetes, heart disease,
chronic lung/ liver/ kidney disease etc. and lactating mothers were allowed home care only after proper
clinical evaluation by the treating Medical Offi cer (MO)/ physician/ family doctor. Home care was not
applicable for pregnant women two weeks before expected date of delivery. For further daily follow-up of
the patient, tele-monitoring through government or private institution/agency was arranged.
Intervention Details
The state government ensured that health teams from the district health authority/
BBMP/ authorized private institution/ agency visited the patient’s home to ensure they
are isolated. Alternatively, an empaneled agency handled telephonic medical triage by
confi rming the person was isolating. A dedicated tele-monitoring link was established
for the patient’s daily follow-up during the entire period of home isolation/ home care. If
the person developed any warning symptoms during the period of home isolation/ home care, the doctor
evaluated the situation and advised the person to be transferred to COVID-19 hospital as per the need.
Ola Foundation (CSR arm of Ola) partnered with GiveIndia for ‘O2forIndia’ which provided free oxygen
concentrators to patients in quarantine with SpO2 levels less than 94 percent.
Initially, 500 oxygen concentrators were provided, and patients were offered door-to-door delivery and
pick-up of oxygen concentrators. Patients could request oxygen concentrators through the Ola mobile
application by providing a few basic details depositing Rs. 5000, a refundable deposit to use the service.
Ola arranged for the oxygen concentrators to be picked up after the patient recovered and no longer
required oxygen support, so that it could be ‘sterilized’ and made ready to be used by patients. In addition,
Flipkart donated 30 ICU ventilators to the Karnataka government in late June 2021.
KARNATAKA 72 |SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
Taking serious note of reports that many patients in home care routinely flouted rules, resulting in
infection spreading and fatalities, the government in May 2021 decided not to allow people to isolate at
home in urban slums and villages. They made it mandatory for asymptomatic patients and people with
mild symptoms to get admitted to COVID-19 Care Centers (CCCs), which also served as triage centers.
The decision was prompted by health department’s data showing 70 patients either died at home or were
brought dead to the hospital between May 14 and 22, 2021. Home care was limited to urban homes which
had separate rooms and attached bathrooms.
In a bid to ensure compliance with isolation rules, the government planned to affix red tape on houses with
infected people. However, officials claimed that due to lack of awareness about the upgraded facilities
at CCCs including a section with oxygenated beds, people who tested positive were reluctant to move to
those centers, with only about 30 percent of the 19,300 beds occupied in 289 newly set up CCCs in 227
Taluks in May. Of the 3,218 CCC beds in Bengaluru, 90 percent of them were left vacant in May, 2021.
To manage and distribute medical oxygen efficiently and transparently at all levels, the Government, in May
2021, decided to set up an oxygen cell in each district, which would function 24x7. The cell coordinated
with hospitals and meet their demand if there was any shortage. The State already had a 24x7 State
Oxygen Unit and a 24x7 State Oxygen Helpline at the Drug Controller Head Office in Bengaluru. The unit
monitored all re-fillers in their district as well as those from other districts who supplied oxygen to their
district. A database of all the hospitals in the district, as well as their oxygen needs and oxygen suppliers
were regularly maintained.
Medical Support and Monitoring
An algorithm was developed for telemonitoring by government or private entities to
determine home care and then connect patients to a facility when required.
In the first wave of the pandemic, the health department with help of SWASTH provided
teleconsultation to home isolated COVID-19 patients. A total of 5,204 patients were
monitored by the NGO (July to Sept 2020). Subsequently, from October 2020, the health
department partnered with Portea to provide home care including attendant support to COVID-19 patients.
Teleconsultation was made available to home isolated cases via StepOne and Portea Medical. For
medical and non-medical emergencies, patients were given an escalation number. When they received
such a call, they were connected to the zonal officer, who directed them to the quarantine teams. Digital
thermometer, pulse oximeter, a sufficient number of masks, two bedrooms and a caregiver were some of
the requirements to be eligible for home isolation. Portea was made responsible to do the physical triage
and the tele-triage. StepOne announced a 24x7 helpline for COVID-19, non-COVID-19 and patients with
mental health issues. Callers chose their symptoms via the Interactive Voice Response System (IVRS),
after which a registered healthcare expert guided the individual on how to proceed.
Counselling was provided to patients with mental health concerns. StepOne was an empanelled partner
for telemedicine consultations on Aarogya Setu Mitr, an ancillary service on the Aaroya Setu app that
enables free teleconsultation for those with COVID19-like symptoms.
Portea Medical partnered with the Government of Karnataka to support the recovery and care unit in
COVID-19-affected rural areas. Portea set up a 50-bed community health center in Konanur, Arkalgud
taluk, Hassan District, Karnataka. For this initiative, the company collaborated with an NGO called DFY.
Portea worked in 15 Primary Health Centers (PHCs) in the surrounding area. The centers could provide
24-hour oxygen support as well as HDU beds equipped with BiPAP machines and oxygen concentrators. | 73SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
As of May 2021, Rajiv Gandhi University of Health Sciences (RGUHS) trained over 7,000 final year MBBS
students to treat and monitor the home-isolated cases. The university registered and trained the students
through StepOne app. COVID-19 duty was mandatory for all the final year MBBS students studying at
colleges affiliated to RGUHS and as of May 2021, 4,000 students had registered and 2,500 of them had
been trained. According to the university officials, each student was assigned to make 40 calls/ contact 40
home-isolated patients every day. If the students discovered a patient who required additional treatment,
they contacted the team’s senior doctors and catered to their needs.
References
¾https:/<> /covid19.karnataka.gov.in/storage/pdf-files/HFWpercent20295percent20ACSpercent
202020percent20Homepercent20Isolationpercent20ver2.pdf
¾https://www.aninews.in/news/national/general-news/karnataka-ropes-in-medical-students-to-
provide-teleconsultation-to-covid-patients-in-home-isolation20210506221706/
¾https://www.deccanherald.com/state/top-karnataka-stories/karnataka-govt-appoints-private-
firm-to-offer-telemonitoring-services-to-covid-19-patients-under-home-isolation-892850.html
¾https://www.biospectrumindia.com/news/77/19046/portea-medical-collaborates-with-
karnataka-govt-for-covid-19-care.html
¾http://www.uniindia.com/flipkart-donates-icu-ventilators-to-karnataka/south/news/2434053.html
Shift to Covid hospital
(DCHC/DCH)
Isolate person at home/
home care
Shift the person to Covid
Care center(CCC)
Asymptomatic/mild symptomsModerate/severe
Not suitable for Home
isolation
Suitable for Home isolation/
Home care
Alogrithm for deciding Home isolation/Home care
Tele-monitoring team/Health team/medical officers/physician
perfrom medical triage of the person and assess suitability of house
A person tests positive for Covid-19 74 |SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
¾ht<> tps://www.honeywell.com/us/en/press/2021/05/honeywell-demonstrates-support-for-india-s-
covid-relief-effo
rts ¾https://projectstepone.org/
¾https://www.newindianexpress.com/states/karnataka/2021/may/13/247-oxygen-cell-to-be-set-
up-in-each-karnataka-district-2301952.html
¾https://timesofindia.indiatimes.com/city/bengaluru/home-care-scrapped-karnataka-government-
now-struggles-to-fill-covid-care-centres/articleshow/82897182.cms
¾https://www.hul.co.in/news/news-and-features/2020/committed-towards-combating-covid-19.
html
¾https://www.india.com/news/india/ola-to-begin-free-home-delivery-of-oxygen-in-bengaluru-other-
cities-amid-covid-19-crisis-4656368/ | 75
SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
Kerala is one of the few states in India with a strong pre-existing public health network to
support COVID-19 home-care without any help from private entities. Their efforts to reduce
burdens on hospitals were largely successful, and were also recognized by the WHO
(World Health Organization) in July 2020
4
. Active surveillance, setting up of district control
rooms for monitoring, strong community engagement and addressing the psychological
needs of the vulnerable population were some of the key strategic interventions implemented by the state
government that kept the disease in control.
Inclusion and Eligibility Criteria
The district
administration
decided when
to initiate
the Standard
Operating Procedure (SOPs)
for home-based management
of asymptomatic COVID-19
patients. The following clinical
criteria were used to determine
eligibility: COVID-19 positive by any
confi rmatory test, asymptomatic
(no symptoms), persons with no
major morbidities/ uncontrolled
comorbidity/ vulnerable
condition, persons who were
psychologically fi t and willing to
be isolated in a room. Children
under the age of 12 were allowed
to be placed in room isolation
with their parent/ caregiver, with
a third person acting as caretaker.
All these category patients were
assessed by Medical Offi cers
(MOs) from the local health
authorities and were provided
care under the breakthrough fi ve
tier COVID-19 care model.
KERALA
The Five Tier Covid 19 Care Pyramid - Ke rala
Cat B-CSL TC-COVID 2nd Line
Treatment Centre
Cat A-CFL TC-COVID 1st Line
Treatment Centre
Asymptomatic with no provision
for home care and isolation-DCC
(Domiciliary care centre)
Asymptomatic - Home care
and isolation
Cat C-Designated
COVID Hospital 76 |
SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
As determined by local self-government and health authorities, adequate access (road and communication),
separate rooms with attached bathrooms, provision for vulnerable people to be isolated/ separated, and
a healthy caretaker were the pre-requisites for home isolation. COVID-19 negative family members from
vulnerable groups were closely monitored by the local primary healthcare teams, either by extending
the three levels of daily monitoring or by having a Junior Public Health Nurse/ Accredited Social Health
Activist (ASHA) Volunteer visit every third day to monitor the vulnerable member using the checklist. All
exposed members of the household were quarantined for 14 days after their last contact with a confirmed
COVID-19 patient at home. The supply of basic commodities to such households was ensured by the
Local Self Government (LSG).
Intervention Details
The state government used innovative approaches to strengthen its health infrastructure.
Coordinated efforts were made between the state and district units to bring out treatment
and discharge protocols.
Test results were sent to the respective district program management and support units,
who handed over the same to Rapid Response Teams (RRTs) as well as the individuals.
The RRTs were responsible to get in touch with individuals, check their health conditions, and give
directions on the next step of care. Those without facilities for proper home isolation were accommodated
in domiciliary care centers arranged by the LSGs.
For the primary contacts at the individual’s home, all help, including food or medicines were ensured by
ward-level committees. Those under home care were moved quickly to the hospital if they experienced
shortness of breath or fall in oxygenation. The rapid response teams were contacted and were made in
charge of the next steps.
Self-Care guidelines and recommendations were laid out in detail by the authorities. Every day, patients were
contacted via phone by local health teams for symptoms in accordance with a prescribed checklist, which
was signed by a medical officer. These patients were monitored for symptoms, SpO2 levels, psychological
evaluation, and social issues. If patients developed symptoms such as hypoxia or tachycardia, they were
transported to the nearest COVID-19 First Line Treatment Centers/COVID-19 hospital, depending on the
severity. Specially designed double chambered vehicles were used for transportation.
Medical Support and Monitoring
Considering the increase in the number of cases, the state government rolled out a three-
level daily monitoring system for providing medical support.
Daily
telphoneic
monitoring
Self
monitoring
and reporting
of symptoms
Finger pulso
oximetry
123 | 77
SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
With an aim to minimize fatalities, Tele ICU Command Centers were established at district level which
were managed by experienced intensivists and nurses on a 24x7 basis. These Tele ICU infrastructures
included monitors, computers with headphones, speakers and high-speed internet connection. The
government also encouraged private hospitals with intensive care expertise to provide tele ICU facility to
small hospitals in Hub and Spoke model. District Medical Offi cer and Institutional medical boards were
made responsible to oversee the plan, establish systems and monitor activities.
Scalability and Replicability
The COVID-19 management and control in Kerala ensured commitment from the highest
administration with proactive timely interventions. In order to scale up and reduce the
chances of virus spread in future, fever clinics can be converted into COVID-19 clinics
across all Hospitals. Further oxygen beds can be arranged at Taluka Hospitals and
wherever possible. At Primary Health Center/ Family Health Center and all other hospitals
it is important to ensure regular stock of steroids and oral anticoagulants in accordance with home care
management advisory. Support mechanisms such as home care and oxygen concentrator arrangement
for home, along with other treatment support can be established for patients’ bed-ridden at home.
Telemedicine units and counsellors can be leveraged for regular assessment of health status.
Daily telephonic follow up by
PHC MO/designated person
Self assesment of symptoms
Daily pulse oximetry and
assesment of pulse rate by patient
YesYesYesNONONO
Shift to
Covid
hospital
Continue
Inform
PHC MO/
DISHA
Continue
home
care
Continue
home
care
Inform
PHC MO
and shift to
designated
Covid
Hospital
Altered sensorium, breathlessness, Chest pain, Drowsiness,
Haemoptysis, excessive fatiguability, syncope, palpitation
Red fl ag
signs
Assess for fever or any red fl ag
signs
Observe for devlopment of
fever or red fl ag sign
SpO2<94 on room air
PR>90/min
Home care of Asymotomatic Category A
Medical Support and Monitoring
Three Level Daily Monitoring System 78 |SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
Isolation wards can be set up at Community Health Care Centers and major hospitals across the state
including building isolation blocks in Kozhikode and Thiruvananthapuram Medical College Hospitals.
Scale up infrastructure for treatment of pregnant women and children is another important measure. The
state can also plan to maximize vaccination drives to reduce transmission. It is also important to focus
on post-COVID-19 care, particularly stress management and anxiety issues.
References
¾https:/<> /dhs.kerala.gov.in/wp-content/uploads/2020/08/Advisory-Home-care-Asymptomatic-
COVID19-Postive-patient.pdf
¾https://dhs.kerala.gov.in/wp-content/uploads/2021/04/Summary-Of-Covid-19-quarantine-and-
isolation-guidelines.pdf
¾nCorona – Guidelines Department of Health and Family Welfare Govt of Kerala
¾Responding to COVID-19 - Learnings from Kerala
¾Teams to monitor patients in home care
¾https://dhs.kerala.gov.in/wp-content/uploads/2020/10/Guidelines-Tele-ICU-and-Intensive-Care-
Servcies-1.pdf
¾https://dhs.kerala.gov.in/wp-content/uploads/2021/05/Guideline-Strengthening-Patient-Care.pdf
¾Kerala is preparing for a possible third wave of COVID-19: Here’s how | 79
SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
Around 24 municipal wards of Mumbai fall under the jurisdiction of the Brihna Mumbai
Municipal Corporation (BMC). Each of these ward offi ces have a disaster control room,
which were converted into COVID-19 response ‘war rooms’. A dedicated helpline number
(linked to 30 more lines) was set up for each war room to oversee cases arising in
municipal wards. Based on the condition of the patient, if they had been recommended
home isolation, staff members enquired whether patients were able to and had the required space to
isolate in their homes. If not, patients were provided with appropriate institutional quarantine facilities to
isolate. A dashboard was also created which provided real time updates to the BMC.
The state of Maharashtra partnered with the private sector to support in the fi ght against the COVID-19
pandemic. Hindustan Unilever Limited (HUL) provided RT-PCR testing kits and other supplies including
pulse oximeters, PPE kits, masks, oxygen concentrators and 29 ventilators to government hospitals in
Maharashtra. To augment the quarantine system instituted by the government, HUL tied up with Apollo
Hospitals, State Bank of India, Oyo, Lemon Tree and others to create isolation facilities equipped with
medical supervision to help reduce the burden on hospitals while providing acute care for patients in need.
They also donated over 74,000 testing kits for early detection of COVID-19. These kits were used to conduct
free testing of patients in government hospitals. Efforts were also made to upgrade medical infrastructure
in hospitals treating COVID-19 patients. Another private sector partner, Honeywell, along with its NGO
partners, in consultation with the state government of Maharashtra, established a COVID-19 critical care
center equipped with beds, oxygen, PPE kits and other basic medical infrastructure.
Intervention Details
In August 2020, StepOne, in partnership with the state government of Maharashtra set up
a 24x7 telemedicine helpline for COVID, non-COVID-19 and mental health related issues.
Callers could choose their symptoms via the Interactive Voice Response System. Following
this, a registered healthcare expert would guide the patient on when and where to seek
care. Patients with mental health issues were provided counselling services. StepOne
is also an empaneled partner for telemedicine consultations on Aarogya Setu Mitr, an ancillary service
on the Aargoya Setu app that enables free teleconsultation for people with COVID-19 like symptoms. In
May 2021, home quarantine was stopped in 18 districts that had a higher COVID-19 positivity rate than
the state’s average and COVID-19 care centers in these districts began functioning as isolation facilities.
Reference
¾https://www.downtoearth.org.in/news/health/bmc-s-24x7-decentralised-war-rooms-helping-
stem-covid-19-cases-in-mumbai-76801
¾https://www.news18.com/news/india/communication-is-key-mumbais-covid-19-model-gets-
govt-praise-maharashtra-coronavirus-mumbai-model-bmc-3727934.html
¾https://www.thehindu.com/news/cities/mumbai/covid-19-maharashtra-to-stop-home-
quarantine-in-18-districts/article34641134.ec
MAHARASHTRA 80 |
SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
To fi ght the COVID-19 pandemic, in June 2020, the government of Odisha announced
setting up of COVID-19 Care Homes (CCHs) in all 6,798 Gram Panchayats of the state.
Odisha also set up special COVID-19 hospitals for critical patients, equipped with
approximately 10,000 beds and ICU facilities and also trained health workers with the
right skills to fi ght this pandemic
In July 2020, the government released detailed guidelines on home isolation for asymptomatic/ mildly
symptomatic patients with no comorbidities. This was facilitated by the state’s Health and Family Welfare
department.
Inclusion and Eligibility
The criteria for inclusion and eligibility of persons to be placed under home isolation
included mild symptomatic/ pre-symptomatic/ asymptomatic cases, having the requisite
facility in their homes for self-isolation. Family members of the isolated patient, who
were in contact with them, were also required to have space for quarantine, along with
a separate toilet. Adult caregivers were required to provide care to patients at all times,
i.e. on a 24x7 basis and communication between the caregiver and state helpline was a requirement
throughout the duration of the home isolation period. Caregivers and all others that came in contact
with COVID-19 patients were asked to take all necessary precautions. Patients were asked to constantly
monitor their health and vitals and keep the Health Authorities informed for surveillance teams to follow
up accordingly. Patients were required to fi ll an undertaking on self-isolation, stating that they would follow
all home quarantine guidelines and other family members in home quarantine were also required to follow
the protocols. Stickers were put outside the homes of COVID-19 patients to caution others.
COVID-19 patients with comorbidities including those with Hypertension, Diabetes, Heart Disease,
Chronic Lung/ liver/ kidney disease, Cerebro-vascular disease etc., Immuno-compromised patients (HIV,
Transplant recipients, Cancer Therapy etc.) and elderly patients were not eligible for home quarantine.
Intervention Details
The COVID-19 Isolation Facilities, known as COVID-19 Care Centers (CCC) / COVID-19
Health Centers (CHC) that were created by the state government were primarily used as
isolation facilities for COVID-19 suspect / positive cases who did not have the required
infrastructure to isolate in their homes. Each of the CCHs set up in the state had facilities
to accommodate 10 to 20 persons, and all put together could accommodate about
70,000 people. Every institute that created isolation facilities - CCCs/ CCHs were required to nominate
a dedicated offi cer, who would maintain close and regular contact with the Chief District Medical Offi cer
ODISHA | 81SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
of the district. Further, a nodal officer was also specially notified by the District Collector/Municipal
Commissioner for home isolation. The state also issued specific SOPs for medical personnel, nursing
officers and security personnel at quarantine facilities. In order to decentralize its COVID-19 management,
the state government further announced the setting up of ward level committees in both urban and rural
areas to monitor the situation and extend help to anyone testing positive.
The ward level COVID-19 management committees in rural areas included ward members, Auxiliary
Nurse Midwives (ANM) and Accredited Social Health Activist (ASHA) workers, and members of local
women’s self-help groups. The village welfare committees overlooked the functioning of the COVID-19
management committees.
In urban areas, ward committees were managed by ward officers, local people and volunteers as members
to monitor the situation. These committees were also set up in CCHs in large slum clusters. The Health
and Family Welfare department developed a simple training module for COVID-19 positive patients and
caregivers in both Odia and English languages. The department also developed a brochures/ leaflets on
the subject which was shared with COVID-19 positive patients and their caregivers.
Medical Support and Monitoring
The District/ Municipal Administration/ Health Authorities were in charge of monitoring
all cases under home isolation. The health status of those under home isolation was
monitored by field staff/ surveillance teams through personal visits, along with a
dedicated call center to follow up with patients on a daily basis. The clinical status (body
temperature, pulse rate and oxygen saturation) was recorded by field staff/ call center.
Patients were guided on measuring their parameters and provided with instructions by field staff. The
details of patients were regularly updated on the COVID-19 portal and facility app and shared with the
District Surveillance Officer.
In case a patient needed to be moved to a COVID-19 facility, they were to be transferred only via dedicated
COVID-19 ambulances of the designated COVID-19 care facility. In case of the following serious signs /
symptoms wherein immediate medical attention was required, patients were to contact the 104 helpline
and not directly go to any hospital, these included: Difficulty breathing, Dip is SpO
2
(<95percent), Persistent
pain/ pressure in the chest, Mental confusion, Slurred speech/ seizures, Weakness or numbness in any
limb/face, Developing bluish discolorations.
In May 2021, the Odisha Transports department fixed hiring charges of various types of ambulances
operated by private hospitals and private operators in the state. Small categories of ambulances like
Maruti Omni, Tata Magic and Maruti Eco etc. could charge Rs 750 up to 10 kilometers of distance. Also,
small ambulances with basic life support facilities could charge Rs 1,000 up to the same distance.
These categories of ambulances could charge Rs 30 per additional kilometer exceeding 10 kilometers.
Further, medium category ambulances like Mahindra Bolero could charge Rs 1,000 up to the distance
of 10 kilometers. These ambulances with basic life support system facilities could charge Rs 1,500 up
to the same distance. Large categories of ambulances like Tata Winger, Force Traveller and Tata 407
etc. could charge Rs 1,250 up to 10 kilometers. These categories of ambulances with basic life support
system facilities could charge Rs 2,000 up to the same distance and ambulances could also charge Rs 30
per additional kilometer exceeding 10 kilometers. Also, large category of ambulances with advanced life
supporting system facilities could charge Rs 3,000 up to 10 kilometers and extra charges per additional
kilometers. 82 |SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
Tele-consultation services were rolled out by the state in partnership with StepOne. The 24x7 helpline was
issues covering COVID, non-COVID-19 and mental health. Callers could choose their symptoms via the
IVRS system. Following this, a registered healthcare expert would guide the patient on when and where
to seek care. Patients with mental health issues were provided counselling services. StepOne is also
an empaneled partner for telemedicine consultations on Aarogya Setu Mitr, an ancillary service on the
Aargoya Setu app that enables free teleconsultation for people with COVID-19 like symptoms.
Scalability and Replicability
During the first wave, the state government had set up 16,815 temporary medical centers
at the Gram Panchayat level across the state, with a total of 7,62,345 beds. Many of these
centers were shut down as the number of returnee migrant workers declined. A new role
can be envisaged for these centers.
References
¾ht<> tps://www.google.co.in/amp/s/www.thehindu.com/news/national/coronavirus-odisha-to-set-
up-covid-care-homes-in-all-gram-panchayats/article31855777.ece/amp/
¾https://nidm.gov.in/covid19/PDF/covid19/state/odisha/300.pdf
¾https://odishatv.in/news/covid-19/odisha-fixes-hiring-charges-for-ambulance-services-issues-
warning-46804
¾https://health.odisha.gov.in/pdf/Guidelines-for-Quarantine-facilities-COVID-19.pdf | 83
SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
Overview
Launched in August 2020, the state of Tamil Nadu’s key initiative was the Amma COVID-19
Homecare scheme, under which kits and teleconsultation was provided at home. The
state also made use of eSanjeevani OPD and launched Siddha-based treatment facilities.
Private players like StepOne and Ola also contributed to home based care in the state.
Inclusion and Eligibility Criteria
All patients with SpO2 level above 94 percent (if RT-PCR results were positive then
irrespective of symptoms, otherwise suspected cases with RT-PCR negative or untested
with symptoms) were advised home isolation by the government. This was prescribed
through testing/ screening/ triaging centers, health facilities, outreach camps and home
visits. Exceptions for this were pregnant/ lactating mothers or patients above the age of
65, who were referred to COVID-19 hospitals.
Intervention Details
Amma COVID-19 Homecare Scheme: Introduced in August 2020, through this scheme
people in home isolation could avail diagnostic services, medicines, and consultations.
The care package was offered for a period of 14 days, at a cost of Rs 2,500.
Patients who tested positive and were advised home isolation, and people with RT-
PCR negative results but suspected symptoms (as of August 2020) were provided with
homecare kits that contained pulse oximeters, digital thermometers, 14 face-masks, soaps, 14 zinc
and 14 multivitamin tablets and packs of herbal immunity boosters like ‘Athimathuram’ and ‘Kabasura
Kudineer’, among others. The kit also contained a COVID-19 booklet. The package included psychological
counselling, prescriptions and monitoring of oxygen levels and temperature by a team of doctors. If
patients showed signs of worsening condition, they were shifted to hospitals.
An exclusive facility with 350 beds for COVID-19 treatment was set up at the Pudukottai Medical College
Hospital. Among the 350 beds, 35 were allotted to intensive care units, 165 beds were equipped with
oxygen lines and separate rooms and advanced equipment were also made available at the facility.
In Chennai, patients were shifted from test and screening centers through GVK EMRI 108 Ambulance
Services based on calls received by the Emergency Response Centre of the organization. Transit of patients
from test centers to government and private hospitals was free of cost. Further, to ensure availability of
ambulances for everyone, private operators were permitted to shift COVID-19 patients. The government
fi xed rates for private ambulances and took strict action against defaulters.
The Ola Foundation (CSR arm of Ola), partnered with GiveIndia for ‘O2forIndia’ initiative. They provided free
oxygen concentrators to patients in quarantine in Chennai. Initially they supplied 500 oxygen concentrators
TAMIL NADU 84 |SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
to patients free of charge by offering doorstep delivery and pick-ups of oxygen concentrators. To avail this
service, patients had to place requests for oxygen concentrators through the Ola mobile app by providing
some basic details. Home delivery was done by specially trained personnel through taxis. After the patient
recovered and no longer required oxygen support, Ola would arrange pick-ups and sterilize the oxygen
concentrators and then deliver to other patients in need.
Medical Support and Monitoring
A citizen-centric initiative for uninterrupted services during pandemic: eSanjeevani
COVID-19 OPD provided integrated telemedicine solutions. Instructions were sent to
Government Health facilities including PHCs, HSCs to provide drugs for ePrescription
generated via the eSanjeevani OPD. Over 3,50,000 consultations were conducted through
this initiative (till December 2020). Symptomatic patients were identified and shifted to
higher facilities for further care.
Tele-consultation and counselling services were provided through StepOne, with a 24x7 helpline for
COVID, non-COVID-19 and mental health related issues. Callers could choose their symptoms via the
IVRS system. Following this, a registered healthcare expert would guide the patient on when and where
to seek care. Patients with mental health issues were provided counselling services. StepOne is also
an empaneled partner for telemedicine consultations on Aarogya Setu Mitr, an ancillary service on the
Aargoya Setu app that enables free teleconsultation for people with COVID-19 like symptoms.
00-bedded facilities were made available at the Government Polytechnic College in Cuddalore district
in June 2021. Patients were given only Siddha formulations i.e. traditional food items and herbal
concoctions. Besides this, breathing exercises for strengthening lungs, exercises for increasing oxygen
saturation, meditation, ‘aasanaas’, relaxation and counselling was done. Discharged patients were given
Siddha formulations to strengthen their physique.
Sustainability and Replicability
The Amma homecare scheme was sustainable, although its popularity was limited
to certain districts till November 2020.The state launched 2,000 Amma Mini-Clinics
in January 2021 and 1,645 doctors were recruited to run them. The Deputy Directors
of Health Services, under whose purview the mini-clinics fall, was instructed to divert
medical officers, on a need basis, as per requests to institutions that come under the
Directorate of Medical Services.
The Government COVID-19 Hospital, a 600-bed exclusive facility in King Institute Campus in Guindy, is
planning to open a comprehensive post-COVID-19 care center with an outpatient unit, testing facilities,
inpatient and rehab services. The state has also upgraded services of post COVID-19 clinics across
all medical colleges. These clinics will have senior pulmonologists, diabetologists, cardiologists and
neurologists posted, and also have rehab wards where physiotherapy and other treatments will be offered.
The state is ramping up infrastructure and human resources in its pediatric wards and sensitizing
pediatricians to COVID-19 treatment protocols and management while ensuring adequate supply of
steroids, IV immunoglobulin and other drugs needed. Additional NICU units are also being added. Medical
colleges and district HQ hospitals are working towards creating additional bed capacity, over and above
existing pediatric capacity, along with ICUs. Incentives have also been offered to manufacturers of oxygen
and COVID-19 related equipment. | 85SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
References
¾https:/<> /www.thehindu.com/news/national/tamil-nadu/home-care-of-patients-with-mild-covid-19-symptoms-
gains-traction/article32896607.ece
¾https://cms.tn.gov.in/sites/default/files/go/hfw_e_257_2021.pdf
¾https://cms.tn.gov.in/sites/default/files/go/hfw_e_240_2021.PDF
¾https://indianexpress.com/article/cities/chennai/covid-19-in-tamil-nadu-updates-6555009/
¾https://www.nhm.gov.in/New_Updates_2018/Innovation_summit/7th/HSS/HSSpercent20PPTspercent
20percent20percent285percent29/Tamilpercent20Nadu-percent20eSanjeevanipercent20Nationalpercent20
Summit.pptx
¾https://projectstepone.org/
¾https://timesofindia.indiatimes.com/city/chennai/tamil-nadu-govt-to-set-up-special-post-covid-care-clinics/
articleshow/83942346.cms
¾https://www.india.com/news/india/ola-to-begin-free-home-delivery-of-oxygen-in-bengaluru-other-cities-
amid-covid-19-crisis-4656368/
¾https://www.newindianexpress.com/states/tamil-nadu/2021/may/09/tamil-nadu-to-add-12-siddha-covid-
care-centres-for-mild-patients-health-ministerma-subramanian-2300371.html
¾https://www.thehindu.com/news/national/tamil-nadu/readying-for-a-third-wave-tamil-nadu-ramps-up-
infrastructure-in-paediatric-wards/article34862019.ece 86 |SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
Annexure 1: Summary of the guidelines on home isolation
I. P<> atients eligible for home isolation:
1. Clinically assigned mild/ asymptomatic case by the treating Medical Officer. S/he must be in
constant contact with a treating physician and promptly report in case of any deterioration.
2. Have the requisite facility at their residence for self-isolation and for quarantining family contacts.
3. A caregiver should be available to provide care on 24 x7 basis. A communication link between the
caregiver and healthcare facility is a prerequisite for the entire duration of home isolation.
II. Who is NOT eligible for home isolation
1. Elderly patients aged more than 60 years and those with co-morbid conditions shall only be allowed
home isolation after proper evaluation by the treating medical officer.
2. Patients suffering from immune compromised status are not recommended for home isolation
and shall only be allowed home isolation after proper evaluation by the treating medical officer/
Community Health Officer.
III. General precautions for the patients:
1. Hydration: To stay hydrated at all times and take adequate amounts of fluids in form of juices,
soups and water.
2. Diet: Healthy diet containing adequate energy, protein, vitamins and minerals, obtained through the
consumption of a variety of foods, including green and orange vegetables, meat, fish, beans, nuts, whole grains and fruit should be consumed.
3.
Toilet use: To flush after closing the lid of the toilet and disinfecting the items used with 1% sodium
hypochlorite spray solution/sanitizers/soap solution.
4. Avoid sharing personal items with anyone else like toothbrushes, eating utensils, dishes, drinks,
bath/hand towels, wash cloths or bed linen, etc.
5. Take adequate rest and sleep well.
6. Do not meet visitors till you are released from home isolation/ home care.
7. Self-monitoring: Check and record your body temperature using mercury/ digital thermometer
(shall be < 100.40 F) in armpit and oxygen saturation with a fingertip pulse oximeter (shall be >95%) thrice daily.
8.
Keep in contact with friends and family through messages, phone calls, or simply conversing with
them from a safe distance – viz. from the balcony/roof/window.
9. Prone ventilation can be practiced by all isolated patients’ multiple times in a day for up to 16 hours,
with 30 minutes in each position.
10. Medication advised during home/community-based isolation should be symptomatic. There is no
requirement of administering hydroxychloroquine, remdesivir, tenofovir, zinc, multivitamin, etc
11. Infection with COVID-19 predisposes people with compromised pulmonary function to developing
severe complications. Therefore, patients with cystic fibrosis, COPD, chronic asthma etc. should be especially careful. Smokers should also be strongly advised to quit smoking, at least for the period of active infection.
ANNEXURES | 87Home-based Management of COVID-19: Best Practices Adopted by States
IV.When to seek medical attention:
Immediate medical attention must be sought if warnings signs or symptoms develop. These could
include difficulty in breathing, dip in oxygen saturation (SpO2 < 94% on room air), failing to perform
the 6-minute walk test, persistent pain/pressure in the chest, extreme fatigue and mental confusion
or inability to arouse
V.Instructions for caregivers:
1.Mask: The caregiver should wear a triple layer medical mask or N95 mask when in the same
room with the isolated person. If the mask gets wet or dirty with secretions, it must be changed
immediately. Discard the mask after use and perform hand hygiene after disposal of the mask.
2.Hand hygiene: Hand hygiene must be ensured following contact with an ill person or his immediate
environment. Use soap and water for hand washing at least for 20 seconds. Alcohol-based hand
rub can be used, if hands are not visibly soiled.
3.Patient care: Avoid direct contact with body fluids of the patient, particularly oral or respiratory
secretions. Avoid exposure to potentially contaminated items in his immediate environment
4. Cleanliness:
a.Clean and disinfect frequently-touched surfaces like phones, remote controls, counters, table-
tops, doorknobs etc with 70% Lysol or 1% sodium hypochlorite solution.
b. Clean and disinfect bathroom, fixtures and toilet surfaces at least once daily. Regular household
soap or detergent shall be used first for cleaning, followed by 1% sodium hypochlorite solution
c.Gloves, masks, disposed tissue and other waste generated during home isolation/home care
shall be sprayed/ soaked in 1% sodium hypo-chlorite solution and disposed in a yellow bag in
separate bin.
5.Waste disposal: Effective waste disposal helps prevent further spread of infection within household.
The waste (masks, disposable items, food packets etc.) should be disposed of as per CPCB
guidelines.
Left-over food, empty juice bottles, disposable utensils, empty water bottles, waste generated from kitchen, packaging material, waste papers, waste plastics, any other items generated or used by family members and the positive person at home isolation/ home care should be collected along with other general solid waste in bags securely tied for handing over to waste collectors.
Masks and gloves used by caregiver and other family members shall be kept in paper bag for a minimum of 72 hours prior to disposal of the same as general waste after cutting, the same to prevent reuse.
When to discontinue home isolation: Patients under home isolation will stand discharged and
end isolation after at least 10 days have passed from onset of symptoms (or from date of
sampling for asymptomatic cases) and no fever for 3 days. There is no need for testing after
the home isolation period is over.
Given below are links to the guidelines issued by MoHFW, CGHS and ICMR
MoHFW:https://www.mohfw.gov.in/pdf/RevisedGuidelineshomeisolation4.pdf https://www.mohfw.
gov.in/pdf/RevisedguidelinesforHomeIsolationofmildasymptomaticCOVID19cases.pdf
CGHS:https://cghs.gov.in/WriteReadData/l892s/Guidelines%20for%20tele-homecare%20of%20
COVID-19%20patients%20(16%20June%202020).pdf
ICMR: https://www.icmr.gov.in/pdf/covid/techdoc/COVID_HOME_CARE_English_v2.pdf
ANNEXURES 88 | Home-based Management of COVID-19: Best Practices Adopted by States
ANNEXURES
Annexure 2: Best practices from partner organizations
USAID-NISHTHA/JHPIEGO
USAID’s flagship health system strengthening project NISHTHA, implemented by Jhpiego, is supporting
13 states in strengthening the delivery of comprehensive primary healthcare. NISHTHA is also working
closely with the states to strengthen their response towards COVID-19. NISHTHA is providing technical
assistance to the intervention states for improved provision of home-based isolation care across following
areas:
Capacitating states in line with GoI’s home isolation guidance – NISHTHA has been providing technical assistance to its intervention states for implementation of the home isolation care guidelines with local contextualization. These guidelines are also being modified into interactive and easy to understand flyers which acts as a job-aid/ checklist for field level functionaries. The project has supported capacity building efforts across five states (Tripura, Meghalaya, Sikkim, Mizoram and Arunachal Pradesh) and about 1900 frontline workers have been trained on home isolation care and management protocols.
Co-design and implementation of home-based care models – NISHTHA has co-designed a menu of home-based isolation care models based on the local needs of the intervention states. These models are being rolled out for enhanced remote monitoring, follow up and home-based care of COVID-19 patients. Following models have been rolled out across intervention states:
a.Integrated Tech Enabled Home-Based Care Model -Tele-Track – NISHTHA is leveraging technology to develop an end-to-end integrated technology enabled home-based care platform i.e. NISHTHA Tele-Track for monitoring, care and management of asymptomatic and mild COVID-19 cases under home isolation. The platform acts as an enabler for effective monitoring and tracking of COVID-19 patients and has functionalities for recording of vitals of home isolated cases on a daily basis, provision of regular & need based SOS telemedicine consultations with a pool of physicians and digital reporting and with generation of system alerts in case a patient develops symptoms and requires referral. The platform has been recently rolled out across five states i.e. Arunachal Pradesh, Mizoram, Meghalaya, Madhya Pradesh and Nagaland.
b.Assisted home care model through home visits by health workforce – The model envisages follow-up through home visits by health workforce of asymptomatic and mild COVID-19 cases under home isolation for early identification of complications and establishing referral linkages with higher facilities. This intervention is being rolled out across two states i.e. Meghalaya and Sikkim.
c.Hybrid model by Integrating IVR and Telephonic Follow up – To strengthen efforts in the management of COVID-19 cases, a solution has been designed for regular monitoring and follow up of patients under home isolation and post discharge patients to identify early symptomatic cases and link them with appropriate care. This is a hybrid model that has been deployed using the IVR technology, web-based google form, and tele-calling by trained human resources to ensure seamless follow-up of patients under home isolation. This initiative has been undertaken with an objective of augmenting state’s efforts towards COVID-19 and thereby, reducing overall morbidity and mortality due to the pandemic. This intervention has covered around 96,080 and 25,686 patients under home isolation in the states of Jharkhand and Chhattisgarh respectively. With the second surge of COVID-19, the platform has been rolled out in Assam also and around 2300 patients have been reached out through this platform till date (rolled out on June 7, 2021), of which 122 patients were found symptomatic and linked with appropriate care. | 89Home-based Management of COVID-19: Best Practices Adopted by States
Floating Home Isolation Kit Bank – Most of the states are struggling with availability of COVID-19
Home Isolation Kits comprising basic state approved medicine for COVID-19 management, self-
monitoring device like pulse oximeter, thermometer and personal hygiene products to provide quality
care for home isolated patients. To address this challenge, NISHTHA in collaboration with the state
government of Nagaland has developed an innovative model of Floating Home Isolation Kit Bank
across two high burden districts i.e. Dimapur and Kohima by creating a pool of CHIKs on a return after
use basis.
Development of differentiated home based care approaches for vulnerable groups – Building upon the ministry’s home isolation guidelines as the reference document, NISHTHA in collaboration with Indian Association of Preventive and Social Medicine (IAPSM) developed an operational guideline for differentiated home-based care approaches for various identifi ed vulnerable groups. The idea is to adapt ministry’s guidelines for home isolation to the current context of various vulnerable groups for use by local self-governments, PRIs, civil society organizations and NGO partners. These operational approaches will focus on differentiated home based care models for identifi ed vulnerable groups like urban poor, migrants, children, transgender, tribal population, people living with HIV, pregnant and lactating women, persons with disabilities, and mental health issues etc. These operational approaches will clearly spell out various kind of operational models for home-based care for these special groups based on their vulnerabilities and specifi c needs.
Risk communication materials for both patients and care givers – NISHTHA is providing support to its intervention states for developing and disseminating risk communication materials on COVID-19 messaging. This includes development of RCCE materials, job aids and protocols on COVID-19 Appropriate Behaviors, post COVID-19 care, care during home isolation, mental health, breastfeeding and COVID-19, wellness etc. A guidebook was also developed for parents on prevention and care of COVID-19 among children.
ANNEXURES
Identifi cation and line
listing of COVID
patients requiring
CHIKs by District
health authority
(DHA)
Sharing of contact
details and address of
the identifi ed patients
by DSO to the
dedicated health staff
for delivery of CHIK
Staff will call the
COVID patients and
brief them about CHIKs
and give necessary
instructions
NGO identifi ed by DHA
to deliver CHIKs to the
patients and obtain
written consent from
relatives of patient
NISHTHA Tele-Track will
monitor patients for10
days and generate alerts
to DHA for linkages for
emergency referral
After 10 days, District
Task Force (DTF) will issue
discharge certifi cates, as
per the existing SOP
NGO to collect CHIKs during
the next 3 days from the
patient and deposit it in
CMO offi ce for disinfection.
Patients will be advised to
sanitize CHIKs before it is
being handed over to NGO
Nagaland: Process fl ow of Floating Home Isolation Kit Bank 90 |Home-based Management of COVID-19: Best Practices Adopted by States
F<> urther, NISHTHA has developed a set of engaging audio visuals for risk communication messaging for
the community as well as training aids for health workers on areas such as care during home isolation,
post COVID-19 care, infection prevention practices, care of the mother and newborn, breastfeeding
and COVID-19, use of digital thermometer and pulse oximeter etc.
The AVs can be accessed through the following link:
https://drive.google.com/drive/folders/1kFM3hIX3DzFbF2TJOGLrQjAUsup4GWgP?usp=sharing
Project StepOne
Project StepOne is a non-profit startup on a mission to augment public health resources with technology,
people and processes to effectively fight against Covid. We work with state/district governments, as an
integral part of the government work flow and systems to fight Covid, bringing appropriate telemedicine
interventions to bring medical support to the COVID-19 affected - all services are not charged and pro-
bono to the governments.
We have a large volunteer network of 12000+ doctors, 15000+ medics/paramedics and 5000+ non-medical
volunteers working virtually connected via our technology framework. Our volunteers man helplines, call
vulnerable/positive citizens to get information & assist them, handle emergencies and solve other citizen
problems/grievances and in all cases connect the patients to doctors providing timely care. All services
were provided free to governments.
Background
Covid-19 pandemic has created a crisis for all countries around the world and it has stretched government
infrastructure and resources even in the most developed countries of the world. India being a developing
country with a high population is expected to be more stretched for resources - all government resources
and infrastructure are expected to be completely over burdened. This is expected to put millions of people
under tremendous danger and pose severe problems for citizens, governments alike. The unprecedented
scale of the pandemic is expected to stretch healthcare resources like hospitals beds, equipment like
ventialors and ICU equipment, healthcare workers like doctors and also other government resources to
perform normal citizen response activities.
The Problem
Governments faced the following problems in dealing with the pandemic:
1.
Severe shortage of staff to perform key functions - Doctors and other healthcare staff, Staff to take
calls, staff to obtain key citizen data, staff for guiding and helping citizens
2. Delays and inability to easily train and onboard new staff to augment the shortage of staff
3. Need for systems to help staff be quickly productive when onboarded
4. Systems to scale up and scale down the staff as the virus spread surges or flatten
The StepOne SolutionStepOne created a system that can quickly helps augment government resources with the necessary
people - people with required background/skills, use technology to connect these people to the government
systems enabling them to work remotely from where they are - which is a key in the COVID-19 world and
tying them via processes/workflows with government systems to seamlessly make the integration of
these people with the government system easy.
ANNEXURES | 91Home-based Management of COVID-19: Best Practices Adopted by States
Project StepOne therefore presents technology, people and processes required to solve the problems
faced by the government.
Operate on a Pro-bono Model
It’s not enough to support the governments with technology, people and processes but it’s very important
to also run the system for a significant timeframe. This is because most of the time, governments don’t
have the resources with the right expertise to run the system and therefore Project StepOne provides the
necessary infrastructure and expertise to operate the system. All services are pro-bono and not charged.
Project StepOne Solution Set
Every COVID-19 patient was contacted everyday via a tele-screening call and followed up by a doctor
consultation or trained professional counselling if required or requested by the patient - emergencies
and cases of deterioration were identified during the call and escalated thereby preventing mortality and
morbidity. All emergency handling was done in close coordination with the government and other on
ground agencies across all states.
Advantages of the Project StepOne Solution Set
Accessible: Project StepOne’s Citizen interface works via normal telephone call, a medium easily accessible
now to all parts of the society. It works on all types of phones and does not require data or smartphone, in
most cases does not even require any phone currency to be available as the helplines are toll free.
Inclusive: Citizens calling Project StepOne’s helplines don’t need to be educated or literate - most helplines support all local languages. The volunteer doctors on the platform can speak 33 languages including rarely spoken languages like Nagamese, Garo, Khasi, Jaintia, Beari Urdu etc ensuring anyone calling on the helplines are helped out.
Free or Affordable: All services by StepOne are provided free of charge and delivery of medical services including ambulance, hospitals and medication are channelized via the government healthcare system or NGO’s ensuring lowest affordable options to the citizens.
ANNEXURES
The Project StepOne Solution
Project Stepone
Technology Platform
Large volunteer network of
doctors, nurses and other
citizens to augment Govt
resources
Proven processes and
systems to quickly deploy
for specific areas where
governments need
7000+ Doctors, 2000+
citizen volunteers
Fully operated by team of
experienced and
independent professionals
Flexibility to scale up based
on surge or demand
Built to quickly scale
StepOne augments government resources with trained volunteers
StepOne helps govt go from problem to operational at scale in a few days 92 | Home-based Management of COVID-19: Best Practices Adopted by States
Annexure 3: List of partners supporting home-based care in
states
StatePrivate/NGO/Development Partners
Arunachal Pradesh NISHTHA/Jhpiego
AssamNISHTHA/Jhpiego, 104 Call Centre
BiharPrivate IVRS Agency
Chhattisgarh NISHTHA/Jhpiego, Indus Action, Samarthan, Piramal Swasthya
ChandigarhRed Cross
DelhiPoreta, Step-One, Prakriti-E-Mobility, Call Doc, Health Care at Home, CATS, CNCTD
GoaRotary Club, Lions Club, Jaycee, other CSRs
Jammu and Kashmir Norway India Partnership, HISP
JharkhandNISHTHA/Jhpiego Step-One, mDoc, National Medicos Organization
KarnalDeloitte, KCGMCH, Hindustan Wellness Lab
KarnatakaSwasth, Protea, Step-One, Ola Foundation, Give India, Doctors For You
Madhya Pradesh NISHTHA/Jhpiego
MaharashtraNISHTHA/Jhpiego, Step-One, HUL, Apollo Hopsital, SBI, Oyo, Lemon Tree
ManipurNISHTHA/Jhpiego, RIMJS, JNIMS, IMA, Medicine sans frontier
MeghalayaNISHTHA/Jhpiego
MizoramNISHTHA/Jhpiego, Young Mizo Association
NagalandNISHTHA/Jhpiego, Seva Bharti
OdishaNISHTHA/Jhpiego, Step-One
PuducherryStep-One, Sri Aurbindo Society
SikkimNISHTHA/Jhpiego, UNICEF
Tamil NaduStep-One, Ola Foundation, Give India
TelanganaHyderabad Institute of Technology and Management
Uttar Pradesh Hindustan Computers Limited (HCL)
ANNEXURES | 93SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
NOTES 94 |SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
NOTES | 95SECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
NOTES | IIISECTION B : STATE PRACTICES (information collected through secondary research)
Home-based Management of COVID-19: Best Practices Adopted by States
ANNEXURES Home-based Management of COVID-19: Best Practices Adopted by States
Health Vertical
National Institution for Transforming India
NITI Bhawan, Sansad Marg
New Delhi - 110001
healthdiv-pc@gov.in
011-23042547
Disclaimer: Every care has been taken to provide accurate information along with references thereof. Only validated data and photographs submitted
by competent authorities at the district and state levels have been used in the document. However, NITI Aayog shall not be liable for any loss
or damage whatsoever, including incidental or consequential loss or damage, arising out of, or in connection with any use of or reliance on the
information in this document.
Monograph design support by USAID-NISHTHA/Jhpiego