Health System Resilience and Sustainability in India - Odisha's Strategies on Human Resources Management during COVID-19

Background: COVID-19 pandemic caused widespread loss of life, economic downturns, emotional distress and overwhelmed the public health delivery systems across the globe. Odisha was one of the few states in India that deployed proactive management of human resources in health (HRH) to fight the menace. This paper analyzes key decisions related to HRH during COVID-19. The findings aim to strengthen HRH practices to address future pandemics. Materials and Methods: We analyzed the structures, functions, and processes related to HRH management during the COVID-19, using a qualitative lens. Through purposive sampling, in-depth interviews were conducted with 20 key informants, including policymakers and state-level managers. Data were analyzed thematically to reflect upon the perspectives of key stakeholders, identify barriers and enablers, and document the decision-making dynamics. Results: Odisha strengthened its hospital infrastructure and capacity of health workforce through additional deployment and skill upgradation in a short period. Restriction of movements and strengthening the health system pillars led to considerable success. As COVID-19 cases surged in mid-2020, focus shifted to clinical treatment, active case finding and surveillance. Specific training modules were developed with guidance from the Ministry of Health, WHO, and UNICEF. A whole range of human resources were trained by both online and offline modes. Community-level training programs focused on enforcing COVID-appropriate behavior and management of vulnerable population. Infusion of technology enhanced the system’s capacity to deliver high quality training in a short period of time to a vast majority of stakeholders. Conclusion: The Odisha State Disaster Management Authority (OSDMA) and the National Health Mission (NHM) played critical roles in enhancing systems’ preparedness and institutionalizing such large-scale capacity building initiatives during periods of crisis. The state's approach in terms of scale, skill, and speed of human resources management could be a model for addressing future health crises.