key: cord-0895854-b4l93n1t
authors: Sarode, Gargi S; Sarode, Sachin C
title: Gastrointestinal services in India during COVID-19: does governance matter?
date: 2021-08-12
journal: Lancet Gastroenterol Hepatol
DOI: 10.1016/s2468-1253(21)00257-0
sha: f7827c67e785fc6a19cf9bcba1ad0ffd41b17a24
doc_id: 895854
cord_uid: b4l93n1t

nan

www.thelancet.com/gastrohep Vol 6 September 2021

We thank Gargi Sarode and Sachin Sarode for their interest in our recent Correspondence. 1 As a designated COVID19 hospital (and the largest nongovernmental COVID19 hospital in our city 2 ), neither nonenforcement of government directives nor referral pattern (both before the pandemic and during it, we received less than 10% of referrals contrast, the governance bodies at private hospitals comprise medical professionals-as reported by Ramakrishnan and colleagues, 1 where the chairman is a renowned health professional. Hence, governance is perhaps a major reason for such divergent results and needs immediate attention.

We would also like to bring attention to the importance of differentiating between patients who had been referred and those who presented directly to the hospital in Ramakrishnan and colleagues' report. Gastroenterology services are superspecialty facilities in India and many patients using these services are referred from private clinics. Thus, differentiation of patients into those referred and those who present directly is of vital importance. This information will indirectly reveal the active/inactive status of the surrounding small clinics, which cater to a large number of patients on a daytoday basis.

We declare no competing interests. A recent multicentre study on the impact of the first wave of the COVID19 pandemic on cancer care in India demonstrated a highly compromised service. 2 In this study, public hospitals had larger reductions in patient numbers and their related services than private hospitals between March and May, 2020, compared with the same period in 2019. For instance, more patients received external beam radiotherapy at private hospitals in 2020 compared with 2019 (4%), whereas there were large reductions over the same time period in public (33%) and charitable (43%) hospitals. This demonstrates the different results between private and public sector hospitals in India, which needs urgent further exploration. Although the functioning and structure of private and public hospitals are somewhat similar, there is a difference in the governance and leadership at a high level. The governing bodies of public hospitals often comprise mostly ministers and leaders from the central or state government political parties and generally have limited medical background and experience. By

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