“Rural Realities: Practitioners’ Experiences in Tackling the Second Wave in Indian Villages” — a note by Impact and Policy Research Institute (IMPRI), New Delhi
The second wave of COVID-19 has now penetrated the rural pockets of India. It has gained traction in the country’s rural hinterland, where health care infrastructure is weaker than in urban areas, at a much faster rate than it did during the first wave of the outbreak.
To discuss the ways to tackle the spread of the second wave in rural areas, the Centre for Habitat, Urban and Regional Studies (CHURS) and Impact and Policy Research Institute (IMPRI), New Delhi organized a Panel Discussion on Rural Realities: Practitioners Experiences in Tackling the Second Wave in Indian Villages on May 5, 2021.
The Esteemed Panelists were Dr Yogesh Kumar, Executive Director of Samarthan: Centre for Development Support; Mr Sanjay Singh, Secretary of Parmarth Samaj Sevi Sansthan; Ms Maya Vishwakarma, Founder of Sukarma Foundation; Ms Smarinita Shetty, Co-Founder & CEO of Indian Development Review; Dr M R Seetharam, Consultant Orthopedic Surgeon, Vivekananda Memorial Hospital, Sargur; Swami Vivekananda Youth Movement Executive Director, VILD Foundation, Mysore Managing Trustee, DISHA Foundation, Mysore; Ms Pratibha Shinde, General Secretary of Lok Sangharsh Morcha.
The Moderator of the talk, Dr Indira Khurana, Vice Chair of Tarun Bharat Sangh, Alwar pointed that the second wave is spreading like an uncontrollable wildfire. We can clearly observe through the data and the statistics that in the first wave the migrant workers were the most affected and faced the social and economic crisis of the pandemic yet, the spread of infection in the rural areas and the hinterlands was relatively lesser than the second wave. Today the media, the policymakers, bureaucrats, politicians both at the state and the central level are focused on formulating policies and finding out ways to combat COVID-19 in urban areas. Thus, it is evident that the rural areas need more focused attention this time.
The objective behind the discussion was to draw attention to the rural second wave crisis, the challenges, and to look for ways to address these challenges.
One of the panellists, Dr M R Seetharam demonstrated the rural scenario through his real-life experiences and gave insights into the rural healthcare system which continues to be neglected. In the past year, it did not see any major improvements which are pertinent in the time of crisis. Primary healthcare centres are inefficient and have inadequate human resources. Though we do have Asha workers, and other healthcare and grassroots workers, their capacity to function is limited making them inefficient.
Ground level COVID situation
Dr Yogesh Kumar began by elaborating on the COVID situation on the ground in rural areas. There has been a large scale spread of the virus in rural areas where at least 10 percent of the population has symptoms. He cites various reasons for it like low awareness on COVID positive case management, lack of medical resources (oximeters, thermometers etc.) at the village level, lack of doctors and paramedics for medical advice and support, an environment of mistrust at the community level for the government.
Strong Resistance and Vaccine Hesitancy
Ms Maya Visvakarma states that the lack of awareness, reluctance and fear of testing and isolation makes the rural population more vulnerable to covid. The problem becomes complex when most of the medical infrastructure particularly the tertiary centres are concentrated in the towns and cities, which becomes problematic for villagers to seek medical help. She also adds to the fact that home isolation becomes a tough task in rural areas as the people live in small households. India’s COVID-19 vaccination programme needs to accelerate, but uptake in rural areas has been low due to the lack of awareness, strong resistance to vaccines and poor ground-level execution.
Mr Sanjay Singh discusses the positivity rate being about 25-30 percent, particularly in the Bundelkhand region. His organisation, Parmarth Sansthan, is conducting massive awareness campaigns, helping the health department in ramping the number of testings, provision of nutritional and medical kits to people, provision of oximeters & thermal screening devices to the Jan Saheli cadre to help the rural population.
Ms Smaranita Shetty points to the rural perspective, which is not usually showcased in the mainstream media, like the poor infrastructure, the belief of the virus not affecting rural population, hesitancy to vaccines, a transformation of the context of the awareness campaigns from the first wave to now, the second wave. She added that in a survey conducted by India Development Review (IDR), they observed that the local level nonprofit organization (NGO) seek support in three major areas- Awareness building among people like awareness around the need to get tested, regarding vaccination and regarding the difference in the covid symptoms in the second wave in comparison to the first one. Support in the provision of rations and maintaining the livelihoods of people & community support. Thus, there is a huge gap between what the people want to fund and what the real need is.
What is the Way Forward?
The rural population is in pressing need of medical help and financial aid to seek medical consultation. Today, this is an integral part of life. People must be made aware of the need for double masking which is a lifesaver and lessens the risk of spread of infection to a great extent. Amid the COVID outbreak, the guidelines were issued to decongest the healthcare facilities as doctors can consult the patients remotely which would protect the patients and the doctors from virus transmission and does not disrupt the lockdown measures. Telemedical consultation facility should be made available in the rural areas where there is lack of health workers and medical facilities and there must be limited attention to the developed towns and cities which are already well equipped with health centres and hospitals. Ms Maya Vishwakarma gives an example of an overseas medical teleconsultation facility initiated by her friend in the rural areas of Madhya Pradesh.
Mr Sanjay Singh reiterates the need for livelihood support, ration support, nutritional security and maximizing livelihood options. It is our responsibility to save people from the COVID outbreak and other societal problems like lack of food availability, water scarcity (especially in the Bundelkhand region), unemployment and other consequences of the current crisis.
Dr Yogesh Kumar focuses on the hierarchical structure of the three-tier decentralized management of COVID.
- District Hospitals and higher-level hospitals for support of critical care patients
- PHC/CHCs and other centres for patients with moderate symptoms.
- Village level home isolation and community isolation facilities for mild symptoms by Gram Panchayats i.e., proactive participation of local-level governments.
He also adds the block level strategy to combat the crisis while systematically supporting the government:
- Value addition to the existing healthcare infrastructure, PHCs/ CHCs and other hospitalization centres in terms of material support for procurement of medical resources, PPE kits, oxygen concentrators, ventilators etc.
- Sensitization and training of volunteers to promote Gram panchayats to support covid positive cases or to curtail their paperwork.
- To build a network of private providers for online counselling.
- Professional management with experience in data management to support block administration to abate the criticality of issues.
- Support to gram panchayats in facilitating the utilization of scheme benefits like rations through PDS, Health insurance facilities, compensation through Atal Pension Yojana etc.
Formation of COVID Support Centre with an objective of management of COVID positive cases, provision of non-scheduled drugs, building a communication network with the government established COVID management centres for secondary and tertiary care is imperative. Temporary pandemic care centres at panchayat, block and district levels have to be identified and kept ready for operation at short notice; an adequate supply of oxygen, oxygen beds, and augmentation of medical equipment’s like ventilators and ambulances with oxygen facilities have to be ensured and deployment plans for doctors, nurses and paramedics kept ready just as Odisha had done during the first wave of the pandemic. Setting up district-level coordination groups, flexible funding to the local governments, enabling NGOs to play an active role is important to mitigate this kind of disaster.
The fundamental needs like water, sanitation, nutrition, basic education, socio-economic requirements, livelihood support are paramount and are a policy issue that people need to advocate for. Governance, transparency & accountability, Humane holistic and contextually relevant approaches based on the needs of a particular community are key issues that need to be focused upon. The local media should also actively participate in highlighting the stark ground realities because it is crucial to change the narrative from being more urban-centric. The need of the hour is to amplify these local-level issues and establish a platform where people can help the organizations working in rural areas monetarily or in any other possible way.