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Managing COVID19 after the Lockdown

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On March 24, Prime Minister Narendra Modi announced a 21-day nationwide lockdown in response to the COVID-19 pandemic. It was in PM Modi’s style like hasty proclamation of Demonetization on November 8, 2016. This unprecedented lockdown imposed at 00.00 hr on March 25, 2020, gave 1370 millions of Indians less than four hours to prepare. 

The unplanned lockdowns have created economic havoc in the lives of the millions who are part of the informal sector – not just daily wagers, but also workers of the gig economy. According to the Employment –unemployment  Survey, 2015-’16, over 80% of India’s workforce is employed in the informal sector. One-third is casual or daily workers.

“The lack of clear risk communication from top leadership and mixed messages from across the system spooked the poorer migrants who chose to start uncertain journeys,” Kurian says. “The exodus of migrants may have spread out the virus far and wide, adding another layer to India’s problems.”

Most experts agree that a lockdown in India is necessary to contain the spread of COVID-19, but it would have planned better. As India enters the final phase of lockdown which began a fortnight ago, hope to exist plan will be better.

What should be done?

After fourteen days into the nation-wide lockdown (March 24 to April 7, 2020),  India is still wondering about its impact on arresting the spread of COVID-19 and is bogged down by the enormity of the tasks ahead, a question is being asked almost everywhere: will the lockdown, with its huge impact on the economy too, be withdrawn on April 15? Since the 21-day lockdown was announced on March 24 the number of COVID-19 positive cases in the country has risen from 600 on March 25 to over 4000 on April 7, and the number of deaths due to virus increased from 15 to more than 160. Thus, the number of positives cases increased around seven times in the first two weeks of lockdown. It means the community transmission stage is ‘inevitable’. Further, we cannot neglect the economy. Thus, the number of positive cases increased around seven times in the first two weeks of lockdown. Most of those who are badly affected by the lockdown belong to India’s massive informal economy, which employs about 424 million Indians, some 90% of the workforce, according to data from the Ministry of Finance, GOI. Construction workers, auto-rickshaw drivers, milkmen, vendors who sell vegetables and snacks from carts are all part of this economy; most live on daily wages, do not receive any benefits and work jobs that do not exist on paper.

Without entering into the debate, the need of the hour is to bring Coronavirus spread under total control.  No doubt, the dateline of ending announced 21 days lockdown is approaching fast. No one should be under the impression of the complete lifting of lockdown from April 15 onwards. India can expect a phased withdrawal of lockdown. How to implement it is a million-dollar question? For this, the following points may be of some help:

1. Follow Cluster approach: Whether India should re-impose total lockdown after the present one? Consider the following facts: India’s current population is estimated at 1.37 billion with a population density of 425 persons per square kilometer in March 2020. Out of this around 350 million population was residing in large cities with 100,000 people and more. So far overwhelming cases of COVID-19 were reported from urban areas, especially from the large cities. It is, therefore, one has to identify clusters or hotspots. Every City Municipal Commissioner and the DM has all the information of clusters where the human density is large and crowded with filth and squalor. Immediate steps to isolate these areas should begin on a war footing.

After the 21-day lockdown is over, the infected clusters can continue with restrictions while other parts of the country/city should be allowed to return to normalcy. This will not only contain the virus in the hotspots but also allow economic recovery. Authorities have already started identifying such clusters across in UP, Rajasthan, Gujarat, Kerala, and Maharashtra. For example, a densely populated Ramganj area, a small community of Jaipur walled city, recorded the highest caseload anywhere in Rajasthan, and thus became the new epicenter of the outbreak in Rajasthan. Such hotspots need special attention. In the next few weeks, testing, tracing, isolation, and quarantine should be focussed on these hotspots.

2. Use minimum labor force and develop a new work culture: India needs to be in fighting mode until people get vaccinated while having minimal casualties. Govt. should come out with a disaster management plan for discussion in public well before the lockdown is lifted on 15th April. The endeavor should be to have a minimum workforce on the ground at a time. My view is that one-third of the workforce can perform all the activities of an organization or farm or mines. A rotation system may be developed, and work from home should be encouraged. All places of mass gathering and congregation may continue to remain shut for some more time.

3. Encourage communal harmony: After Markez incident, some politicians tried to make the corona pandemic as Hindu-Muslim issue. If someone is disturbing the social harmony or creating obstacles against state efforts to control the virus, they must be immediately punished in public under the relevant sections of the IPC.

Here the role of free and impartial Media is important to fight COVID-19 in India. Imagine, for a movement, a raging pandemic in India without credible journalists to verify the facts, Rumors would become the only information available. Amidst the uncertainty, fear would grow. The panic in society that any government rightly fears, would be much worse without trusted facts to counter it; and that is happening in present India. “There should always be room for the argumentative Indian and not the intolerant Indian. The media must be the watchdog, the mediator between the leaders and the public,” Indian President Pranab Mukherjee emphasized while delivering a seminal lecture honoring former press baron Ramnath Goenka some three years ago. His words are very timely in the face of the growing threat of the Corona pandemic.

In addition, as India has been battling the outbreak of the coronavirus pandemic, at the same time the government has to contend with growing communal polarization. It would be a significant move by GOI if all controversial issues like CAA, NPR and NCR are put in the cold storage for one year or so. And our PM Modi can take such a brave step in the national interest.

4. Enhance health spending: Doctors in hospitals across India said the lack of proper protective equipment available for medical staff, including basic masks, meant that patients presenting with coronavirus symptoms were being turned away. Doctors in Kolkata described how they were made to wear plastic raincoats to examine possible coronavirus patients, while a doctor in a Delhi hospital resorted to wearing a motorcycle helmet to cover his face. Further, India is not well equipped with testing. This is where much work is needed and India is behind. The number of tests performed has to escalate and the return of results has to be prompt. Private partnerships may be necessary to manufacture testing kits. One also needs to pay attention to disease surveillance, monitor respiratory illness cases across the country look at spikes in insurance claims due to such illnesses in the hotspot metro areas and watch out for emerging hotspots and outbreaks. We cannot fight this war blindfolded. For the future, set up disease surveillance, testing, contact tracing, create a high alert pandemic response team. We need to build public health forces and trained professionals across the country. Trust and invest in science. India has to increase the health budget.

India’s average expenditure on health is far below that of other developing countries, showing it to be a relatively low governmental priority. Health expenditure in India amounts to 3.7 percent of the GDP, of which only around a third is government expenditure. This is substantially below the low- and middle- income country average of 5.4 percent, of which nearly half comes from the government.

India’s public expenditure on health now stands at 1.28 percent of the GDP but even then, it is way lower than the average expenditure by countries clubbed as among the “poorest”. More embarrassingly, the country’s public health expenditure is lower when compared with other South-East Asian countries like Nepal, Sri Lanka, Bangladesh, Indonesia, Thailand, and Bhutan. It is interesting to note that the government’s own National Health Policy 2017 envisages increasing the health budget to 2.5 percent. We hope to see some action around this in the current situation.

5. Strengthen Centre-State partnership: Finally, we have to recognize that Central government alone can’t fight corona alone. Close cooperation of states is urgently needed. The constitutional vision envisages that both the central and the state governments must embrace a collaborative federal architecture by displaying harmonious coexistence and interdependence. This crisis is an extraordinary situation that required extraordinary coordination. It is, therefore, increased coordination between states and the Centre, and among political parties, it is essential

Further, all states haven’t seen the same incidence of positive cases. Moreover, there are significant regional differences in economic structure. Therefore, it’s best if states are given leeway to tailor an exit plan according to the local context. “The exit strategy will influence both the economy and public health. It is essential to get it right.”

In sum, the success of Janata curfew’ demonstrated that people are willing to abide by government advisories and especially the appeal made by the Prime Minister. But a 21-day national lockdown on a four hours’ notice suddenly put millions of people at risk, leaving many struggling with basic requirements of food and medicines. They were left with a choice between the coronavirus infection and starvation. Hunger is the more desperate, deadly, and immediate of the two alternatives, and hence it prevailed. In the future, sufficient time should be given before taking such decisions.

 It is hoped that PM Modi will announce such an exit plan which will help to rid of coronavirus and push the economic revival.

 

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An ambassador and trained facilitator under Eco Femme (a social enterprise working towards menstrual health in south India), Sanjina is also an active member of the MHM Collective- India and Menstrual Health Alliance- India. She has conducted Menstrual Health sessions in multiple government schools adopted by Rotary District 3240 as part of their WinS project in rural Bengal. She has also delivered training of trainers on SRHR, gender, sexuality and Menstruation for Tomorrow’s Foundation, Vikramshila Education Resource Society, Nirdhan trust and Micro Finance, Tollygunj Women In Need, Paint It Red in Kolkata.

Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

Saurabh has been associated with YKA as a user and has consistently been writing on the issue MHM and its intersectionality with other issues in the society. Now as an MHM Fellow with YKA, he’s launched the Right to Period campaign, which aims to ensure proper execution of MHM guidelines in Delhi’s schools.

The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

Read more about his campaign.

Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

Her campaign #MeriMarzi aims to promote menstrual health and wellness, hygiene and facilities for female sex workers in UP. She says, “Knowledge about natural body processes is a very basic human right. And for individuals whose occupation is providing sexual services, it becomes even more important.”

Meri Marzi aims to ensure sensitised, non-discriminatory health workers for the needs of female sex workers in the Suraksha Clinics under the UPSACS (Uttar Pradesh State AIDS Control Society) program by creating more dialogues and garnering public support for the cause of sex workers’ menstrual rights. The campaign will also ensure interventions with sex workers to clear misconceptions around overall hygiene management to ensure that results flow both ways.

Read more about her campaign.

MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

With YKA MHM Fellow Vineet, Sabna launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society. As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Read more about her campaign. 

A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Find out more about the campaign here.

A native of Bhagalpur district – Bihar, Shalini Jha believes in equal rights for all genders and wants to work for a gender-equal and just society. In the past she’s had a year-long association as a community leader with Haiyya: Organise for Action’s Health Over Stigma campaign. She’s pursuing a Master’s in Literature with Ambedkar University, Delhi and as an MHM Fellow with YKA, recently launched ‘Project अल्हड़ (Alharh)’.

She says, “Bihar is ranked the lowest in India’s SDG Index 2019 for India. Hygienic and comfortable menstruation is a basic human right and sustainable development cannot be ensured if menstruators are deprived of their basic rights.” Project अल्हड़ (Alharh) aims to create a robust sensitised community in Bhagalpur to collectively spread awareness, break the taboo, debunk myths and initiate fearless conversations around menstruation. The campaign aims to reach at least 6000 adolescent girls from government and private schools in Baghalpur district in 2020.

Read more about the campaign here.

A psychologist and co-founder of a mental health NGO called Customize Cognition, Ritika forayed into the space of menstrual health and hygiene, sexual and reproductive healthcare and rights and gender equality as an MHM Fellow with YKA. She says, “The experience of working on MHM/SRHR and gender equality has been an enriching and eye-opening experience. I have learned what’s beneath the surface of the issue, be it awareness, lack of resources or disregard for trans men, who also menstruate.”

The Transmen-ses campaign aims to tackle the issue of silence and disregard for trans men’s menstruation needs, by mobilising gender sensitive health professionals and gender neutral restrooms in Lucknow.

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A Computer Science engineer by education, Nitisha started her career in the corporate sector, before realising she wanted to work in the development and social justice space. Since then, she has worked with Teach For India and Care India and is from the founding batch of Indian School of Development Management (ISDM), a one of its kind organisation creating leaders for the development sector through its experiential learning post graduate program.

As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

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A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

A Gender Rights Activist working with the tribal and marginalized communities in india, Srilekha is a PhD scholar working on understanding body and sexuality among tribal girls, to fill the gaps in research around indigenous women and their stories. Srilekha has worked extensively at the grassroots level with community based organisations, through several advocacy initiatives around Gender, Mental Health, Menstrual Hygiene and Sexual and Reproductive Health Rights (SRHR) for the indigenous in Jharkhand, over the last 6 years.

Srilekha has also contributed to sustainable livelihood projects and legal aid programs for survivors of sex trafficking. She has been conducting research based programs on maternal health, mental health, gender based violence, sex and sexuality. Her interest lies in conducting workshops for young people on life skills, feminism, gender and sexuality, trauma, resilience and interpersonal relationships.

A Guwahati-based college student pursuing her Masters in Tata Institute of Social Sciences, Bidisha started the #BleedwithDignity campaign on the technology platform Change.org, demanding that the Government of Assam install
biodegradable sanitary pad vending machines in all government schools across the state. Her petition on Change.org has already gathered support from over 90000 people and continues to grow.

Bidisha was selected in Change.org’s flagship program ‘She Creates Change’ having run successful online advocacy
campaigns, which were widely recognised. Through the #BleedwithDignity campaign; she organised and celebrated World Menstrual Hygiene Day, 2019 in Guwahati, Assam by hosting a wall mural by collaborating with local organisations. The initiative was widely covered by national and local media, and the mural was later inaugurated by the event’s chief guest Commissioner of Guwahati Municipal Corporation (GMC) Debeswar Malakar, IAS.

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