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Rural Realities | Maharashtra’s Practitioners’ Experiences In Tackling The Second Wave

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This post is a part of YKA’s dedicated coverage of the novel coronavirus outbreak and aims to present factual, reliable information. Read more.

In continuation with the ongoing discussions on the Rural Realities around the country, the Centre for Habitat, Urban and Regional Studies (CHURS), IMPRI Impact and Policy Research Institute, New Delhi, organised a panel discussion on Rural Realities | Maharashtra Practitioners’ Experiences in Tackling the Second Wave in Indian Villages on 13 May, 2021.

The IMPRI team informed the discussion by locating for the event participants the situation of COVID-19 in India and Maharashtra. The team also provided an insight into the geography and socioeconomic conditions of the state. The rationale was to provide the participants with an overview of the state of Maharashtra.

Multi-Pronged Issue

vibhu 1
Prof Vibhuti Patel.

Prof Vibhuti Patel, Former Professor, TATA Institute of Social Sciences (TISS), Mumbai, was the webinar’s moderator and highlighted that rural areas had more cases and Maharashtra was topping the charts. Inadequate testing facilities, primary health centres (PHCs) are medically ill-equipped, and the Ayushmaan Bharat scheme has become ineffective as fewer oxygen beds are available. Public health care is the need of the hour.

People are facing a financial crisis and selling their lands off to get health services. Oxygen shortage is causing critically ill patients to die on roads. SHGs (Self-help Groups), ASHAs, Anganwadi stories of valour can be heard all across India for their determination towards work. People to people solidarity can go a long way in tackling this deadly virus. Teachers and police officers are also playing a vital role.

Women are more vulnerable to sexual violence. The term “COVID widows” is used in Maharashtra. Women don’t have land in their names and no ration cards, which add to the problems. Education is a major casualty as online education is not possible in rural areas. COVID-19 is a multi-pronged Issue as socioeconomic issues, food security, employment and health emergency are at the core of the issue.

Equitable Health System

dhan
Dr Dhananjay Kakade.

Dr Dhananjay Kakade, Head of Institution at Support for Advocacy and Training to Health Initiatives (SATHI), Pune, asserted that COVID-19 would have an immediate mid-term and generational impact. We need to focus on the health system. A long-term view is required. There is distress at the community level, which needs our immediate attention.

Many kids are out of school, which will have a long-term impact on the children’s psychological health. COVID has unequally impacted people. The basics of our health systems are not in place. Common people have many questions like, “Why actors and celebrities are getting beds and not us?” There is socioeconomic influence on the ladder.

We need to have a comprehensive picture to assess the impact. COVID has a multi-dimensional impact on people. There is a deep crisis ongoing. Sheer apathy and ignorance from the decision-makers and state apparatus to equip the frontline workers to deal with this pandemic as ASHA workers don’t have necessary medical equipment.

Scientific-based information needs to be generated. Insurance needs to be provided to ASHA and Anganwadi workers.

Traditional fault lines became more prominent in COVID. PSAs are ill-equipped. The impact of this pandemic will be much more-worse on the marginalised sections. For some, the pandemic is an opportunity to make profits as black marketing has been reported of essential medical drugs.

“Transparency and accountability mechanisms at the grassroot level needs to be strengthened.”

We need an equitable health system. Civil society organisations’ role in changing the governance structure of the state is crucial. A new vision is required. Can public-private partnerships be the future? This question needs more discussion.

Universal Healthcare

arun
Dr Arun Gadra.

Dr Arun Gadra, Head, SATHI CEHAT, Pune, pointed that COVID-19 had shattered the middle class. There is a paradox of equality. It is an opportunity to pitch for Universal Health Care. Out of pocket expenditure on health has increased. The private sector was absent in the first wave, a big burden on the public health system.

Lack of resources is a major issue. 80% of people are getting admitted in the private sector. Awareness is very low in rural areas. We have to come together to save lives and be action-oriented.

Women Centric Issues

lata
Ms Lata Bhise.

Ms Lata Bhise, State Secretary, National Federation of Indian Women (NFIW), Maharashtra, said that women had the identity as citizens, women and part of the working class. There is a political, social, cultural and religious impact of COVID. Ration and unemployment are the main problems in rural areas.

An allowance of ₹1500 has been given to domestic and construction workers in Maharashtra, but the problem is that women only below 60 receive it. There are long lines in banks. Social security pension disbursement is a major problem. ASHAs have been stigmatised too, with no proper treatment as many accused them of spreading COVID in rural areas. There are a lot of insecurities.

Child marriages are increasing in rural areas as fewer people are invited due to COVID. Girl’s education and dropouts are increasing rapidly. Beedi workers in Maharashtra (Padmashaali Samaaj) is in total unemployment, with no provision for them. Microfinance companies too have made SHGs and disbursed loans, but there is sexual harassment.

In COVID wards also, sexual harassment has been reported. CCTV and responsible officers are now deployed in ICUs. Government dialogue should be promoted. Vaccination of ASHAs is the need of the hour as they can’t go for registration due to many problems.

Humanitarian And Rights-Based Approach

dhruv
Dr Dhruv Mankad.

Dr Dhruv Mankad, Managing Trustee of Anusandhan Trust with centres – CEHAT, Pune, highlighted that the migrant issue and subsequent lockdown of villages was the first reaction in the first wave of COVID-19. The community responded correctly as nobody knew the nature of the virus. A humanitarian and rights-based approach should be working in tandem. Food security is a major issue.

We need to have a micro-planning system. The following points need our attention:

  1. Social distancing.
  2. Direct responsive coping system.
  3. Secondary level caretakers.
  4. The approach of triaging.

We now know what we need to do. People have to be aware. Identification and care at the earliest level is needed. The following measures can be taken:

  1. Micro-level Planning.
  2. Oxygen checking.
  3. Training ASHAs.

Faith-building among the masses is very important at this stage. The trust deficit needs to be tackled soon. We have to revive things as there is a huge financial crunch. SHGs can provide a strong platform for preventing domestic violence in rural areas.

Health And Nutrition

shaileash
Dr Shailesh Dikhale.

Dr Shailesh Dikhale, Health and Nutrition Karykarta, Support for Advocacy and Training to Health Initiatives (SATHI) CEHAT, Pune, focused on determinants of health. “Aab Chidiya Chugh Gayi Kheth” is the proper idiom that depicts the current situation. Delay in the testing of COVID-19 is a major issue.

Nutrition services is a major issue. Anganwadi centres are closed. Stunting and severely wasted children have increased. We need to be proactive as it is predicted that children will be the most affected in the third wave of COVID-19.

Action Agenda:

  1. System strengthening through help desk, basically to provide guidance to patients regarding treatment-related to COVID and other illnesses, immunisation and testing and to create education related to various health schemes. Facilitate dialogue within the community.
  2. People’s health and nutrition education in the context of COVID. Development of educational material in local tribal languages. Use of social media to educate the rural and tribal communities through Anganwadi, ASHA workers and Poshan Hakka Gat. Education regarding the importance of VCDC, CTC and NRC in the current pandemic situation.
  3. Strengthening health and nutrition services and practices through community participation. Community feedback is important.
  4. Improvement in household nutrition practices and follow-up of malnourished children. Follow up with malnourished children is important.

Learnings:

  1. To ensure treatment of non-COVID patients for non-communicable diseases.
  2. We need to strengthen the government health and nutrition system and services through community participation.
  3. Regulation of private health sector.
  4. To strengthen preventive and curative aspects of health and nutrition.
  5. Keeping in view the third wave of COVID-19, we need to develop a “COVID Care Centre” for children at the block level.
  6. Immunisation in campaign mode while ensuring counselling for the same.
  7. Strengthening social services.
  8. Strengthening coordination and convergence b/w various line departments.

“We need to document experiences during the COVID pandemic to use these as input at the policy level.”

Conclusion

climate change women
Representative Image.

Responding to the question of what crisis situation women farmers were facing, Ms Lata Bhise said that farmer suicides were increasing in Maharashtra. Fertilisers, seeds and credit are not available due to COVID. No sale of eggs and milk due to lockdown. Women’s space has shrunk.

The land is registered in the name of males, which puts a question mark on women’s identity as farmers. Subsequently, they are not able to avail the benefits of government schemes. No training available. Separate women dairies should be built. Credit facility needs to be given to women and implementation of forest act are the demands of women.

Dr Dhruv responded to the question of the effectiveness of early lockdown by stating that early lockdown helps in some ways. The state is helping us and coordinating in combating this deadly virus. Gaps need to be bridged.

Dr Arun said that we had to develop a synergy and community involvement which can be helpful. The government is taking initiatives, but good management is the need of the hour.

Dr Shailesh pointed that the Public health system should work in coordination with NGOs.

Prof Vibhuti concluded by asserting that vaccination infrastructure, lack of beds and reverse migration are the major issues. Civil society organisations should carry a communication drive and create awareness at the rural level. Robust data is needed to come with an action plan. A multi-pronged strategy can go a long way.

IMPRI Team

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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.

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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.

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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.

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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.

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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.”

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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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