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
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
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
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
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
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:
- Social distancing.
- Direct responsive coping system.
- Secondary level caretakers.
- 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:
- Micro-level Planning.
- Oxygen checking.
- 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
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:
- 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.
- 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.
- Strengthening health and nutrition services and practices through community participation. Community feedback is important.
- Improvement in household nutrition practices and follow-up of malnourished children. Follow up with malnourished children is important.
Learnings:
- To ensure treatment of non-COVID patients for non-communicable diseases.
- We need to strengthen the government health and nutrition system and services through community participation.
- Regulation of private health sector.
- To strengthen preventive and curative aspects of health and nutrition.
- Keeping in view the third wave of COVID-19, we need to develop a “COVID Care Centre” for children at the block level.
- Immunisation in campaign mode while ensuring counselling for the same.
- Strengthening social services.
- 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
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