Written by: Arjun Kumar, Indira Khurana, Ritika Gupta, Anshula Mehta, Sunidhi Agarwal, Sakshi Sharda, Chhavi Kapoor
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 healthcare 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, organised a panel discussion on Rural Realities: Practitioners Experiences in Tackling the Second Wave in Indian Villages on May 5, 2021.
The esteemed panellists 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 and CEO of Indian Development Review; Dr M R Seetharam, Consultant Orthopedic Surgeon, Vivekananda Memorial Hospital, Sargur and Swami Vivekananda Youth Movement Executive Director, VILD Foundation, Mysore Managing Trustee, DISHA Foundation, Mysore; and 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 statistics that in the first wave, migrant workers were the most-affected and faced the social and economic crisis of the pandemic, yet, the spread of infection in rural areas and the hinterlands was relatively lesser than the second wave.
Today the media, policymakers, bureaucrats and 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 rural areas need a more focused attention this time.
The objective behind the discussion was to draw attention to the rural second wave crisis and its challenges, and to look for ways to address these challenges.
Panellist Dr M R Seetharam demonstrated the rural scenario through his real-life experiences and gave insight into the rural healthcare system, which continues to be neglected. In the past year, it did not see any major improvements pertinent in the time of crisis. Primary Healthcare Centres continue to be 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 less efficient.
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% of the population has symptoms. He cites various reasons for it, such as low awareness of 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, and an environment of mistrust of the government at the community level.
Strong Resistance And Vaccine Hesitancy
Ms Maya Visvakarma stated that the lack of awareness, and reluctance and fear of testing and isolation make the rural population more vulnerable to Covid. The problem becomes complex when most of the medical infrastructure, particularly the tertiary centres, are concentrated in towns and cities, which becomes problematic for villagers to seek medical help. She also added to the fact that home isolation becomes a tough task in rural areas as people there live in small households. India’s Covid vaccination programme needs to accelerate, but uptake in rural areas has been low due to lack of awareness, strong resistance to vaccines and poor ground-level execution.
Mr Sanjay Singh discussed the positivity rate being about 25-30%, particularly in the Bundelkhand region. His organisation, Parmarth Sansthan, is conducting massive awareness campaigns, helping the health department in ramping the number of testings, providing nutritional and medical kits to people, and oximeters and thermal screening devices to the Jan Saheli cadre to help the rural population.
Ms Smaranita Shetty pointed at the rural perspective, which is not usually showcased in the mainstream media. This includes poor healthcare infrastructure in villages, a belief among the rural population of the virus being ineffective, hesitancy to vaccines and 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 the India Development Review (IDR), they observed that the local-level non-profit organisation (NGO) seek support in three major areas. The first is Awareness Building among people around the need to get tested and vaccinated, and regarding the difference in Covid symptoms in the second wave in comparison to the first one. The other two areas are: Support in the provision of rations and maintaining the livelihoods of people, and 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 a 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 of double-masking, which is a lifesaver and lessens the risk of infection from spreading to a great extent. Amid the Covid outbreak, guidelines were issued to decongest healthcare facilities as doctors could only consult patients remotely to protect the patient as well as the doctor from virus transmission.
Telemedical consultation facility should be made available in rural areas as well where there is a 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 gave an example of an overseas medical teleconsultation facility initiated by her friend in the rural areas of Madhya Pradesh.
Mr Sanjay Singh reiterated the need for livelihood support, ration support, nutritional security and maximising livelihood options. It is our responsibility to save people from the Covid outbreak and other societal problems such as lack of food availability, water scarcity (especially in the Bundelkhand region), unemployment and other consequences of the current crisis.
Dr Yogesh Kumar focused on the hierarchical structure of the three-tier decentralised 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 hospitalisation centres in terms of material support for procurement of medical resources, PPE kits, oxygen concentrators, ventilators etc.
- Sensitisation 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 utilisation of scheme benefits such as rations through PDS, health insurance facilities, compensation through Atal Pension Yojana etc.
Formation of a Covid Support Centre with the objective of management of Covid-positive cases, provision of non-scheduled drugs, building a communication network with government-established Covid management centres for secondary and tertiary care are imperative. Temporary pandemic care centres at the 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 equipments like ventilators and ambulances with oxygen facilities have to be ensured; deployment plans for doctors, nurses and paramedics must be kept ready just as Odisha had done during the first wave of the pandemic. Other steps to mitigate this kind of disaster can be setting up district-level coordination groups, making flexible funding available to the local governments, and enabling NGOs to play an active role.
Fundamental needs like water, sanitation, nutrition, basic education, socio-economic requirements and livelihood support are paramount, and are a policy issue that people need to advocate. Governance, transparency and accountability, and 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 organisations working in rural areas monetarily or in any other possible way.
Acknowledgement: Tarishi Chaturvedi is a research intern at IMPRI and pursuing Masters in Development Policy Planning and Practice from Tata Institute of Social Sciences, Tuljapur, Maharashtra.
YouTube Link for Rural Realities: Practitioners Experiences in Tackling the Second Wave in Indian Villages
