Rural realities amid second COVID surge

The second wave of COVID-19 has now spread to the rural pockets of the country at a much faster rate than it did during the first wave of the outbreak. The health care infrastructure here is weaker as compared to urban areas, and hence, the social and economic impact of the health crisis is likely to be more profound.

To discuss the ways to tackle the spread of the second wave in rural areas, 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 panelists comprised 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; and Ms Pratibha Shinde, General Secretary of Lok Sangharsh Morcha.

The discussion drew attention to the crisis emerging from the second wave in rural areas, the challenges, and ways to address these.

Dr Indira Khurana, Vice-Chair of Tarun Bharat Sangh, Alwar while moderating the talk said “The second wave is spreading like wildfire. Data and statistics indicate 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 hinterlands was relatively lesser than in the second wave.”

She pointed that 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. The rural areas need more focused attention this time.

Dr M R Seetharam, a panellist described the rural scenario by drawing from his real-life experiences and provided insights into the neglected rural healthcare system. “In the past year, it did not see any major improvements to deal with the crisis. Primary healthcare centres are inefficient and have inadequate human resources. Though we do have ASHA workers, and other healthcare and grassroots workers, their capacities are limited,” he said.

Ground-level COVID situation

Dr Yogesh Kumar, Samarthan elaborating on the COVID situation on the ground in rural areas said “There has been a large scale spread of the virus in rural areas where at least 10% of the population has symptoms.” He cited various reasons for this - 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

“Lack of awareness, reluctance, 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, with villagers having limited options from where they could seek medical help,” said Ms Maya Vishwakarma. Also, 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,” she said.

Mr Sanjay Singh, Parmarth Sansthan said that the positivity rate was about 25-30%, particularly in the Bundelkhand region. The organisation is conducting massive awareness campaigns, helping the health department in ramping the number of testings, enabling the provision of nutritional and medical kits to people, providing oximeters & thermal screening devices to the Jan Saheli cadre to help the rural population.

Ms Smaranita Shetty brought in a rural perspective, which is usually not showcased in the mainstream media. She highlighted the presence of poor infrastructure, myths that the virus does not affect the rural population, vaccine hesitancy, the need to transform the framework of the awareness campaigns in the second wave.

She said that a survey conducted by India Development Review (IDR) indicates that local level non-profit organizations are seeking support in major areas such as: (a) awareness building among people such as on the need to get tested, (b) the necessity of vaccination, and (c) the differences in the COVID symptoms in the second wave and the first one. 

They are also seeking support in the provision of rations and maintaining the livelihoods of people and community support. 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 would not disrupt the lockdown measures.

Telemedical consultation facility should be made available in the rural areas 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 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 focused on the hierarchical structure for the three-tier decentralized management of COVID.

• District Hospitals and higher-level hospitals for support of critical care patients
• Primary Health Centres (PHCs)/Community Health Centres (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.

Dr Kumar discussed the block level strategy to combat the crisis through governmental support:

• Value addition to the existing healthcare infrastructure, PHCs/ CHCs and other hospitalization centres in terms of material support for procurement of medical resources, personal protective equipment kits, oxygen concentrators, ventilators etc.
• Sensitization and training of volunteers to enable 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 the public distribution system, 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. Also, the deployment plans for doctors, nurses and paramedics should be kept ready just as done in Odisha 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 and accountability, humane, holistic and contextually relevant approaches based on the needs of a particular community are the 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 present narrative that is 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.

Acknowledgement: Tarishi Chaturvedi is a research intern at IMPRI and is pursuing Masters in Development Policy Planning and Practice from Tata Institute of Social Sciences, Tuljapur, Maharashtra.