Managing Covid-19 crisis in rural areas

We are saw the second wave of the Covid crisis ravaging the nation and fortunately, it is now on the wane. Whether it is individuals, institutions or entire states - the problem has affected everyone. This wave has not only exposed the unpreparedness of the system and the state, but has also shown the poor understanding of both public health management and the inappropriateness of several of the knee-jerk solutions being attempted.

The actions of the government with specific reference to the vacillating decisions related to managing the pandemic in rural Karnataka shows that decision-making is being done by people with an inadequate understanding of not only public health but also the prevailing realities of rural areas. Covid cannot be seen as a mere illness and the responses cannot be limited to managing it as one. The crisis is a development challenge and solutions should not only be driven by science and evidence but also be compassionate in its approach, comprehensive in its vision, be culturally appropriate and driven by the contextual realities of rural areas.

Apart from focusing on medical solutions, one needs to begin with operating with the resources that one already has in place. Managing Covid begins at the individual and family levels and one needs to see the ‘family’ as the fourth tier of healthcare provision. This pre-primary level of care is critical in managing epidemics and enlisting citizen participation. Using the dependable three sisters (Anganawadi workers, ANM and ASHA workers) for creating awareness – on understanding the disease and its management, vaccination and covid appropriate behaviours will go a long way in alleviating fear and reducing panic.

These field workers can also be trained to ensure that they double up as counsellors (social, emotional and grief) and be the referral point in case people need to go to the Covid care centres (CCCs) that are being set up. The healthcare system should not only trust them but also empower them with the ability to refer and transport patients who need care beyond the home setting. Equipping them with the proper PPE, pulse oximeters and some basic drugs will ensure that their confidence and esteem levels will go up and the community seek them out as the point of first contact.

The context and culture of villages are distinctly different from those of cities. Rural communities are more close-knit and tend to come to each other’s aid during times of crisis – whether it is illness or death. One needs to keep this in mind and put in place a system of monitored home isolation care as the first step in Covid management. This should complement a sub-taluk level CCC that can function as the second level of care. Strengthening the taluk hospitals with both oxygenation and ICU facilities can act as the third level of referral.

Working together

Existing hospitals – whether in the private, NGO or public sector - should work together synergistically and partner with communities in providing the much needed medical care. Only when collaborations are encouraged, can one hope to ensure that no one is left behind. This is especially critical in remote, resource limited and geographically challenged settings. These facilities should also ensure that care continues to be provided to non-covid illnesses too.

Beyond healthcare, one needs to create support mechanisms to ensure that the poor and marginalised continue to have access to food, basic level of income, and other social entitlements including burial and cremation services, if required. Convergence of all government departments under a unified block level leadership with special powers for the administrators can ensure timely and responsive action whenever required.

One also needs to keep in mind the realities of the digital divide. Systemic changes including expanding the CoWin app to regional languages and permitting the field workers to enlist and register larger numbers of people (beyond the currently permissible four) will reduce this divide to some extent. One needs to keep in mind the wealth of experience embedded in our public health system in the domain of immunisation. Using these established systems to promote awareness, enlist the population and ensure vaccination will expand the much-needed coverage in rural areas.

All this is not rocket science and does not require expert committees or task forces to advise the government. One cannot ignore the fact that confused decisions is a clear reflection of the poor levels of governance capability and that issues of corruption cannot be ignored or wished away. All it needs is the political and bureaucratic leadership to operate with determined optimism and in an ethical and transparent manner. One needs to demonstrate both conviction and clarity in taking full responsibility for restoring the trust of the citizens in the system and the government on a war footing. This will be critical in ensuring that the third wave is either completely prevented or managed effectively with minimal casualties, if it does arise.

(The writer is Founder, Swami Vivekananda Youth Movement and Visiting Professor, Cornell University, USA)