While the COVID-19 pandemic has hit the world alike, its impact on people from disparate socio-economic standings has been unequal. Keeping in line with this and in continuation of the rural realities webinar series, the Centre for Habitat, Urban and Regional Studies (CHURS), IMPRI Impact and Policy Research Institute in collaboration with Centre for Development Communication and Studies (CDECS), Jaipur and Tarun Bharat Sangh, Alwar organized a panel discussion on “Rural Realities | Rajasthan Practitioners’ Experiences in Tackling the Second Wave in Indian Villages” on May 13th, 2021.
Dr. Indira Khurana, Senior Expert, Water Sector; Vice-Chair, Tarun Bharat Sangh, Alwar guided the session with her opening remarks.
She thanked the panelists for taking out the time to discuss their experiences and opinions. The objective of the webinar is to analyze the impact of COVID-19 on the states of Rajasthan and cross-learn from practitioner’s experience from other states. With the recurring theme of Atma Nirbhar in the country, Dr. Khurana asks, with firm belief in ‘prevention is better than cure’, how our villages can become the same in terms of health.
The IMPRI team gave a brief presentation in order to provide an overview of the state of Rajasthan. They informed the participants about the state’s geographical and socio-economic status and gave insight into the situation of COVID-19 in India and Rajasthan, highlighting pertinent emerging issues.
Systemic and Cultural Deficiencies
Dr. Rajiv Gupta, Former Head and Professor, Dept. of Sociology University of Rajasthan; Advisor, CDECS, Jaipur believes that the second wave of the pandemic is different from the first one, in a way that it is system-created, especially the government- related systems. The rural population was severely impacted by the reverse migration in the first wave, in a limited manner however and Kumbhmela returnees in the second. This devastation has not been quantified due to the lack of data.
Strengthening of the districts and related tehsils community- based capacities, facilities and organizations through democratic processes has to be brought on the center stage, said Dr. Rajiv Gupta
RT-PCR and Antigen tests, along with vaccines have to penetrate into the villages. This has not been done yet, favoring urban areas for development and taking advantage of the powerlessness of the rural population. Dr. Gupta made a firm suggestion of building multiple mobile groups out of community-based organizations, civil societies and medical staff.
Primary Health Care Centers
Mr Maulik Sisodia, Executive Director, Tarun Bharat Sangh, Alwar agreed with Dr. Gupta by saying that the tehsil and primary health care (PHCs) level rural health infrastructure and oxygen supply has always been weak and never developed presuming that the disease was an urban one. In some cases, it worsens the mild symptoms of a patient into critical ones.
One deficiency was that the community organizations were not able to utilize their strength like in the first wave. Another is that in case of COVID related symptoms, doctors are directly prescribing medicines, while claiming that tests are not required. This makes the process counter-productive, because if the number of new cases is not known then there will be a mismatch in the number of beds and other facilities. Tarun Bharat Sangh has initiated a self-observation kit and a helpline number for assistance.
Ms. Maya Vishwakarma, Founder, Sukarma Foundation, Madhya Pradesh drew a comparison between healthcare facilities and social institutions of Madhya Pradesh and America. Further, she envisioned tele-medicine primary health center, even before the pandemic, through her foundation, especially in the backward regions lacking infrastructure and political connect.
Ms. Maya Vishwakarma highlighted that Political unwillingness to collect data has been a major hurdle.
Some cultural values that hold rural communities together turned out to be inconsistent with COVID-19 guidelines. They also worked towards establishing isolation beds for early treatment, supplying medicines and tracing contact.
Multi- pronged issue
Dr. M R Seetharam, Consultant Orthopedic Surgeon, Vivekananda Memorial Hospital, Mysore; Swami Vivekananda Youth Movement (SVYM) recapped the definition and determinants of health. He acknowledged that at the international level, there is a more system or policy approach towards health security and what we need is a human-centric approach at the grass-root level. Security has to be for everybody, both at the individual and group level.
Life style or behavioral issues can cause and enhance diseases. Employing trained human resources and focusing on other aspects in addition to IU beds and ventilators requires major attention, said Dr. MR Seetharam
Further, he laid down the principles of maintaining COVID crisis, including containing transmission, structured management, ensuring routine health care, training and capacity building of gram panchayats and self-help groups, relief materials for affected families, livelihood and economic stability and working together in networking and coordination with the gram panchayats and PHCs. Aarogya Raksha Samiti (ARS) focuses on water sanitation and hygiene interventions with COVID- appropriate approach. Collaborative initiatives with ASHA and Anganwadi workers have been an integral part.
Directing the attention from government systems to behavioral approach, Dr. Upendra Singh, Director, Centre for Development Communication and Studies (CDECS), Jaipur highlighted the indifference and lack of capability to access healthcare among people. The public functionaries’ interest towards the patients is minimal, while the cost of private health care is out of bounds for most.
Civil societies have been kept at the peripheral of the decision-making and implementation process, said Dr. Upendra Singh
In effect, they have to push harder to draw attention and create an impact. We have to accept the situation at hand and create an enabling environment. With the looming pandemic and any other crisis that may come our way, our priority is to employ the existing system to build awareness and vigilance among people, unify support systems of the government and civil societies, engage community organizations that lack vision and reduce morbidities.
Social and Health Infrastructure
Dr. Meena Kumari, Professor and Head, Department of Civil Engineering at Faculty of Engineering, Manipal University, Jaipur has worked towards creating awareness among rural communities about safe sanitation practices. In addition to physical training, informative messages and videos through discussion forums and social media have played an important part of the same.
Financial support from the government should be increased to support healthcare and economic status of the rural population, which is a three quarters of the population of Rajasthan.
The confidence and trust between healthcare doctors and people have to be enhanced, said Dr. Meena Kumari
Prevention and early detection through PHCs has to be strengthened, which will also reduce the dependency on urban centers.
Mobilization of Resources
Ms. Sion Kongari, Regional Manager, ActionAid, Jaipur brought the indirect impact of COVID-19 on the livelihoods of the Farmers, Adivasi community and ghumantu caste into focus.
Government schemes have to be uniform and ubiquitous, said Ms. Sion Kongari
The various frontline functionaries, collectives and civil society organizations have to work together.
She further made a suggestion that for migrant workers, we can utilize village- level institutions and centers instead of home quarantine to break the chain. Village development plans have to incorporate health infrastructure. Following up on Dr. Meena’s discussion, she has advised extraction of authentic information from government websites and mobilization of resources to be available to all.
Decentralized and Community-based Approach
Shri Rajendra Singh, Waterman of India, Chairman, Tarun Bharat Singh, Alwar explained that the immunization systems in medical sciences are mainly driven by corporates and corporate-driven democracies, the priority of which is profit-making.
For health security a decentralized, community-driven system has to be devised, said Shri Rajendra Singh
He linked the surge in number of cases to the changing seasons. We can follow this pattern and plan for the future. He was pleased to note that organizations have set aside their political and religious ideologies to work collectively in the time of crisis.
Community-driven natural resource development became active during the reverse migration. Ayurvedic, unnani and homeopathy have to be revived and along with modern medical sciences, have to be integrated in order to ensure long term health security.
- Holistic, community-based interventions
- Interventions should be consistent with the development programs, and not be disease or symptom specific
- Training and capacity building
- Strengthening primary health centers
- Integration of traditional medicines
- Awareness program using social media
- Post-COVID employment and supply of output