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) and Impact and Policy Research Institute (IMPRI), in collaboration with Centre for Development Communication and Studies (CDECS), Jaipur, and Tarun Bharat Sangh, Alwar, organised a panel discussion on ‘Rural Realities | Rajasthan Practitioners’ Experiences in Tackling the Second Wave in Indian Villages’” on May 13, 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 analyse the impact of Covid-19 on the states of Rajasthan and cross-learn from practitioners’ experience from other states. With the recurring theme of Atmanirbhar in the country, Dr Khurana, with a firm belief in ‘prevention is better than cure’, asked 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 Rajasthan. They informed the participants about the state’s geographical and socio-economic status, and gave insight into the Covid-19 situation in India and Rajasthan, highlighting pertinent emerging issues.
Systemic And Cultural Deficiencies
Dr Rajiv Gupta, Former Head and Professor, Deptt. of Sociology, University of Rajasthan, and 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, particularly pointing at the government-related systems. The rural population was severely impacted by reverse migration in the first wave and the Kumbh Mela reverse migration in the second. This devastation has not been quantified due to a lack of data. He said:
Strengthening of districts and related tehsils, community-based capacities, facilities and organisations has to be brought on the cenre stage through democratic processes.
RT-PCR and Antigen tests, along with vaccines, have to penetrate into villages. This has not been done yet, as urban areas are being favoured for development, taking advantage of the powerlessness of the rural population. Dr Gupta made a firm suggestion of building multiple mobile groups out of community-based organisations, civil societies and the medical staff.
Primary Healthcare Centers
Mr Maulik Sisodia, Executive Director, Tarun Bharat Sangh, Alwar, agreed with Dr Gupta by saying that rural health infrastructure at the levels of tehsils and primary health care (PHCs) has always been weak and never developed, presuming that the virus was an urban one. In some cases, it worsened mild symptoms of a patient into critical ones.
One deficiency is that community organisations are not able to utilise their strength, like they were during the first wave. Another deficiency is in the treatment 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.
Tele-Medicine
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 centres through her foundation, even before the pandemic had struck, especially in the backward regions lacking infrastructure and political connect.
Ms 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. Their foundation also worked towards establishing isolation beds for early treatment, supplying medicines and tracing contact.
Multi-Pronged Issues
Dr M R Seetharam, Consultant Orthopedic Surgeon, Vivekananda Memorial Hospital, Mysore, and Swami Vivekananda Youth Movement (SVYM), recapped the definition and determinants of health. He acknowledged that at the international level, there is a more systemic- or policy-oriented approach towards health security, and what we need is a human-centric approach at the grassroots level. Security has to be for everybody, both at an individual as well as group level. He said:
Life style or behavioural 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.
Further, he laid down the principles of maintaining the Covid crisis, including containing transmission, structured management, ensuring routine healthcare, training and capacity building of Gram Panchayats and self-help groups, relief material 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.
Civil Society
Directing attention from government systems to a behavioural approach, Dr Upendra Singh, Director, Centre for Development Communication and Studies (CDECS), Jaipur, highlighted the indifference and lack of capability in accessing healthcare facilities among people. The public functionaries’ interest towards the patients is minimal, while the cost of private health care is out of bounds for most. He said:
Civil societies have been kept at the peripheral of the decision-making and implementation process.
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, and engage community organisations 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 in the same.
Financial support from the government should be increased to support healthcare and economic status of the rural population, which is three quarters of the population of Rajasthan. She said:
The confidence and trust between healthcare doctors and people have to be enhanced.
Prevention and early detection through PHCs has to be strengthened; this will also reduce dependency on urban centres.
Mobilisation Of Resources
Ms Sion Kongari, Regional Manager, ActionAid, Jaipur, brought in to the focus the indirect impact of Covid-19 on the livelihoods of the farmers, Adivasi communities and the Ghumantu caste in the state. She said:
Government schemes have to be uniform and ubiquitous.
The various frontline functionaries, collectives and civil society organisations have to work together. She further made a suggestion that for migrant workers, we can utilise village-level institutions and centres instead of home quarantine to break the chain. Village development plans have to incorporate health infrastructure. Following up on Dr Meena’s discussion, she advised extraction of authentic information from government websites and mobilisation of resources to be available to all.
A Decentralised And Community-Based Approach
Shri Rajendra Singh, Waterman of India, Chairman, Tarun Bharat Singh, Alwar, explained that the immunisation systems in medical sciences are mainly driven by corporates or corporate-driven democracies, the priority of either being profit-making. He said.
For health security, a decentralised, community-driven system has to be devised.
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 organisations 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. Ayurveda, Unani and homeopathy have to be revived and, along with modern medical sciences, integrated in order to ensure long-term health security.
Learnings
- Holistic, community-based intervention
- Interventions to be consistent with development programmes, and not be disease or symptom specific
- Training and capacity building
- Strengthening of PHCs
- Integration of traditional medicines
- Awareness programmes using social media
- Post-Covid employment and supply of output
YouTube Video for Rural Realities | Rajasthan Practitioners’ Experiences in Tackling the Second Wave in Indian Villages
IMPRI Team