In continuation with the ongoing discussions on the rural realities around the country, the Centre for Habitat, Urban and Regional Studies (CHURS), Impact and Policy Research Institute (IMPRI), New Delhi, organized a panel discussion on Rural Realities: Maharashtra Practitioners’ Experiences in Tackling the Second Wave in Indian Villages.
Vibhuti Patel, Former Professor, Tata Institute of Social Sciences (TISS), Mumbai, moderator of the webinar, highlighted that rural areas were having more cases and Maharashtra topped the charts. The reason is, inadequate testing facilities at primary health centres (PHCs), which are medically ill equipped. Ayushmaan Bharat scheme has become ineffective. There are fewer oxygen beds available in the rural areas. Public healthcare is the need of the hour.
People faced financial crisis and sold their lands off to avail health services. Oxygen shortage caused critically ill patients to die on roads. Self-help groups (SHGs), ASHA workers, and anganwadi showed valour, which could be heard all across India for their determination towards work. People to people solidarity can go a long way in tackling this deadly virus. Teachers and police officers are also playing a vital role.
Women became vulnerable to sexual violence. The term Covid widows is being used in Maharashtra. Women don’t have land in their names. They don’t have ration cards in their name, which added to their problems. Education has been a major casualty, as online education is not possible in rural areas. Covid-19 is a multi-pronged issue as socio-economic issues, food security, employment and health emergency are at the core of the issue.
Inequitable health system
Dr Dhananjay Kakade, head of the Support for Advocacy and Training to Health Initiatives (SATHI), Pune, asserted that Covid-19 will have an immediate mid-term and generational impact. We need to focus on the health system. A long-term view is required. There is distress at the community level which needs immediate attention.Many kids are out of school which is going to have a long-term impact on the psychological health of the children. Covid has impacted people in an unequal way. Basics of our health systems are not at place. Common people have many questions like, “Why actors and celebrities are getting beds and not us?”
We need to have a comprehensive picture to assess the impact, he said. Covid has had multi-dimensional impact on people. There is a deep crisis ongoing. Sheer apathy and ignorance from the decision makers and state apparatus to equip the frontline workers to deal with this pandemic as ASHA workers don’t have necessary medical equipment. Scientific information needs to be generated. Insurance needs to be provided to ASHA and Anganwadi workers.
Traditional fault lines became more prominent during Covid. The impact of this pandemic will be much worse on the marginalized sections. For some, pandemic is an opportunity to make profits also. Black marketing has been reported in essential medical drugs. “Transparency and accountability mechanisms at the grassroot level needs to be strengthened”, said Dr Kakade. "We need an equitable health system. Civil society organizations’ role in changing the governance structure of the state is crucial."
Dr Arun Gadre, head, SATHI, Pune, pointed that Covid-19 shattered the middle classes. There is a paradox of equality. It is an opportunity to pitch for universal healthcare. Out of pocket expenditure on health has increased. Private sector was absent in the first wave, and there was a big burden on public health system. During the second wave, lack of resources was a major issue. Nearly 80% people were getting admitted in private sector hospitals. Awareness was very low in rural areas.
Women centric issues
Lata Bhise, State Secretary, National Federation of Indian Women (NFIW), Maharashtra, said that there is political, social, cultural and religious impact of Covid. Ration and unemployment are the main problems in rural areas. Rs 1500 allowance has been given to domestic and construction workers in Maharashtra but the problem is that women only below 60 received it.There were long lines in banks. Social security pension disbursement was a major problem. ASHAs have been stigmatized. They do not get proper treatment of them as many accused them of spreading Covid in rural areas.
Child marriages have increased in rural areas. Girls’ education and dropouts have increased rapidly. Beedi workers in Maharashtra (Padmashaali Samaaj) became totally unemployment. Micro finance companies have made SHGs and disbursed loans, but there is sexual harassment. In Covid wards, sexual harassment has been reported. Vaccination of ASHA workers is the need of the hour.
Dr Dhruv Mankad, Managing Trustee, Anusandhan Trust, Pune, highlighted that migrants issue and subsequent lockdown of villages was the first reaction in the first wave of Covid-19. Community responded correctly, as nobody knew the nature of the virus. Humanitarian and rights-based approach is the need of the hour. Food security has been a major issue. We need to have a micro planning system.
Faith building among the masses is very important. Trust deficit needs to be tackled. We have to revive things as there is huge financial crunch. SHGs can be a strong platform for preventing domestic violence in rural areas.
Health and nutrition
Dr Shailesh Dikhale, who is with SATHI, Pune, said delay in testing of Covid-19 has been a major issue. Nutrition services need to be addressed. Anganwadi centres are closed. Stunting and severely wasted children have increased. We need to be proactive, as it is predicted that children will be most affected in the third wave of Covid-19.Dr Dikhale suggested the following action agenda:
- System strengthening through Help Desk, basically to provide guidance to patients regarding treatment related to Covid as well as other illnesses, immunization and testing and to create education related to various health schemes. Facilitate dialogue within the community.
- People’s health and nutrition education in the context of Covid. Development of education material in local tribal languages. Use of social media to educate rural and tribal community through Anganwadi, ASHA worker and Poshan Hakka Gat.
- Strengthening health and nutrition services and practices through community participation. Community feedback is important.
- Improvement in household nutrition practices and follow up of malnourished children. Follow up of malnourished children is important.
- Ensure treatment of non- COVID patients for non- communicable diseases
- Strengthen the government health and nutrition system and services through community participation
- Regulation of private health sector
- Strengthen preventive and curative aspects of health and nutrition
- Keeping in view the third wave of Covid-19, need to develop Covid Care Centre for children at block level
- Immunization in campaign mode while ensuring counselling for the same
- Strengthening social services
- Strengthening coordination and convergence b/w various line departments
- We need to document experiences during Covid pandemic to use these as a input at policy level.
Women’s space has shrunk. Land is registered in the name of males which puts a question mark on women’s identity as farmers. Subsequently they are not able to avail the benefits of government schemes. Separate women dairies should be built. Credit facility needs to be given to women.
Prof Vibhuti concluded by asserting that Vaccination infrastructure, lack of beds and reverse migration are the major issues. Civil society organizations should carry a communication drive and create awareness at the rural level. There is a need for robust data with action plan. Multi-pronged strategy can go a long way.
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