Enabling local government systems to combat COVID-19 in India

Front line workers from all the departments play an integral role in containing the pandemic

By Ishani Palandurkar, Praharsh Patel
Published: Tuesday 28 April 2020

The novel coronavirus disease (COVID-19) is not the first pandemic faced by the world. The earliest recorded one was Athen’s Plague in 430 BC and the deadliest one that came just before COVID-19 was the H1N1 virus (Swine Flu) in 2009-10, that killed more than 500,000 people worldwide.

A few things common to all pandemics are poor healthcare facilities, lack of awareness and dearth of basic necessities and public services to marginal societies. The Millennium Development Goals launched in 2000, in fact, primarily focused on these three pillars through its first six goals.

Governments in India play an important role in bridging the access gap that save millions at the bottom of the pyramids.

This is done through the public distribution system (PDS) which takes care of food security, the National Health Mission and the Union Ministry of Health and Family Welfare that provide for village-level healthcare facilities and the Ministry of Human Resource Development that looks after inclusive development through education from elementary level to higher education and skills development.

In addition to doctors and local authorities, front line workers (FLWs) from all the departments play an integral role in containing the pandemic. To build a comprehensive resilience of these pillars, FLWs become the first line of defence for the nation under any crisis.

Strengthening PDS

State and district authorities struggle to feed the poorest sections and while there are civil society organisations (CSOs) that help, unorganised arrangements led to more burden than solving the problem.

Some volunteers working to deliver food were themselves found infected and had become carriers. Surat and Delhi have experienced this very phenomenon.

One example here — although not perfect — is the ‘Amma Canteen’, run by the state government of Tamil Nadu.

It shows how integrating the distribution of ration can be altered to deliver a daily cooked meal for people who cannot afford meals by themselves.

Many other state governments are initiating community kitchens for the poor, but proper monitoring of hygiene and physical distancing is essential in providing such a facility, as the kitchen itself can become a hotspot.

Community resource persons (CRPs) are appointed by the authorities to monitor overall development work and assist in proper implementation of policies. They can also be assigned to ensure physical distancing among beneficiaries.

Symptomatic people can be immediately taken to healthcare facilities and isolated from crowd and hygiene and precautions are met in the kitchen and for the staff.

Another short-term solution is to make the district administration a regulator of CSOs and allocate areas and activities to different organisations willing to donate. This solution is already working in several cities, bridging the demand-supply gap.

In addition to ration, the public also needs other necessities such as spices, vegetables, basic hygiene and health material.

The lockdown will not be effective if marginalised communities are not provided with essential goods and have to step out to fetch them.

This challenge can be solved to an extent if civic bodies can provide these necessities in a centralised way by limited and monitored supply channels. In many cities, municipal councils have taken an initiative to sell ‘vegetables on wheels’ to its citizens, so that they do not have to step out of the house to procure them, limiting their contact as far as possible.

PDS channels and information can be leveraged in estimating the number of households in the remotest areas and provide them with the basic vegetables along with staple grains. Piloting this scheme will also give an insight if the country can include vegetables and fruits in the scope of the PDS.

Empowering FLWs

India’s last-mile healthcare delivery mechanism is carried out by the auxiliary nurse midwife, accredited social health activist, anganwadi workers, and CRPs. The World Health Organization (WHO) is extensively focussing on raising awareness on COVID-19, demystifying myths and stigma in maintaining safety standards.

It is essential that a clear distinction is provided in each of these roles while constantly supporting each other, for this purpose.

First, extensive awareness has to be created for hand washing, maintaining physical distancing, behavioural practices for coughing or sneezing in elbows or handkerchiefs and safe disposal of used tissues or masks.

Governments and the WHO have released several dos and don’ts as well as other information material to be followed by FLWs while interacting with communities that ensure standard information is being disseminated and well understood among the public.

Second, there is a need to identify high risk groups and carry on healthcare delivery accordingly. Older individuals across the globe are more prone to the disease. In India, however, people aged between 40-60 are at high risk of infection.

India already has a severe burden of hypertensive and diabetic populations in this age group.

Third, there should be focus on pregnant and lactating women. While there is no evidence that pregnant women are at high risk from COVID-19, complications during pregnancy can make them more susceptible. India has a higher number of hypertensive pregnancies and it is important that pregnant / lactating women and children are closely monitored for nutrition needs in rural areas.

Finally, a strict administration of health and hygiene should be conducted for FLWs themselves.

Leveraging educational forces

Educational institutes are temporarily closed. Also, given the lack of access to internet and cellular networks, online classes are not viable for children from marginalised communities at large. The expertise of teachers, facilitators and educational networks, however, can be leveraged for spreading impactful awareness, assess on-ground grievances and ensure education in whatever form possible.

Education facilitators are better trained to know how some information can be reached out to certain sections of the society and how to trigger their emotion that will ensure proper compliance to hygiene and social distancing practices.

For areas that have internet accessibility, innovative and engaging learning videos or simple quizzes can be designed that can be viewed and completed through phones, using either internet or SMS. This will eliminate the need for children to own laptops and would ensure continuity in learning.

In conclusion, the challenges posed by COVID-19 are not limited to the spread of the infection. The solutions, therefore, shouldn’t be limited to treatment for the disease either.

Food security, health and education for all are some services that cannot be halted even during a pandemic. It is, thus, essential that these three pillars are strengthened through right innovations, rethinking systems and encouraging collaborations.

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