With the second wave of the pandemic touching India, the daily average cases went on to around 1,00,000. Later in June, when the number of cases weakened in big cities, the pandemic started spreading across rural areas of the country. As said in a report produced by the State Bank of India, by mid-May, rural districts accounted for nearly 50% of all the new cases in the country.
Figure 1 shows that around September 2020 when the first wave was at its peak, it was about 65% in both rural and semi-rural districts and had nearly 34 % of urban and semi urban districts. It is well known that the rural healthcare system is not well prepared to fight against such a deadly virus in India due to shortage of hospital beds, doctors, medicines and alternative infrastructure.
According to the National Health profile (NHP) data of 2019 [Figure 2, Source: NHP 2019] rural India had 3.2% government hospital beds per 10,000 people. The data also showed that there are more hospital beds in urban areas than in rural areas. The healthcare services and systems in India are still developing and the government has taken a number of steps to improve the status of health awareness among rural people.
It is necessary to work at the grassroot level to bring about changes in rural districts of the country. The rural parts being remote from the places where proper health facilities are available, the only way to improve the scenario is to try to reach basic healthcare to their doorsteps. In May 2021, the Government of India released special orders under Standard Operating Practices (SOP) that mainly focused on Covid-19 management in rural and semi-rural areas. The major action included training Accredited Social Health Activist (ASHA) workers by Panchayati Raj institutions to identify the early signs of Covid-19. Stress is being given in building up a three-tier structure consisting of a Covid-care centre for handling mild cases, Community Health Centre (CHC) for moderate cases and hospitals for the severe cases.
The Standard Operating Protocol (SOP) on Covid-19 management, especially for rural and peri-urban areas, released by the central government aimed at strengthening the primary level of healthcare infrastructure. It stated that proper surveillance is to be done in every village, for both severe and acute respiratory diseases and ASHA workers are in charge of this task along with Village Health Sanitation and Nutrition Committee (VHSNC).
Responsibility is also given to the Community Health Officers (CHOs) for handling the patients who are symptomatic. The CHOs are doing a great job in fighting against Covid-19, particularly in rural areas. They are being properly trained in carrying out the process of Rapid Antigen Test (RAT). The government is also keeping an eye on sufficient availability of RAT kits in Primary Health Centres and village sub-centres. Figure 2 shows that Indian rural health infrastructure has improved to an extent since the Ayushman Bharat programme was implemented in 2018. Source: Ministry of Health and Family Welfare. The National Governors Association Center for Best Practices (NGA) has instructed the state officials and community-based health organizations to uptake the pace of vaccination and also improve their confidence level in vaccination in rural communities.
We all are aware that the only way to escape and eradicate this deadly virus is vaccination and we, the Community Health Officers (CHOs), are being ordered to help reach the vaccination to the doorsteps of rural people. The first and foremost challenge was to build confidence and trust of the villagers regarding the safety of the vaccines. For this, the CHOs along with the extension workers like ASHA, ANM and ICDS workers are carrying out camps on a regular basis to eradicate fears and doubts regarding the side effects of vaccination. Moreover, for every village there is a Village Health Sanitation and Nutrition Committee (VHSNC) acting as the sub-committee of the gram panchayat. Under this body the ASHA workers function as the convener of the committee. They carry out a special type of meeting known as” mothers meeting” with the assistance of the CHOs. The main motto of this meeting is to gather together the village women and make them aware about washing hands, using masks, hand sanitizers and maintaining the entire covid protocol during the pandemic.
Another productive initiative by the government is the use of telemedicine. The government has provided each one of us a laptop and with that we carry out the primary health check-up of every patient. We consult doctors digitally and try curing the patients in the sub centres. Most of the villagers visiting sub centres are either farmer or daily wage labours. Lack of time and finance is their major problem. So, we try not to send them to far away hospitals and this in return saves their transportation cost and time as well. Apart from this, the government is continuously sending funds for buying masks and sanitizers to distribute in every village household. Summing up, we can say that the sub centres, primary health centres and we, the CHOs, are the government’s major task force for handling the Covid-19 situation in rural India. The nationwide fight against Covid-19 will only be successful with faster vaccination coverage. At the rural level, more engagement needs to be done with communities and government health services. MADHURIMA MISRA PATHAK, Community Health Officer, Pearapur Suswasthya Kendra, Hooghly