Experts on Strategy to Combat the Third Wave In Rural India

From the given experience of the second wave it has become clear that rural India is the most vulnerable. People in villages in particular and rural areas in general were devoid of even basic medical care facilities. The first wave gave the impression that the pandemic was urban centric but the second wave proved us all wrong as it was widespread in rural areas and villages. Healthcare facilities and infrastructure was further exposed and the helplessness of the people in the absence of proper medical care became more evident.

It would be wrong to point fingers towards any government because none of them since Independence gave priority to healthcare or even education in rural areas since Independence. The successive governments in states and at the centre failed to address the rural-urban distress. The second wave reminded us of the utter neglect of the concern of the people in rural areas. On the one hand the pandemic has exposed our healthcare system in both rural and urban areas but on the other it has reminded that without any dilly-dallying, and blame game, the government at the states and central level should do everything to ensure that our healthcare system is vibrant from villages to smart cities.

On Doctors Day, Chief Justice of India N.V. Ramana addressing the medical fraternity in the national capital while expressing concern at the lack of government priority for health care said, “Issues such as insufficient number of medical professionals, infrastructure, medicines, outdated technologies, and government not giving priority to the medical sector are issues of immediate concern.”

According to A Amarender Reddy, Principal Scientist (Agricultural Economics) and expert in rural economy, ICAR-Central research Institute for Dryland Agriculture, Hyderabad, “Various countries experiencing third wave of COVID, India is not exception with most of the population still not vaccinated. India has to prepare to nib the third wave in its initial stage itself. The time tested ‘trace, test, track and treat policy’ needs to be adopted in each village by forming a village covid committee. It is now the time to focus on rural health care infrastructure. The link between patients and public health system is very weak in rural India. The covid, exposed the countries divide between haves and have-nots and rural and urban areas in hospital infrastructure. In most of the remote villages, people are dying without diagnosis of disease and stigma attached to COVID.”

On how to manage the third wave in rural areas, Reddy said, “The public health system has to depend on time-tested traditional village panchayat system in fighting pandemic. The villagers place more trust on village elders, opinion leaders. Each village should form a ‘COVID management committee’ comprising of village president, primary health centre doctor, local science teacher, Aasha worker and Anganwadi worker to guide villagers on various issues relating to COVID like hand washing, mask wearing and social distancing. This committee should be proactive in creation of public awareness, identification of cases, controlling the spread of infection and arranging treatment.

He added, “The village COVID committees have to arrange preliminary diagnostic checks and if necessary collect samples for COVID test and arrange recommended free medicine kit to identified patients. The village COVID committee should have direct contact with ‘rapid response teams’ already formed at district level to coordinate the ambulance and hospital admissions for severe cases. Overall, use of village level local institutions on a mission mode by creating a separate ‘covid management committee’ at village level to oversee all arrangements from increasing awareness, diagnose, identify and treatment of covid cases will save many lives and reduce burden on health system.”

On the availability of doctors, he said “There is a huge shortage of doctors in rural areas. In some villages, no doctor appears to see the patients even on emergency and kin are left to take care of the patients themselves. Hence, in addition to the public health system, in rural areas government has to rope in well trained Rural Medical Practitioners (RMPs) as first contact between patient and the government machinery. Government has to give brochures and other information bulletins on ‘how to give first aid to COVID patients’ in local languages to RMP doctors in the villages. Generally, these RMP doctors are available all the time in the villages at nominal costs.”

Stressing on the fact that India needs to prep up for a third wave, Dr. Wasim Ghori - Consultant Diabetologist & Fellow - Royal Society of Public Health, UK said that the healthcare system in rural areas stands exposed and it shows we haven't paid any attention to it. Overall, we have to focus on healthcare infrastructure to avoid and combat the third wave.

He further highlighted the discrepancy of healthcare system for children and healthcare services in rural areas of the country. Giving statistics, he added, 65 percent of the population is in rural India. 40 percent of the population is under 19 years of age. There are different data that suggest there are 3.2 government hospitals per 10,000 patients. There are 90,000 ICU beds for adults but only 2,000 beds for kids. From first and second wave, there has been an increase in children being affected by 5 times. Furthermore, India has 62 percent vacancies of pediatricians in rural areas and we have 37 percent of children who are malnourished. Not just doctors, shortage of nurses needs to be addressed too in our country, especially in rural areas.

According to Ghori, “It's a wake-up call that most important part is healthcare in rural India and anticipated third wave can be prevented or mitigated on the basis of lessons learnt from the past two waves of Covid-19 pandemic. In order to strengthen our rural healthcare networks and work towards setting child-friendly Covid centers which are equipped with all essential services. Dr Ghori also suggested some measures like:

1) Invest in rural healthcare infrastructure and promote rural healthcare providers. We have a huge system of ASHA workers, if we can leverage them, it would be great. 2) Mass education programmes on behavioural vaccines include appropriate wearing of face masks, practicing Covid-appropriate hygiene and maintaining adequate physical-social distance. The Tana Bhagat community of the Oraon tribe in Jharkhand has shown how to beat Covid-19 without vaccines. The community has set an example for others on how to avoid the disease. They are teetotallers and are known for their high standard of hygiene and cleanliness, besides plain and healthy eating. 3) Create a strong surveillance system that can help us reduce fatality. ‘Test, track and treat’ has been the mantra of health agencies across the world, including the World Health Organisation. But, what has been observed is that this principle has remained mostly on paper and enforced less rigorously on the ground for various reasons. 4) Speeding up Vaccination in rural India: In rural areas, not only there is a lack of knowledge about the COVID-19 disease and the protection one gets from a vaccine, but also there are challenges to register for vaccination.

Dr Ghori added, “This could be the best time to ensure that Covid-management fatigue does not creep in as it happened on the retreat of the first and the second wave. Fresh Covid-19 cases should be aggressively managed, contact-traced and treatment protocol thoroughly followed at the local level. A catastrophic second wave of COVID -19 infections has brought India together, united in grief and pain, but with an overwhelming desire to help each other through the toughest of times. As India braces for a possible third wave, the time for us to stand together once again, is now.”

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