Tackling pandemic in Rural India – Explained, pointwise

Introduction

The impact of the pandemic in Rural India is quite high, especially the second wave. The positivity rate is quite high due to which India has witnessed the loss of many human lives. The situation becomes even more concerning when one looks at the dismal state of rural health infrastructure that is devoid of quality infrastructure and a sufficient number of healthcare professionals.

The time is ripe for the government to focus on rural India and rural healthcare in particular if it seriously wants to defeat the pandemic and prepare the region for future challenges. For this, a host of new measures are desired including greater devolution of funds towards rural healthcare and robust training of healthcare functionaries in the rural region.

Impact of the pandemic in Rural India

• Loss of Human Lives: The first wave didn’t reach smaller towns and hinterland regions. However, this situation was reversed in the second wave. 
  • Health ministry data for the last two weeks of May found that 66 percent of the districts having a test positivity rate of 10 percent or more were rural. This automatically resulted in greater deaths in these regions.
• Increasing Unemployment: Many rural people lost their jobs amongst the second wave of the Pandemic. According to the Centre for Monitoring Indian Economy (CMIE) data, the unemployment levels in rural India touched 14% in May 2021.
• Reduction in Non-Farm activities: The pandemic didn’t brutally impact the agricultural output, but it left an impact on non-agricultural activities of the rural region. 
• A rise in medical expenses: The poor state of the health care system induced a heavy financial burden on the rural masses. They had to travel long distances and pay hefty fees for getting treatment facilities. 
  • Many non-infected people created a buffer for future medical emergencies by reducing their demand for other products.
• Psychological Stress: The first wave of the pandemic forced the migrants to travel 500-1000 km barefoot towards their homes. In the second wave, a lesser quota of vaccines was allocated to rural regions that created a feeling of being second class citizens in their own country. 
• Education Divide: The pandemic enhanced the pace of digitalisation in the country. Both the teachers and students shifted towards the online medium. However, this progression enhanced the education divide in the country due to the poor availability of the internet, electricity and electronic gadgets in the rural regions.
• Prevalence of Hunger and Malnutrition: Both of them are rising in rural regions as schemes like Mid-day meal have come to a halt in many states. Further loss of income has reduced access to quality food.

Need to give attention to Rural India during the Pandemic

• Population Size: Around 65% of the population resides in rural areas. If the country wants to control the pandemic and achieve herd immunity, then adequate vaccination in rural regions is the need of the hour.
• Greater Vulnerability: The region comprises people who are not as affluent and resilient as their urban counterparts. Their ability to absorb extreme situations like a pandemic is very less due to inadequate financial cushions. 
  • Many in rural regions are hand to mouth workers who barely possess emergency funds of 2-4 days.  
• Inadequate Health Care System: The rural health care system in India is not adequate or prepared to contain COVID-19 transmission. This can be seen more evidently in densely populated regions of northern states. As they face a shortage of doctors, hospital beds, and equipment.
  • As of March 2018, there was a shortfall in health care facilities in rural regions. It was 18% at the Sub-Centre level, 22% at the PHC (Primary Health care) level and 30% at the CHC (Community Health Care) level 
• Country’s Economic Revival: The rural sector provides human resources for sectors such as retail, construction, manufacturing, hospitality, education and transportation. Further, continued consumption expenditure by the rural population creates demand for multiple goods and boosts the overall economy.
  • This is worrisome as India’s economy contracted by 7.3 percent in 2020-21, marking its worst performance in over four decades.
• Reducing expenditure on healthcare: Robust Rural health infrastructure will help in treating the disease at the primary level. It will help us save a lot of money and resources that are further spent at secondary and tertiary level health care.

Government Initiatives towards the betterment of Rural India during the pandemic

• The E-Sanjeevani platform provides virtual consultations to patients including patient-to-provider and provider-to-provider consultation. 
  • Under this a hub and spoke model was used which connected smartphone equipped rural wellness centres to specialist doctors located in cities.
• The government announced additional grains for the poor under the Pradhan Mantri Garib Kalyan Yojana.
• The Centre had allocated 73,000 crore rupees for 2021-22 for MGNREGS (Mahatma Gandhi National Rural Employment Guarantee Scheme) and notified an annual increment of about 4% in wages.

Challenges in vaccination and controlling the pandemic in rural India

• Supply of Vaccines: The supply of vaccines has been biased towards the urban centres. 
  • The government allowed private sales of vaccines for adults aged under 45 years, this favoured residents of cities with larger private hospital networks. 
  • For the first four weeks of May, nine big cities (Delhi, Mumbai, Hyderabad etc.) gave 16 % more doses than all the combined rural districts.
• Vaccine Hesitancy: It refers to delay in acceptance of vaccines or refusing vaccines despite their availability. The rate of vaccine hesitancy is higher in rural regions due to lower literacy levels.
• Infrastructure Deficit: The rural regions have a scarcity of testing services, weak surveillance system and poor medical care. This creates an impediment in taking relevant measures towards the pandemic. 
• Human Resource Constraints: Many health care providers in rural areas are unregistered and untrained and do not know what to do in such an emergency.
  • There is a shortfall of 81.8% specialists as compared to the requirement for existing CHCs.
• Poor Approach: The State has focused more on curative care rather than preventive care. This enhances the burden on the rural healthcare system and puts a greater economic impact on the masses in terms of higher medical bills.
• Sharing of Burden: The central government is taking lesser responsibility towards easing the situation arising from state lockdowns. Some states (such as Kerala and Tamil Nadu) have announced relief measures, but others have not done much. The latter ones are not in a position to do much because of their financial situation.

Suggestions to tackle the pandemic in Rural India

• The central government should ensure robust development of the rural health network (SHCs, PHCs and CHCs) by providing a greater amount of funds. 
• The government should take active support from public-spirited citizens. For instance, Swasthya Kalyan Samitis, or SKSs were constituted for all CHCs and PHCs in haryana.
  • It allowed health providers to engage with all kinds of rural community organisations (panchayats, municipal bodies, non-governmental organisations etc.) and minimise the adverse impact of the pandemic on rural life.
• Rural health networks should have access to the health data of people in their respective areas. This will enable them to identify those likely to slip into the secondary or tertiary care zone.
• There is also a need to conduct Regular health camps. It will help us to identify those on the verge of developing tuberculosis, hypertension, diabetes or any diseases owing to their socio and economic conditions.
• India can establish an independent team of experts under the aegis of the WHO. They will ensure adherence to recruitment standards, consent conditions, adverse event record management, and compensation standards. 
  • This will improve public confidence and provide enough data for the future policies of the government.
• The center should do the bulk purchase of vaccines rather than leaving the states at their own mercy. Further voluntary licencing of patents must be encouraged to boost the production in a lesser time and attain the goal of universal vaccination.
• The country should also adopt new methods like Remote shared medical appointments. This would allow virtual interaction of a doctor with multiple patients having similar issues, thereby saving cost and time.

Conclusion

The government should take immediate steps to control the pandemic in Rural India. They must use this as an opportunity to strengthen and improve the primary health care system in rural India, thereby preventing it from becoming the next Covid-19 hotbed.