COVID-19 in rural India: Centre must provide states with funds and expertise, not just issue guidelines
Since we have very little or no health infrastructure and facilities in the rural and tribal areas of the country, the situation is becoming worse by the day
The Centre has finally discussed the strategies to contain and manage COVID-19 in the rural India, but only after hundreds of bodies floating in the Ganges, the holiest river of the country, and buried in its sand, revealed how the disease is devastating even the small towns, peri-urban, and rural areas.
The guidelines and the standard operating procedures (SoPs) have come late – only a couple of days ago – but the help needed by them must reach faster since the battle there is likely to be more challenging than we have braved in the cities with comparatively far better health infrastructure and facilities.
Since we have very little or no health infrastructure and facilities in the rural and tribal areas of the country, the situation is becoming worse by the day. A rise in infection is being reported daily, but these are only those people who are residing near a health centre, and who can reach there despite unavailability of transport facilities due to containment measures or lockdowns.
We don’t have any idea as to what is happening in the far flung areas and small villages, where there are not even a health sub-centre, which are available only in bigger villages. Primary health centres are available at block levels, while referral hospitals or civil hospitals are available at district level.
Moreover, COVID-19 specific temporary hospitals are available only in the district headquarters. It is very difficult to take a COVID patient to the district level facilities due to various reasons including ignorance, misinformation, lack of transportation facilities, poverty, etc.
We have already witnessed the unavailability of medicines and oxygen at the district level due to which thousands have died.
The bodies of people dying in the village or semi-urban areas are not even being disposed of in hygienic manner, which is likely to lead to further spread of the infection and the casualties thereby.
The Centre’s new guidelines have proposed numerous suggestions to be implemented. The state governments are supposed to implement these on the ground, but the Centre seems to have given no thought to the ability and capacity of the states, both in terms of expertise and finance.
Most of the states lack both - their coffers are empty, and they may not have sufficient expertise to handle the emerging situation. The Centre’s suggestions are akin to suggesting that a person with a broken leg run a marathon.
The Centre, therefore, must come out with sufficient finance to support the states along with all help required to successfully handle the situation. For one, the Rural Health Mission should be immediately strengthened not only by suggestions but with funds and expertise.
The Centre, in its guidelines, has advised that peri-urban and rural areas plan a minimum 30-bed COVID Care Centre (CCC) for asymptomatic cases with co-morbidities or mild cases where home isolation is not feasible. It suggested providing Rapid Antigen Test (RAT) kits at all public health facilities including sub-centres, health and wellness centres, and primary health centres.
It has also suggested that CCCs can admit a suspect or confirmed case but should have separate areas for suspected and confirmed cases with preferably separate entry and exit for each.
Even if the suggestions are carried out on the ground level, these would prove too little, given the faster spread of infection. The government therefore must be ready with other supporting plans to augment the facilities in a very short period of time if required.
In every village, there should be surveillance mechanism in place, not only for tracking, identifying, and treating the patients but also for other public health and administrative issues. The guidelines have suggested that active surveillance should be done for influenza-like illness and severe acute respiratory infections periodically by ASHA and Anganwadi workers with the help of Village Health Sanitation and Nutrition Committees, but it is only the health aspect of the issue.
For tackling other issues, we must give responsibilities to Panchayati Raj System officials and their elected representatives. NGOs and other volunteers can be invited to participate in the surveillance.
The personnel involved in the work must be trained as fast as possible, with facilities as to when and how a patient should immediately be sent to the nearest appropriate higher level health centres.
Community Health Officers (CHOs) and ANMs also need immediate training to perform tests and handle kits.
Since monitoring of oxygen saturation in patients is important, the government must supply oximetres and thermometers in each village in sufficient quantities and train people on how to use them. Mere suggestion is not sufficient; the government must assure that there would be no scarcity of such instruments in the market, as we have seen in the case of drugs and oxygen. There will also be requirement of large number of home isolation kits including drugs and instruments.
One of the most important issues is disposal of a COVID victim’s body. Unlike in the urban areas, the rural areas have no regulated crematoriums. It would be really a tough task for the administration to secure the safe disposal of the bodies either in crematoriums or in the graveyards.
Views are personal