Analysing the recently-released SOP on COVID-19 Containment and Management in Peri-urban, Rural and Tribal areas by the Union Ministry of Health and Family Welfare, GYAN PATHAK explains what the SOP gets right, and what else needs to be done to check the spread of the COVID-19 pandemic in rural India.
THE Union Government has finally come up with a uniform strategy to contain and manage COVID-19 in rural India, but only after the Ganga, the holiest river of the country, was found with hundreds of bodies floating in it and buried in its banks, revealing how the disease is devastating even the rural heartland of northern India.
The guidelines, in the form of a standard operating procedure (SOP) document, has come late, only three days back, but they must materialise and get implemented expeditiously since the battle in peri-urban, rural and tribal areas is likely to be more challenging than the one faced by cities with comparatively better health infrastructure and medical facilities.
Rapidly deteriorating situation in rural India
Since we have very little or no health infrastructure, either public or private, in the rural and tribal areas of the country, the COVID situation is getting worse in these parts with each passing every day. A rise in infection is being reported daily, but these statistics are only accounting for those people who reside near a health centre, and those who can reach there in spite of unavailability of transport facilities due to containment measures and lockdowns.
We must realise that we have little idea as to how many people are infected in far flung areas, where one is not likely to find even a health sub-centre, which are available only in bigger villages. Primary health centres are available in usually the biggest village in each block, while referral hospitals or civil hospitals are available one per district.
Moreover, COVID-specific temporary hospitals are available mainly at the district headquarters. It is difficult to get a COVID patient to the medical facilities at the level of the district headquarters due to various reasons such ignorance and misinformation among patients, lack of transportation facilities, or socio-economic depravity of the patient.
We have already witnessed the unavailability of medicines and oxygen in cities and towns, due to which thousands have died. The bodies of people dying in villages or semi-urban areas are not being disposed of in a hygienic manner, threatening further spread of the infection and casualties.
What the union government’s SOP says, and what it is missing
The Centre’s new SOP has proposed numerous suggestions to be implemented. The state governments are supposed to realise the Centre’s directions 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, to do so. Most of the states lack the latter, with their coffers depleted.
The Centre’s suggestions, therefore, seem like advising a person with a broken leg to run a marathon. The Centre must come out with sufficient financial resources to support the states, along with all other technical and material help required to successfully handle the predicament. To begin with, the National Rural Health Mission should be immediately strengthened, not only by guidance, but with funds and expertise.
The Centre, in its SOP, has advised that peri-urban and rural areas plan COVID Care Centres (CCC) with at least 30 beds for asymptomatic cases with comorbidities or mild cases where home isolation is not feasible.
The provision of Rapid Antigen Test (RAT) kits has also been suggested to be made available at all public health facilities, including sub-centres, health and wellness centres, and primary health centres. It has also suggested that CCCs should have designated areas for suspected and confirmed cases, with preferably separate entry and exit for each.
Even if the suggestions are carried out at ground level, they would prove too little, given the rapid spread of infection. The State, therefore, must be ready with other supporting plans to augment medical facilities in a very short period of time, if required.
In every village there should be surveillance mechanisms in place, not only for tracking, identifying, and treating patients but also for other public health and administrative issues. The SOP has already suggested that active surveillance should be done for influenza-like illness and severe acute respiratory infections periodically by ASHA (Accredited Social Health Activists) and Anganwadi workers with the help of Village Health Nutrition Sanitation Committees, but this only tackles the health aspect of the matter.
For tackling other issues, responsibilities must be devolved officials and elected representatives at the panchayat level. NGOs and volunteers could be invited to participate in surveillance.
The personnel involved in the work must be trained as fast as possible, with facilities arranged as to when and how a patient could immediately be sent to the nearest appropriate higher level health centres when needed. Community Health Officers and ANMs (auxiliary nurse midwife) also need immediate training to perform tests and handle kits.
Since monitoring of oxygen saturation in patients is important, the government must supply oximeters and thermometers in each village in sufficient quantities and train people on how to use them. Mere suggestion are not sufficient; the union government must assure that there is 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, which should be arranged for.
Another key issue is the disposal of dead COVID patients’ bodies. Unlike in urban areas, most rural areas have no designated crematoriums. It would be really difficult for the administration to secure the safe disposal of the bodies either in crematoriums or in the graveyards.
What should then the union government do? The most important thing would be to impart information to villagers about the dangers of the coronavirus and build in them the capacity and self-sufficiency to deal with the pandemic on their own or with the help of the local administration and frontline health workers.
Efforts must also be made to speed up vaccination and remove vaccine hesitancy among the rural populace. (IPA Service)