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 Table of Contents  
EDITORIAL
Year : 2020  |  Volume : 25  |  Issue : 2  |  Page : 59-61

Empowered rural communities: The key to India's response to COVID-19 pandemic


Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India

Date of Submission14-Oct-2020
Date of Acceptance03-Nov-2020
Date of Web Publication15-Dec-2020

Correspondence Address:
Dr. Subodh Sharan Gupta
Department of Community Medicine, MGIMS, Sevagram, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmgims.jmgims_125_20

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How to cite this article:
Gupta SS, Kothekar P. Empowered rural communities: The key to India's response to COVID-19 pandemic. J Mahatma Gandhi Inst Med Sci 2020;25:59-61

How to cite this URL:
Gupta SS, Kothekar P. Empowered rural communities: The key to India's response to COVID-19 pandemic. J Mahatma Gandhi Inst Med Sci [serial online] 2020 [cited 2021 Jun 21];25:59-61. Available from: https://www.jmgims.co.in/text.asp?2020/25/2/59/303413



The COVID-19 pandemic has posed unprecedented challenges to the whole world. In India, despite early and intensive efforts, the total number of cases has crossed the 6.6 million mark with more than 100,000 deaths as on October 5, 2020.[1] Families across India are facing serious crises, not only related to health but also related to food and job insecurities. The pandemic, that initially had its epicenter in metropolises and urban areas, has gradually spread to rural and remote areas which have limited health-care services and other resources to respond to it.[2],[3] More than 50% of the cases of COVID-19 in August 2020 were reported from “mostly rural” and “entirely rural” districts.[4]

India has implemented a strict nationwide lockdown in an attempt to contain COVID-19. While the pandemic and lockdown have resulted in short-term challenges, there are manifold long-term medical, nutritional, economic, and social impacts of the pandemic. These factors, individually and in combination, will adversely affect the long-term health indicators. There is an increased possibility of undernutrition among those who belong to the low socioeconomic strata.[5] The Indian government has progressively begun relaxing the strict measures and restrictions in an attempt to reverse the economic losses. Community transmission of the virus is being accelerated in this process of balancing lives and livelihoods.

In this situation, we need our communities to be better prepared and equipped. We must prioritize the community-level preparedness and response with active community participation. As the COVID pandemic shifts to the rural areas, community response at the village level, through a system of local governance and collective leadership, will prove critical in the control and mitigation of the pandemic.

The cost of failing to empower the rural communities could be huge. There are multiple factors which make rural populations more vulnerable. These include lack of awareness, undernutrition, and weak public health infrastructure and services. According to the National Family Health Survey-4, only 25% of rural Indians have access to public outpatient health care.[6] Data from the World Bank show that more than 65% of India's population resides in rural areas, but around 65% of all government hospital beds are in urban India.[7] Most of the COVID-19 testing labs are located in urban areas. The health-care facilities which are crucial for the management of COVID-19 such as X-ray facilities, noninvasive ventilation, and life support ventilators are highly saturated in urban areas. Overall, it is comparatively easier to prevent the transmission than to contain the pandemic in rural areas.

In India, we have a great history of leaders who had envisaged the decentralized governance through local self-government. Mahatma Gandhi through his vision of Gram Swaraj advocated the empowerment and self-reliance of Indian villages to create a pattern not only for India but perhaps for the whole world. The 73rd amendment of the Constitution of India provides an institutional framework to implement this vision.[8]

Community participation and decentralized local governance might prove to be the biggest strength of villages in the fight against the pandemic. Preventive strategies such as social distancing and containment can be implemented in a better way if planned and organized strategically considering the lower population density and natural geographical separation of the villages. This allows cases in rural areas to be identified, isolated, and treated early. Surveillance and its compliance could be better. These are important factors to effectively prevent the spread of COVID-19. Communities are better placed to plan and facilitate the process required to ensure preventive measures and early response. Local bodies can enable safe operations of local markets, ensuring physical distancing.

We have various platforms available to ensure community empowerment. Under the National Health Mission, Village Health Nutrition and Sanitation Committees (VHNSC) are formed at the village level. For the decentralized health planning, VHNSCs act as centers of “local-level community health action.” VHNSCs are expected to support health-care providers, improve community awareness and access to health services, develop customized village health plans based on the local needs, and promote community action for health.[9],[10]

Under proper guidance, communities can promptly take necessary actions to mitigate the impact of the pandemic. Communities are capable of not only ensuring that the needs of vulnerable populations are being met with dignity but also maintaining solidarity at the community level. While rural communities have an inherent potential for organized collective action, they may however lack technical expertise for the same. If some organizations or agencies facilitate rural communities for collective health action, villages will be able to respond in a better way. When appropriate action is taken to empower rural communities, they will be able to support the health system to strengthen primary health care. If we are able to envision and implement strategies for a long term during this pandemic, it will enable us to reorient the socioeconomic model toward rural areas. This will result in more stable and sustained development.

In many states of the country, village councils have emerged as the center of action in response to COVID-19. They have realized the responsibilities, and responded positively during this crisis. The Gram Panchayats are going the extra mile to ensure that essential services are not disrupted. In Odisha, the Gram Panchayats have been strengthened by delegating the powers of the district collectors to Sarpanchs for effective containment of the COVID-19 pandemic.[11] The state has extended complete support to Gram Panchayats to lead at the grassroots level. Gram Panchayats are also ensuring that beneficiaries receive entitlements under the public distribution system. Members of women self-help groups have also been actively engaged in many activities such as running community kitchens and stitching masks.

One of the key factors in Kerala's much-applauded response to combatting the pandemic are empowered Gram Panchayats. Nearly a third of Kerala's plan funds have been given to the Gram Panchayats as flexible development and maintenance funds.[12] The Kudumbashree system, which encourages women to form self-help groups and their federations, acts as an organized civil society.[13] In Karnataka, village-level COVID-19 task forces, which have been created to handle the crisis, meet twice a week. These task forces ensure the supply of essential services, provide food to the needy, and implement preventive measures.[13] In Sukma, a tribal district in Chhattisgarh, the Gram Panchayats has provided rations to families without waiting for supplies from the state government. Self-help groups, farmers, and youth groups are working united to help the Gram Panchayats.[14] In Osmanabad district of Maharashtra, a community policing model has been developed to check the compliance of preventive measures.[15]

In order to utilize the power of organized collective action for containing the disease, the Government of India took an important step by adopting a self-assessment and action tool in the form of a checklist developed by a team at MGIMS, Sewagram.[16] The checklist is comprehensive in nature, along with a section on the promotion of preventive measures; helps with surveillance activities; and responses when someone tests positive. It also includes sections on promoting solidarity and inclusiveness, efforts to ensure non-COVID health services, and identification of needy families and plan for their help. The coronavirus preparedness checklist has the potential to catalyze community empowerment and help the community to be better prepared to contain the COVID-19 transmission.

While the government has decided to engage local governing bodies for this purpose, there is a definite need to further empower these local bodies. In turn, the approach that the local bodies would use with the larger community must also be participatory and empowering.[17] The community members should not only be told “what to do” but should also be provided greater control over the decisions affecting their lives. Even though actions to prevent transmission of the infection may seem well known, decision-making will also be guided by socioeconomic and structural conditions. For example, it may be impossible to isolate persons, confirmed or suspected cases, where the entire family shares a single room with inadequate access to safe water and sanitation facility. Likewise, social distancing in an overcrowded slum may be extremely difficult to operationalize. Better community ownership of the decisions could be ensured if there is an effort to search solutions to social and economic problems that determine the spread of the disease along with actions to control the circulation of the virus.[17]

In the long-drawn-out battle with COVID-19 ahead, collective community action is the most important weapon India needs to invest in. It will not only lessen the vulnerability of rural communities but also serve as an early remedy for the socioeconomic crisis the country faces during and after the pandemic. This will also be an investment for the future.



 
  References Top

1.
World Health Organization. Coronavirus Disease (COVID-19) India Situation Report-36; 2020. Available from: https://www.who.int/docs/default-source/wrindia/situation-report/india-situation-report-36.pdf?sfvrsn=f5aef67f_2. [Last accessd on 2020 Oct 12].  Back to cited text no. 1
    
2.
Ranscombe P. Rural areas at risk during COVID-19 pandemic. Lancet Infect Dis 2020;20:545.  Back to cited text no. 2
    
3.
Kumar A, Rajasekharan Nayar K, Koya SF. COVID-19: Challenges and its consequences for rural health care in India. Public Heal Pract 2020;1:100009.  Back to cited text no. 3
    
4.
Kawoosa VM, Mullick J. Battle Shifting as Covid-19 Threat Stalks Rural India. Hindustan Times; 26 August, 2020. Available from: https://www.hindustantimes.com/india-news/battle-shifting-as-covid-19-threat-stalks-rural-india/story-GZJsSPOOpNR0RF9Yj5B59M.html. [Last accessed on 2020 Sep 10].  Back to cited text no. 4
    
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Gopalan HS, Misra A. COVID-19 pandemic and challenges for socio-economic issues, healthcare and National Health Programs in India. Diabetes Metab Syndr 2020;14:757-9.  Back to cited text no. 5
    
6.
International Institute for Population Sciences (IIPS) and ICF. National Family Health Survey (NFHS-4), 2015-16: India. Mumbai: IIPS; 2017. Available from: http://rchiips.org/nfhs/NFHS-4Reports/India.pdf. [Last accessd on 2020 Oct 12].  Back to cited text no. 6
    
7.
Radhakrishnan V, Sen S, Singaravelu N, The Hindu Explains Is COVID-19 intensifying in rural India? The Hindu; 30 August, 2020. Available from: https://www.thehindu.com/news/national/the-hindu-explains-is-covid-19-intensifying-in-rural-india/article32476163.ece. [Last accessd on 2020 Oct 12].  Back to cited text no. 7
    
8.
Government of India. The 73rd Amendment of the Constitution of India; 1993. Available from: https://www.panchayatgyan.gov.in/documents/30336/0/Constitution+73rd+Ammendment.pdf/bd9dcfbd-34c3-4d33-bd51-a49c0aa9635d. [Last accessd on 2020 Oct 12].  Back to cited text no. 8
    
9.
Ministry of Health and Family Welfare. Government of India. Guidelines for Community Processes. New Delhi; 2013. Available from: https://nhm.gov.in/images/pdf/communitisation/vhsnc/order-guidelines/Guidelines_for_Community_Processes_2014.English.pdf. [Last accessd on 2020 Oct 12].  Back to cited text no. 9
    
10.
Ministry of Health and Family Welfare. Government of India. The Handbook for Members of Village Health Sanitation and Nutrition Committee; 2015. Available from: https://nhm.gov.in/images/pdf/communitisation/vhsnc/Resources/Handbook_for_Members_of_VHSNC-English.pdf. [Last accessd on 2020 Oct 12].  Back to cited text no. 10
    
11.
Boutilier M, Rootman I. Community Action and Reflective Practice in Health Promotion Research. Health Promotion International. Great Britain: Oxford University Press; 1997. Available from: https://academic.oup.com/heapro/article-abstract/12/1/69/720208. [Last accessed on 2020 Jun 04].  Back to cited text no. 11
    
12.
Bhatia L. How Gram Panchayats are Keeping COVID out of Villages. Times of India; 14 September, 2020. Available from: https://timesofindia.indiatimes.com/india/how-gram-panchayats-are-keeping-covid-out-of-villages/articleshow/77605460.cms. [Last accessd on 2020 Oct 12].  Back to cited text no. 12
    
13.
Raghunandan T. Responding to COVID-19 at the Grassroots. The Hindu; 11 May, 2020. Available from: https://www.thehindu.com/opinion/op-ed/responding-to-covid-19-at-the-grassroots/article31552359.ece. [Last accessd on 2020 Oct 12].  Back to cited text no. 13
    
14.
Chandrashekhar S, Naik M. Gram Panchayats, Unsung Warriors Finally Emerging as States' Saviour in COVID Battle. The Print; 24 April, 2020. Available from: https://theprint.in/opinion/gram-panchayats-unsung-warriors-emerging-states-saviour-covid-battle/408306/. [Last accessd on 2020 Oct 12].  Back to cited text no. 14
    
15.
Kulkarani S. One Cop in Each Village Along with Group of Volunteers: How Osmanabad's Community Policing Model Helpinh in Fight against COVID. The Indian Express; 22 July, 2020. Available from: https://indianexpress.com/article/cities/pune/one-cop-in-each-village-along-with-group-of-volunteers-how-osmanabads-community-policing-model-helping-in-fight-against-covid-6518826/. [Last accessd on 2020 Oct 12].  Back to cited text no. 15
    
16.
Principal Secretary, Ministry of Panchayati Raj, India. Letter issued to Chief Secretaries of all state (DO No M-11015/76/2020-CB Date: May 15, 2020) Community Preparation Checklist for action against Covid19 pandemic. In: Dr RST Uttarakhand Academy of Administration, Nainital. COVID-19 and the Role of Rural Functionaries: Resource Book of GoI & Government of Uttarakhand Advisories for Indian Villages; 2020. p. 132-140. Available from: https://www.uaoa.gov.in/sites/default/files/page-2020-07/COVID-19-final.pdf. [Last accessd on 2020 Oct 12].  Back to cited text no. 16
    
17.
Bispo Júnior JP, Morais MB. Community participation in the fight against COVID-19: Between utilitarianism and social justice. Cad Saude Publica 2020;36:e00151620.  Back to cited text no. 17
    




 

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