Author: Smile Team

By Santanu Mishra India can never get over the devastating losses incurred because of the second wave of Covid-19 that overwhelmed the entire health system. People were struggling to find hospital beds and medical supplies- which became scarce and exorbitantly priced. Many perished due to overburdened healthcare facilities. The losses engulfed the entire human race at multiple levels, including emotionally and financially.

Although the second wave primarily affected cities, tremors were also felt in rural India. Rural areas in states such as Madhya Pradesh, Maharashtra, Rajasthan, and Jharkhand contributed to a steep rise in the number of active and positive cases across India and subsequent deaths.

Experts believe vaccination along with the use of masks, hand-washing and social distancing is the way out of the pandemic. However, in many parts of India, in particular rural areas, vaccine indecisiveness coupled with a general lack of healthcare facilities have contributed to a surge in case fatality.

Misleading information and rumours like “5G causes corona”, “Government declaring people Covid-positive even if they are not”, spread by word-of-mouth made it challenging to control and combat the spread of the virus. This deceptive information played a devastating role especially in the villages that anyways have a dearth of reliable sources of information.

Multiple states and central government-sponsored surveys which assessed misrepresentation of facts about Covid-19 in rural areas have revealed that a large number of people believe vaccination could be life-threatening as the vaccines have become available in the market in a very short time thereby compromising on ethical and quality compliances. Studies and surveys have also highlighted that a large section of the population considered forwarded messages on Social Media Platforms as reliable sources of information.

We need to resolutely tackle the twin concern towards lack of awareness and spread of deceptive information among masses– both in urban and rural areas. This requires a multi-pronged strategy comprising effective planning, sustained counselling, and combating the spread of rumours. There is a need to emphasise and bring about assurance and trust about the importance of getting vaccinated.

Research shows that there are five established categories of adopters to change, and while a majority of the general population tends to fall in the middle categories, it is still necessary to understand the characteristics of the target population. These are:

a) Innovators –people who want to be the first to try the innovation

b) Early Adopters –those who represent opinion leaders, enjoy leadership roles and embrace change opportunities

c) Early Majority -people who are rarely leaders, but they do adopt new ideas before the average person. They typically need to see evidence that the innovation works before they adopt it

d) Late Majority – sceptics of change, adopt only after innovation has been tried by the majority

e) Laggards – people bound by tradition, very sceptical of change, and the hardest group to bring on board.

While promoting an innovation like vaccines, it is to be understood that there are different strategies to be used to appeal to people from different adopter categories. Through continuous and sustained efforts, civil society organisations like Smile Foundation have worked with people in the early majority and late majority groups particularly among underserved communities to help them overcome their perceived barriers and get inoculated.

As of now, not only vaccine uncertainty, even the identification of Covid-19 cases appear to be a huge obstacle for health workers as people are often treating the virus-like common cold and flu. Getting frontline health workers to do regular household-to-household monitoring will help in the identification of positive cases and effective management & treatment.

A survey conducted by Smile Foundation, across Delhi, Haryana, Uttar Pradesh, Telangana, Tamil Nadu, Chhattisgarh, Gujarat, Maharashtra, Karnataka, West Bengal, Jharkhand, and Rajasthan via telephonic interviews in regional languages, among 27,216 respondents found that almost one in four Indians is unable to protect themselves completely from getting infected. While 22.7 percent of respondents said they visited private hospitals or clinics for primary healthcare services, about 45 percent relied completely on PHCs/CHCs.

Rural Health Statistics (RHS 2019-2020) found there are only 24,918 Primary Health Centres (PHCs), 155,404 rural sub-centres (SCs), and 5,183 Community Health Centres (CHCs).

The problem is deep-rooted and lies in the inaccessibility of these PHCs and CHCs. In some cases, these centres are quite far from the villages because of which people are deprived of proper healthcare facilities and accurate information. Additionally, these healthcare centres are ill-equipped to handle and cure even basic illnesses.

o fulfil their needs, Smile Foundation initiated the HealthCannotWait campaign. The campaign includes multi-pronged initiatives which aim to provide healthcare services to the larger community, a telae-counselling service for the underprivileged aimed at providing emotional and psychological support, and online telemedicine service through e-clinics.

We at Smile believe that there needs to be a very strong collaboration between Panchayats and community leaders in villages with NGOs and health workers to generate awareness and to upgrade healthcare centres. When lives are threatened due to lack of information and misinformation, clear communication is key.

Community leaders and local influencers must be roped in to effectively weed out untruths about vaccination. People must understand that the virus cannot be tackled with doubt or denial. Getting tested and vaccinated is the only way to stop Covid-19 from spreading.

•By Santanu Mishra, Co-Founder and Executive Trustee, Smile Foundation (DISCLAIMER: The views expressed are solely of the author and ETHealthworld.com does not necessarily subscribe to it. ETHealthworld.com shall not be responsible for any damage caused to any person/organisation directly or indirectly.)

Shahid Akhter, editor, ETHealthworld, spoke to Santanu Mishra, Co-Founder and Executive Trustee, Smile Foundation, to know more about the participation of civil society organizations in the wake of the second / third wave of Covid-19 pandemic.

How is the Indian civil society preparing for the third wave of Covid-19 which experts say is imminent?

Covid-19 is a black swan event. The ferocity of the second wave has warranted coordinated action on a large scale. From the very beginning of the pandemic in India, civil society organizations have helped ease the shock of Covid-19 for millions of Indians. Their relentless efforts have ensured the delivery of essential services to people at the end of the line. Our countrymen need a healing touch, which civil society organizations have strived to provide.

As the country approaches the third wave of Covid-19, there is a need for all stakeholders – the government, civil society organizations and corporates to mobilize resources, build greater trust and work closer than ever to help people cope with the pandemic.

We must all work in unison to help India navigate this trying phase, chipping in wherever possible and in any capacity. We must proceed with the firm belief that we can and will be able to make a profound difference. There are inherent strengths in each of the sets of stakeholders – corporates have capital, the government has reach and NGOs have ground connect and know-how. The effort should be for stakeholders to fill in wherever they see room for greater efficiency.

The pandemic has led to overburdening of Primary Health Centers across the country. What impact do you see should the pandemic start peaking in rural India?

It is true that India’s public healthcare infrastructure is currently overburdened. But it is important for us to realize that this pandemic has stretched the health infrastructure of even the most advanced countries, which are thought to have the best healthcare facilities. The sheer size of India’s population and the highly contagious nature of the infection has put immense pressure on health infrastructure. Our healthcare workers are putting up an exceptionally brave fight.

The pandemic has so far not impacted rural populations in a big way, but our administrators are cognizant that the situation can change, and quickly at that. The need for India to strengthen its Primary Healthcare Centers (PHCs) has been voiced for long. The pandemic has put this capacity expansion on top of the priority list as the Indian government has mobilized a very high quantum of resources towards fighting the spread of Covid-19.

As per data from the Union Ministry of Health and Family Welfare, as on March 2019, there were 24,855 rural PHCs and 5,190 urban PHCs functional across the country. This translates to one center per 30,000 population in general areas and one center per 20,000 population in difficult/tribal and hilly areas. Although the numbers appear alright, the functional status of these centers needs to be studied carefully in terms of the physical infrastructure, manpower, equipment, drugs, and other logistical supplies at the disposal of these centers. One then arrives at the conclusion that there is a great need for quality infrastructure and manpower to ensure these centers can deliver high quality healthcare services and meet the challenge ahead. There is no doubt that we must urgently work to iron out deficiencies in our vast network of Primary Healthcare Centers, especially and particularly in view of the third wave of the pandemic.

Considering reports of parts of rural India getting left out in the vaccination drive, how should India ensure equity in vaccine distribution?

As part of the decentralized vaccination strategy, the government has mandated Co-Win registration which can be tough to navigate for users in rural India, both in terms of access to the app and an English-only user interface. So, changes will have to be made for ease of access and use by a large chunk of the population.

Mandatory registration on CoWin portal, as part of the Liberalized and Accelerated Phase 3 Strategy of Covid-19 Vaccination deters the rural populace as rural tele-density in India stands at below 60%. Further, as per data from the Telecom Regulatory Authority of India (TRAI), India has 58 internet subscribers for every 100 people, which means a significant chunk of our population does not have access to the internet. Our vaccination rollout strategy must, going ahead, address this reality. The digital divide is clear and present, and administrators should take it into account in the interest of fair and equitable distribution of vaccines.

Having said that, even as vaccine distribution is ironed out, the union government has laid down a clear roadmap for the supply of vaccines, as it has been assured supplies by vaccine manufacturers. Over 2 billion doses could become available for India between August and December 2021. Additionally, the government is in talks with global vaccine manufacturers for augmented supply.

What is Smile Foundation’s role in easing the burden on the nation’s healthcare infrastructure?

The second wave of Covid-19 has shaken the country. Fighting the new, more infectious variant of the virus, frontline health workers are working round the clock even as hospitals run out of beds and oxygen supply, and thousands succumb to preventable deaths.

As the situation worsens with each passing day, the need of the hour is to provide urgent necessities like PPE kits to health workers, strengthening the existing public health infrastructure through supply of oxygen and medicines, reducing the load of primary healthcare facilities, providing hygiene kits to masses, and spreading awareness to contain the spread of the viral infection.

We are of the firm belief that health cannot wait. Health cannot wait for people who are suffering at the hands of the pandemic, and for people struggling to see their loved ones survive, for people working tirelessly to help save lives. These people need your support now, and the whole country should come forward to help. Smile Foundation has launched the Health Cannot Wait campaign to address all these needs on a massive scale. As part of the campaign we are soliciting donations for ensuring uninterrupted healthcare services at people’s doorstep. The aim is to benefit 2 million people with mobile hospital and telemedicine projects in the ongoing financial year.

Through the Health Cannot Wait campaign, there is a target to provide 1 million protective gear kits to frontline healthcare workers. These kits include PPE Kits, N95 masks and sanitizer. We would also provide 500,000 hygiene kits (soap, sanitizer, mask) to underprivileged families.

Vaccine hesitancy among people continues to hinder the country’s progress towards recovery. The vaccine provides protection against the virus to a high extent and is our best bet to curb the spread of the virus. However, doubts and fears prevent people from getting vaccinated. We are sensitizing people about the benefits of vaccination through tele-counseling and spreading awareness on prevention against the virus. So far, we have sensitized more than 100,000 people through tele-counseling, and our target is to reach out to 500,000 people.

We are striving provide oxygen cylinders, oxygen concentrators, BiPAP machines, PPE Kits, sanitizers, oximeters, thermal scanners & masks to 100 Covid Care centres & government health institutions with support from corporates and institutions.

Additionally, Smile Foundation aims to create 100 oxygen banks in the country. On the ration relief front, we aim to provide three square meals to more than 2,50,000 families by supplying dry ration kits. The effort is also to mobilize resources and provide 50,000 home isolation kits for COVID patients.

We must all stand and be counted in this hour of dire need and serve the millions who are looking for assistance so they can barely survive.

There is a sense of vaccine hesitancy among sections of the population. How can this be overcome?

Vaccine hesitancy among people is an issue that must be addressed. People must realize that the vaccines protect us from the viral infection to a great degree.

Tele-counselling is one of the most impactful ways of approaching this problem. People must be educated – one-on-one – about the benefits of getting vaccinated. The personal benefits of getting vaccinated, rather than the collective ones, must be clearly spelt out.

Individual tele-counselling has the potential to work wonders as people are more receptive when addressed intimately.