Logistics across the country is not the central government's strong suit. This time, the central government has given the responsibility to the state governments and I think this was required, said Ved Arya, Founder of Rapid Rural Community Response to COVID. "For example, the oxygen concentrators are arriving from abroad and we needed to run a system like FedEx or Amazon to transport them in time. That infrastructure is not in place. This is where cooperative federalism was really needed, whatever central and state relations may be, (they) should have acted like one nation. Oxygen concentrators were needed a month ago when we didn't have enough, but now we have an excess of everything," he added. Arya was speaking at The New Indian Express' online event COVID Think Tank on The cost of lockdown: What could we have done? on Tuesday, June 15. He was in conversation with Senior Journalist and author Kaveree Bamzai.
Speaking about some lessons that we have learnt from the first wave, Arya said, "The foot soldiers during these times are the community resource persons — such as women leaders of the self-help groups. When the number of ASHA workers are inadequate, when the rural health infrastructure is inadequate, then the people's own representatives will make the country more atmanirbhar. We also learnt that we are not prepared for such destruction. Last time, the destruction was in the form of migrants returning home, but this time it is migrants returning with the virus. COVID is no longer restricted to urban centres."
But like everyone else, Arya too is worried about the second wave. Elaborating on what has him worried, Arya says, "People are really scared during the second wave and it is affecting their mental health. It is not the stigma of COVID that is affecting them as much this time around, but the fear of death. This fear is being reinforced by the news on television." He added, "Vaccine hesitancy is another aspect that has me worried. People, especially in the rural areas, remember what happened in family planning sterilisation camps. In villages, people are saying that men will become impotent and women will become infertile if they take the vaccine. Moreover, the vaccine is being given at the same place where the COVID patients are being treated and the people are fearful of contracting COVID. Vaccine hesitancy is also due to the lack of human resources on the ground and personal contact. Some celebrity endorsing vaccines on television is not enough."
Recommending some short-term solutions to curb the spread in the rural areas, Arya said, "Health experts advise that the first step should be mitigation and then vaccination. Every ASHA worker should be equipped with oximeters to understand the extent of the illness in the villages. We also need apps that will tell the person if they are safe or not. To reduce vaccine hesitancy in rural areas, what can work is if the village sarpanch or figurehead takes the vaccine and a video of him or her taking the vaccine is made in the local language by a local influencer and broadcast. Messages from the top will not reduce hesitancy. While mitigation is the starting point, educating the people about the vaccines, helping them register on CoWIN and give them the vaccine as soon as it is available are the next steps."
Arya also advocates more human resources at the ground level. "While we have 10 lakh ASHA workers right now, we should have a second rung of another 10 lakh ASHA workers. This is important because rural health infrastructure has always been inadequate. There are various other diseases — non-communicable diseases, diabetes and hypertension have now become common in villages too. The third wave of COVID might also come and we should be prepared for it. Along with ASHA workers, collaborative work should be done with the NGOs, PHCs and the local government at the village level," he said.
Moreover, Arya also suggests adequate personnel training. "It is important to train the frontline workers on how to use the devices. Most of them don't know how to use oximeters or oxygen concentrators. Most of the government's focus is on building infrastructure but training the personnel is also very important," he said. Explaining the need for a health infrastructure survey to better prepare for what's up ahead, Arya said, "This survey should be done immediately and the infrastructure should be made available at the block level. The country should not be urban-focused. Rural healthcare infrastructure should be given attention. A database for the demand should be created and then supply should be done accordingly. Using existing technology and systems established by corporates can help solve logistical problems."
