The second wave of the COVID-19 pandemic bared the weaknesses in the primary health care systems of the country, more so for communication on health issues and disease prevention. As the cases surged, people around the country searched desperately for authentic information on disease prevention and where to access treatment and vaccines. Traditionally, the National Health Mission depends on Front-Line Workers (FLW), Accredited Social Health Activists (ASHA), the Auxiliary Nurse Midwife (ANM) and Male Multipurpose Worker (MPW) to communicate critical health messages to large communities, particularly in rural areas. The NHM also houses an Information, Education and Communication (IEC) bureau that contributes to informing communities on health issues, largely through mass media like television or newspapers.
The community-facing front-line workers are responsible for keeping village communities informed and aware of health issues, by holding regular community meetings, counseling women and children, conducting special events, home visits, etc. But, time-motion studies indicate that an ASHA worker spends the bulk of her time escorting pregnant women to institutions for delivery, rather than interacting with the community, while midwives are engaged in recording and reporting, or organising village-level health service delivery programs. The IEC bureau has a long and time consuming process to design and roll out IEC material. Hence, when the pandemic hit the country, the health system could not reach out to people adequately or quickly, and privately-owned media became the main source of information for the public.
Someone has rightly said that along with Coronavirus, this is also a pandemic of misinformation. Now, information, good or bad, circulates with unprecedented speed, with 40% of the Indian adult population having access to a smart phone on which they can rapidly access the internet. In the absence of established and trustworthy sources of health-related information, people access information wherever they can get it. Media trends over the last several years show that Indian readership/viewership has seldom been exposed to accurate technical information about diseases or their spread. Hence, the sudden influx of medical and health-related information in hundreds of newspapers, fifty or more TV channels, YouTube, WhatsApp, Facebook, Telegram etc. overwhelmed the masses. The lack of credible information combined with the inability of people to absorb, understand or interpret the information coming in on social media made people vulnerable to scores of misunderstandings and myths. Some of these claimed that consuming onions with salt can cure COVID-19, warm saline gargles and warm water will prevent infection, drinking cow urine or using a cow dung body-pack can prevent Covid, and that the Covid vaccine causes impotence or death. All this was circulated widely on social media which has to have impacted the vaccination campaign.
So, can the health system handle such emergencies alone? What are the other possible groups that can be utilized as helping hands? Women's Self-Help Groups and their federations, constituted under the Deen Dayal Antyodaya Yojana-National Rural Livelihoods Mission (DAY-NRLM) of the Ministry of Rural development (MoRD), have emerged as a big and important component. The DAY-NRLM was launched in 2011, and now has more than 70 million women in different self-help groups. In villages, women regularly come together in groups of 10-15 to discuss livelihood opportunities, micro-credit, loans etc. In 2016, to support the Poshan Abhiyaan, the DAY-NRLM included health and nutrition within its mandate which helps to disseminate accurate information on these important topics to a vast number of households.
Self-help groups held awareness generation drives in their villages, helped screen populations for COVID-19 cases, were part of village committees on COVID-19, manufactured millions of masks and sanitizers, ran hundreds of community kitchens, provided food to thousands of migrants, supported helplines and call-centers. In the recent past, pilot studies done in Jharkhand, Bihar and Chhattisgarh have generated ample evidence that women's groups can effectively change the health and nutrition behavior of their community, contributing to reduction in newborn deaths, improving the dietary intake of women and children.
The active participation of these groups in the Covid crisis demonstrates the willingness of this platform to take part in health-related activities and can empower communities to understand their own health needs and work collectively towards these, ultimately creating stronger and more resilient health systems.
(Dr. Amrita Misra is a Public Health specialist with two decades of experience in health systems and services. She has worked with UN agencies and several International NGOs in rural India.)
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