Till fairly recently, Covid-19 was popularly perceived to be purely an urban concern. This notion rested on the fact that the first wave of the pandemic largely bypassed India’s villages. But the second onslaught of the virus this year has confirmed the worst fears of medical experts — that the under-prepared rural populace is extremely vulnerable.

There are as yet no official figures that plot the rural impact of the pandemic. But field reports in the media from Uttar Pradesh, Madhya Pradesh, Bihar, Karnataka, Punjab, Rajasthan, Uttarakhand, Telangana, and West Bengal paint a dismal picture. Bodies abandoned in the Ganga, mass cremations on riverbanks, panic stories about deaths after a cough and fever, fears of the black fungus infection spreading, lack of oxygen, and hardly any provision for vaccines or even testing for the virus. According to estimates, 48 per cent of the case load burden is now rural.

All this points to poor or non-existent medical infrastructure, lack of awareness and overall ignorance about responding to the crisis. The feedback has one common thread — in this crisis rural India sorely misses the footprint of basic health and medical services. There is clearly a lack of planning for a second wave, despite the fact that alarms bells were rung in many quarters.

So, what must be done to improve rural healthcare — in the short term to combat the onslaught of the virus and in the long term to help villagers access their basic right to medical care? The Centre recently released a new set of SOPs for Covid-19. This includes village-level surveillance, tele-consultation with community health officers, and training in rapid antigen testing. It also spoke of a home isolation kit to be provided to all active cases, which would include the appropriate medicines and a detailed pamphlet indicating how to deal with the infection.

On paper the recommendations look good. But does the hinterland have a working infrastructure to implement these SOPs in real time? At the village level the first stop is the Primary Health Centre (PHC). If it is barely functional, then the linkage to tertiary hospital care is broken. It is at the PHC that medical advice is first sought. If that is absent or inadequate, then it is a recipe for disaster.

Significantly, the SOPs suggest, to ensure that community-based services and primary health infrastructure in rural areas are equipped to manage infections. But given the intensity with which the virus is spreading, it may be a bit too late to start building infrastructure or finding personnel on the ground to deal with the pandemic.

“In every village, active surveillance should be done for influenza-like illness/severe acute respiratory infections (ILI/SARI) periodically by ASHA workers with the help of Village Health Sanitation and Nutrition Committee (VHSNC),” the guidelines say.

The ground reality

But this is more easily said than done. A series of webinars organised by Impact and Policy Research Institute and some others focus on different States and capture the reality on the ground. They reveal how villages, civil society and some administrations are struggling to provide services and reduce fatalities.

‘Rural Realities: Practitioners’ Experience in Tackling the Second Wave in Indian Villages’ gives voice to speakers who have been working at ground zero. Through the series it is clear that in areas where there was some semblance of a rural health structure, it has been easier to manage patients at PHCs itself, while sending those who need emergency care to tertiary facilities. But in others even a pulse oximeter or an oxygen cylinder are difficult to come by. How does one even monitor saturation levels?

The webinar series and the media relate many stories of sheer grit, of medical professionals, schoolteachers, self-help groups, ASHA workers, sanitation staff, and even ordinary citizens risking their safety to save lives. But there are unfortunately even more stories of total helplessness, of desperation, of running to get services and failing miserably, of seeing loved ones die without being able to provide them medical help.

Unfortunately, the pandemic continues and so does the despair. We are nowhere near the end of the disaster story, with even a third wave being predicted. Even now there is a lack of testing and tracing. Practitioners spoke of how prescriptions were being given without testing for the virus, so the cases do not even enter the national statistics. Ditto the death toll: data discrepancies in some regions are too stark and worrisome.

Rethinking health policy

But while the pandemic plays out, it is imperative that we think of the future; how we need to rethink our health policy and the Budget allocation for it.

For the last few decades, with the accent on privatisation and specialised care, basic health care and preventive health care have been ignored. With a population as large as ours and 7.5 crore of it below the poverty line, according to 2020 estimates, it is critical that we put in place a robust health system that our people can access.

Undoubtedly, there has to be a pronounced rural focus when it comes to health planning. As things stand, doctors and health officials rarely visit rural areas removed from district headquarters.

In fact, reporters who went into the villages were appalled to see PHCs which had remained closed for weeks. The pandemic has exposed the dark underbelly of medical care in the country. The need for a well organised public health system is possible if there is a will. It is a crucial index of the ‘development’ that we strive to achieve.

The writer is a senior Delhi-baed journalist