In rural India, the State must walk the last mile

If the government wants to control the sharp surge in coronavirus cases, it has to ensure the collection and reporting of correct and usable data for rural India, transparently and with the help of epidemiologists. Until testing is done effectively across the country’s rural spread, we will not be able to ascertain the scope and extent of this virus’s devastation; more importantly, we will not be able to forecast scenarios and put in place or implement any workable strategy and plan.

In Haryana, the state to which I belong to, panchayats were dismantled in February 2021. In Uttar Pradesh (UP), the largest state in the country and the most populated, panchayat elections have just concluded; so the new panchayat members have not settled in fully. This absence or weakness on the last leg of governance is the reason for the poor, nonproactive response to the epidemic. This can be easily remedied by activating the gram sabhas, the panchayat sachivs, non-governmental organisations (NGOS) and block development officers to work in concert on testing and treatment.

The government must engage with all kinds of rural community organisations, including non-profits working in these areas. Khaps in UP and Haryana should be engaged proactively. It is vital that rural communities be convinced about the need for Covid-19-appropriate protocols, and the need for testing and vaccinating. Hardly any testing happens in rural areas as most labs are in urban locations. It is not always feasible to send samples for RT-PCR tests from rural areas to urban centres. The logistics chain for the transfer of such samples does not exist.

Hence, for rural areas, the government will have to shift to rapid antigen testing (RAT). This will reduce the time for testing and processing. More RAT kits will have to be procured; the manufacturing of such kits should be scaled up. In a country like India, these kits are the most crucial first line of defence. Until we know the extent of the problem, we won’t be able to commit the necessary resources or eradicate the scourge. This is not ideal, and it is not enough, for we know the RT-PCR tests are the gold standard — but we are facing a situation of no tests, and a positive result in RAT will give a sense of the spread and catch at least a segment of cases early on.

Rural areas need far more resources, especially as health care services there have been neglected for long. Doctors and nurses do not like to work in rural areas due to poor infrastructure, the absence of educational facilities, and several other reasons. We cannot force any professional to work in rural areas, so we need to offer incentives to attract them; district commissioners (DCS) or sub-divisional magistrates should be empowered to hire doctors or nurses for a year until this epidemic gets over or slows down appreciably. They should be paid higher salaries than offered by the private sector. This is particularly important for anaesthesiologists as they are a crucial cog in the epidemic treatment process. Anaesthesiologists are needed to operate ventilators in intensive care units for a Covid-19 patients. Ventilators are lying unused in several district-level hospitals as there are no anaesthesiologists.

My experience as chief minister (CM) is that there has to be a clear line of communication with district magistrates (DMS) and DCS in any disaster, along with some freedom and flexibility for last-mile officers. Yet some CMS are monitoring the spread of Covid-19 at the last mile. Even the prime minister is trying to talk to them directly. But talking or holding a Zoom call once in a while is not the way to handle an epidemic, especially at the state-level.

All CMS have to set up a system for monitoring, tracking and implementing at district-level in their own offices. The epidemic will come under control only in states where there is a clear system connecting CM to DM. For a huge state such as UP, Bihar or Madhya Pradesh, it is difficult for the CM to manage all the districts; the responsibility for such coordination should be given to another minister.

Systemic weaknesses have been exposed in the epidemic. The capability and governance gaps are visible to all; these can be criticised ad-nauseam but it does not serve any purpose in times of emergency.

In these times, it is important to build solutions, bridge the gaps, and address the problem jointly. History will judge us. History will ask us what we were doing during this epidemic. History

Bhupinder Singh Hooda

will ask us whether we made the problem worse or came up with solutions, helped somebody, procured resources.

The role of political leaders, whether in power or in Opposition, is crucial. Real leaders should be in their constituencies, working with and for the people. If they are not with the people now, they cannot be called political leaders. If they are sitting at home, they are not leaders. Leaders lead from the front; in this war on Covid-19, the front is where the people are sick or need our help the most.

There’s no point in being a political leader only on social media. Much of rural India is not on social media. They cannot ask for help on social media via some App.

Keep your phone lines open, deploy your party workers on the helplines, and on the ground for resource distribution. I know some areas that have barred politicians from coming into the villages. This is a sign that the overt dereliction of duty by political leaders has not been lost on their constituents.

A post-covid-19 world is a long way away; the falling numbers in our cities should not fool the Union government into believing that the epidemic is over. The virus is shifting regions, striking villages, small towns and other cities. The district in-charge needs to start separating the data for the big cities, small cities, towns and villages. But this will only happen if all levels of governance rebuild transparency and faith in the data. This epidemic has to be fought together. Only if we rise above petty gains will we be able to defeat this invisible and deadly enemy that is attacking our fundamental right to a healthy life.