Optimising use of grassroots public service to manage COVID -19
“Mahattaya padinchiya mahanuwa r a neda? Ehenam bayak sakak nethiwa inna puluwani. Dalada saminduge balma thiyenawa ne... ane waasanaawai.” This was told to me by a fellow passenger, clad in white national garb, sharing a seat in public transport.
My home is in Aniwatta, Kandy. I am safe. No visitors. House bound for over a month due to COVID-19.
It is six weeks since the lockdown. The government took a series of measures to curb the spread of the COVID19 virus. Yet the infection is spreading. The number of infected is over 900. Experts say that the worst is yet to come and we will see a peak in August. A second wave is also predicted.
We must address two key questions. What is at stake? Who should be at the forefront to control the pandemic?
The effects of COVID- 19, caused by a virus can be fatal – death after excruciating suffering. Many have not seen the effects. The film on a previous pandemic of this century, the Spanish Flu of 1918 is worth watching - https:// www. youtube.com/watch?v=UDY5COg2P2c). If infected and not diagnosed early and not treated, persons will die.
I observe an interesting breakdown of common sense and disregard for basic public health practices when curfew is lifted. Even during curfew, many people are on the road, some accompanied by families. Many do not wear facial masks. The nonchalant behaviour of people on the street is troubling. I see many people wearing the facial masks incorrectly. Many have it like a scarf round the neck, others cover only the mouth! Policemen wearing masks stand by. People find it difficult to observe social distancing. We are used to standing close to each other in a huddle when we shop, or when waiting to be served in a store or restaurant. Do we realise that the country is in a state of public health emergency?
Divine deities
It appears that the virus is more powerful than the divine deities. It does not differentiate between our “Ranaviruwo” national war heroes and common masses. The effect of infections and suffering is also not known, seen or felt. COVID- 19 is an equal opportunity experience. It infects the rich and the poor, politician and voters, the powerful and the disenfranchised, teacher and student, men and women, elderly and children, Muslim, Tamil, Burgher and Sinhalese, the sex worker and the pious, all citizens of Sri Lanka. In short, we are all in this together. On the other hand, they also have equal rights for protection and care. This is a sobering reality.
We have valuable lessons to learn from a recent crisis, i. e. the protracted ethno- political conflict. The root causes of this national tragedy were not addressed effectively. We did not learn lessons from other countries that went through processes of managing post- colonial societies. The price we paid for the folly was very, very high. Due to a multitude of factors, the guns went quiet; the body bags and coffins stopped reaching homes in the four corners of the country. This was no simple accomplishment. Millions in the country and abroad, are grateful to those responsible for ending the war. The intelligence services and military experts, as well as the political leaders supported by the public, found an effective approach to end the war. This, however, is different from handling a pandemic.
Mighty military powers were unable to bring pandemics, i. e. the tiny viruses “to their knees” easily. The viruses that caused the pandemics are different. In the early pandemics, the invisible “enemies” swept across whole continents, leaving misery and death in their trail. Science and medicine had not developed then as much as it has today. The knowhow of viruses remained limited. Led by the WHO, various research centres across the world now have the required capabilities. The knowhow is shared and there is cooperation. Medical science and knowledge, public health, disease control and management have advanced tremendously. Why is the virus spreading like wildfire all over the world? Should people die? Are we so ineffective? Don’t we have the knowhow or human resources to engage in controlling the spread?
Professional public health experts
Controlling or managing a virulent virus requires professional and astute public health experts, health care professionals, and community level workers as well as a well-informed citizenry. This has been demonstrated in Sweden and New Zealand.
When one looks at the degree of the geographic penetration Sri Lanka’s government institutional apparatus has in the communities, it is difficult to accept the faulty public health awareness and education programmes currently underway. The state agencies are well distributed and present in the villages, plantation areas and urban neighbourhoods.
Having spoken to numerous local- government level officers, I realised that there remains a huge potential to use these agencies for a well- planned public health education/ awareness programme. The experience these agencies have in controlling the spread of dengue could be well utilised. The efforts may need slight modifications.
Each community has the following state officials attached to a national level or provincial level authority associated with health, well-being or public administration: a) Grama niladhari, b) Sam urdh io ff icer,c) Economic development off icer,d) Krushikarma Paryeshana Saha Nishpaadana Sahakara ( Goviniyaamaka), e) Women’s development officer, f) Public health inspector, and g) Midwife.
There is a plethora of government employees who are responsible for delivering every conceivable service. Each of the 331 AGA divisions has 56 cadre positions for staff. This number includes over 25 Development Officers. Their focus ranges from youth affairs, women, to enterprise promotion, counselling and social empowerment, to mention a few. The officials are attached to various departments at national and provincial levels. The total number of these state officials in the country is about 18,500. They are distributed among the 25 districts. Over 20 officials visit local communities regularly. There are close to 30 state agencies represented at the divisional council level. There are numerous graduates recruited as Development Officers attached to various government departments. In short, the concentration of government officers at grassroots level is enviable.
Reaching out to households
In this national emergency the available state officers able to reach each household is sufficient to implement a well- designed public health education programme. We have the required experts in all of the related fields in medical and social sciences. Yet, we seem to be lacking the mechanism to coordinate, design, and get commitment. An effective programme must make people aware of what COVID-19 is, and inform them of how it spreads, the dangerous effects on the individuals infected, its prevention and the status of availability of a cure. We need a national door- to- door campaign that covers all communities undertaken by persons who have already worked at the community level where trust has been built and discourse is possible. The campaign must include the necessary administrative measures that impose various curbs in behaviour. The COVID19 crisis requires long term measures that are based on self- driven changes rather than government regulations and impositions.
This is a public health crisis. There can’t be short cuts. Addressing this crisis can’t be put on a “war footing” under the exclusive purview or dominated by the security forces and the police, although they may play an important but limited role. Lasting change can’t be achieved at the end of a gun. We need effective communication, convincing people of the need for change. The support for change must be from the bottom to the top-of-the-age pyramid. Children who are taught by teachers, families that are contacted by the PHIs and public health nurses are important allies in a national prevention programme. In addition, the government officials attached to the Divisional Secretarariats are also potential change agents. What we need is a well- designed knowledge pack and the guidelines for a change programme that will reach every family and individual. The media should be utilised effectively to disseminate important messages. A coordinated multi- agency approach is required. We have the knowhow and the personnel. The creativity of young women and men across the country waits proper harnessing.
When designing a national programme to address the present crisis, a crucial consideration is adhering to ethics. Often due to urgencies and zeal, ethics are compromised resulting in long term repercussions. Strengthening trust and interpersonal relationships are vital for long term post- crisis development. The control and management of COVID- 19 must have an inclusive, humane programme based on trust. The latter may be in short supply. Hasn’t COVID-19 provided us another opportunity for inclusive nation building? Are we going to squander this opportunity too?