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Assisted Telemedicine for Rural Healthcare Ecosystem

COVID-19 left the rural population in poorer states more distanced from access to basic healthcare facilities. Lack of access to qualified physicians, basic clinical screenings, reasonable care and basic quarantine precautions became more pronounced. In order to enhance equal health opportunities and access to all, in such uncertain times, the Medical Council of India in March 2020 announced the Telemedicine Practice Guidelines. While this announcement led to the rise of many telemedicine platforms, the reach did not include rural populations, where the access to technology is limited and the need much greater.

In response to this, the E-Health Research Centre (IIIT-Bangalore) in collaboration with Partnering Hope Into Action (PHIA) Foundation and Patharitech Private Ltd. piloted an assisted-teleconsultation model in three rural districts of Jharkhand. A software application was customised and fine-tuned for usage in the rural healthcare system with frontline health workers.

This report examines details of analysing, developing and performing pilot runs of an ‘Assisted Telemedicine’ model towards the design of a blueprint of a telemedicine platform that caters to the rural healthcare needs, along with a feasible approach for scale and usage during and beyond COVID-19.


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Role of Gram Panchayats and Community Based Organisations (CBOs) in Jaipur and Tonk districts during Corona Pandemic

COVID-19 brought state and non-state actors to the fore, in their efforts to combat the far-reaching effects of the virus. Is the local government the most important body by virtue of being the grassroot leadership role at the ground in times of distress? How do they realise community-based disaster preparedness? Are they able to ensure active involvement of elected members at different spheres, officials, members of CBOs and other stakeholders?

Dr Amit Kumar of Kumarappa Gram Swaraj Sansthan in this study attempts to answer a few of these questions through an exploration of the roles played by the Gram Panchayats and other CBOs during the times of COVID-19. This study focused on 10 Gram Panchayats in the Jaipur and Tonk districts of Rajasthan in responding to the people’s basic concerns, needs and issues in the middle of a crisis. A few of the best practices by the local governments in their responses to unprecedented issues of hunger, migration and certain issues of gender have also been documented.


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The undeniable willpower of elected Local Government Institutions

The onset of COVID-19 brought about an urgent cry for improved public health interventions. While all levels of government were trying to respond to the unprecedented challenges quickly, creatively and effectively, a few Village Panchayats (VPs) in Tamil Nadu found themselves struggling to combat COVID-19 activities, due to the lack of any direct funds reaching them from the state government. Their efforts were really put to the test as they battled against all odds, proving in the end that they are in fact highly important in the fulcrum of decentralized governance in our country.

This study led by a team at the Institute of Grassroots Governance focuses on the nature and extent of how VPs in selected districts of Tamil Nadu, battled with COVID-19. It attempts to compare the VPs with elected leadership and those without to ascertain the dynamics of power and its application and captures best practices of VPs which went above and beyond to respond to the needs of their people.



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Innovative Methods to Increase Immunisations during COVID-19

COVID-19 forced people, young and old alike to be confined to their houses to risk getting infected. This threatened a break in otherwise routine childhood immunisation for many families across the country. Suvita, a non-profit organisation has been working on increasing the uptake of childhood immunisation in India, through sending SMS reminders directly to caregivers, close to when their child is due for vaccination and by inviting influencers nominated by their fellow community members to act as volunteer immunisation ambassadors within their community.

This study conducted by the co-founders of Suvita sought to understand how to minimise missed vaccinations in India. It investigated the feasibility and effectiveness of delivering their programme, using remote, phone-based surveys rather than in-person surveys to identify and recruit immunisation ambassadors, during COVID-19.



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Atmanirbhar Adivasis: Community Role in Prevention and Management of Covid Crisis

An Assessment of the Situation, Challenges and Good Practices

The outbreak of COVID-19 pandemic created an unprecedented crisis, shrouding the world in uncertainty. While India’s initial lockdown strategy severely impacted the most vulnerable groups (migrant workers, financially disadvantaged, women, children, sick and disabled persons, etc.)across the country, those residing in the cities were given access to at least a few facilities— partially-opened groceries/pharmacies, medical facilities, transportation of the migrant workers etc.

In the rural belts of many states, people were left to fend for themselves with nothing other than spurious rations and emergency monetary relief, if that. Vulnerable sections of society may be doubly worse off in these far-off, tribal regions than in the cities.

This research study attempts to assess what a public health crisis like COVID-19 can entail in a less developed, tribal community. With this objective in mind, the study takes a close look at the post-lockdown scenarioin10 tribal-majority districts across 7 states.

Additionally, in light of Prime Minister Modi’s call to make the nation ‘atmanirbhar’(independent) and support the Indian economy, this study sheds light on the approaches by which indigenous Adivasi communities have managed their livelihood, economy and health, thereby becoming truly self-reliant.

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Role of Rural Local Bodies in Pandemic in Odisha

The 2020 COVID-19 pandemic, caused by severe acute respiratory syndrome (SARS-CoV-2), emerged as a serious global challenge. The rapid spread of the virus, its fatality rate, structural inadequacies and shortages of human resources in healthcare systems, rendered a helpless situation before countries across the globe.

Odisha witnessed the first COVID-19 case in the middle of March 2020 and immediately sprung into complying with the nationwide lockdown to contain the virus’ spread. In a series of strategic decisions, the Odisha government-appointed Panchayati Raj Institutions (PRIs or local self-governments) as the primary agency responsible for containing and mitigating the spread of COVID-19. This decentralised approach to COVID-19 management proved to be successful in bringing the COVID-19 death rate below the national average.

This research study attempts to explore the schematics of the decentralised approach followed by the Odisha government in dealing with the COVID-19 pandemic and assesses the efficacy of governance practices thought to be pandemic-resilient.

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Civil Society Response to Domestic Violence Survivors during COVID-19 | Building Better Support for Survivors

The COVID-19 pandemic brought with it unprecedented challenges which led to systems either coming to a halt or learning to adapt to new ways of functioning. There is increasing evidence that the lockdown led to a substantial reduction in support to survivors of domestic violence, an increase in cases of domestic violence and the emergence of new patterns of domestic violence.

This research study by One Future Collective examines the response of Civil Society Organisations (CSOs) to the needs of survivors of domestic violence, and the ways in which CSOs had to adapt to be able to support survivors during the pandemic.

Additionally, the study analyses the shifts in patterns of domestic violence incidence, as observed during the initial lockdown, and maps them against adaptations made by CSOs to propose recommendations for building stronger support systems for survivors of domestic violence.

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Delivery of Social Welfare Entitlements in India: Unpacking Exclusion, Grievance Redress, and the Role of Civil Society Organisations

The COVID-19 public health crisis and subsequent containment measures followed in India have severely impacted poor and vulnerable populations with respect to food security, livelihood, and access to health services. The national lockdown led to significant distress among citizens due to employment loss, wage cuts, transportation etc., and increased dependency of people on social protection schemes.

Although several relief measures have been mobilised by the government, there has been extensive documentation of exclusion of deserving people from availing these social protection measures.

In this research project, Gram Vaani, Dvara Research, University of Montreal and Tika Vaani utilised their collective knowledge and field resources to undertake action research specific to the context of the COVID-19 pandemic. The report explores three research objectives:

  1. Analysis of over 20,000 voice reports of grievances submitted on one of Gram Vaani’s Interactive Voice Response (IVR) platform to understand the different challenges citizens face in accessing social welfare entitlements.
  2. Understanding the various modalities through which Gram Vaani volunteers assist callers in resolving the hindrances they report.
  3. Proposing a set of Standardised Operating Procedures (SOPs) that can be used by civil society organisations to reduce exclusion at the last mile.

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Community Mobilisation and Good Governance: Via the Community Radio Network – Umeed, in the Himalayan State of Uttarakhand, in the time of COVID-19

Community radio (CR) is a participatory form of radio where communities own, manage and run their own radio stations, creating engaging programming in their local language/dialect. The People’s Power Collective (PPC) is an NGO that specialises in CR capacity-building and training, working across isolated regions in the Himalayan state of Uttarakhand.

When the COVID-19 outbreak sent India into a total lockdown (in March 2020), the isolated communities of Uttarakhand struggled with poor state communication, fake news and many unanswered questions. In order to address this issue, the PPC coordinated with five CR stations in Uttarakhand – Kumaon Vani, Mandakini Ki Aawaz, Pantnagar Janvani, Radio Khushi and Radio Zindagee – to create the Umeed Network.

The Umeed Network’s mission over the past months has been to:

  1. Build awareness of COVID-19, its symptoms, precautions, treatment and recovery.
  2. Disseminate daily updates on government directives and community relief policies.
  3. Respond to communities’ daily needs for information, reassurance and support through tailor-made content.

Through their research report, Community Mobilisation and Good Governance: Via the Community Radio Network – Umeed, in the Himalayan State of Uttarakhand, in the time of COVID-19, the PPC lays out the process, operations, challenges and achievements of the Umeed Network since inception and until the end of the research period i.e., November 2020.

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Exploring the challenges, psychological problems, and mental health needs among frontline health workers of government hospitals: A study in Hyderabad Karnataka Region

Frontline health workers have always played a critical role in providing health solutions to the public. Since the advent of the COVID-19 pandemic, health care workers (HCWs) have been pushed to work beyond their usual capacities. This, with the looming risk of contracting the coronavirus infection, increases the likelihood of frontline healthcare workers developing mental health issues. Such issues may, in turn, alter their capacity to manage the ongoing crisis.

A team of researchers led by Professor Romate John of Central University of Karnataka conducted a study to explore the mental health issues faced by frontline Health Care Workers (HCWs) placed in government hospitals within the underdeveloped Hyderabad-Karnataka region during the COVID-19 pandemic. The researchers asked 221 HCWs (doctors, nurses, Group-D workers, lab technicians, and security) working in government hospitals in the H-K region to reflect on their experiences of working in the COVID-19 ward. Using semi-structured interviews, the researchers asked participating HCWs to gauge the impact it had on their mental well-being.

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Understanding the Perspectives of Frontline Health Workers (ASHAs, Anganwadi workers & ANMs) in Bundelkhand Region to Improve COVID-19 Containment Efforts

Community health workers (CHWs) have been the backbone of the fight against the COVID-19 pandemic in India. CHWs (such as ASHA workers, Anganwadi workers, and ANMs) have played a key role in preparing the national health system for the hyperbolic rise in COVID-19 cases and containing the spread of the virus at the ground level.

Owing to their embeddedness in their communities, these CHWs can offer unique insight into our community-based COVID-19 responses. Despite this, the voices of health workers have been largely ignored in policy prescriptions and initiatives.

In this short-term study, SRIJAN (Self Reliant Initiatives through Joint Action) aims to address this research gap. It covers the experiences and perspectives of CHWs fighting the COVID-19 pandemic in Bundelkhand, one of the poorest regions in rural India. In capturing the ground-reality in Bundelkhand, Stutilina Pal and Devanik Saha attempt to document the lessons learnt from the past year and incorporate them into future responses to health crises.

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Local Governance During The COVID-19 Pandemic

Kerala’s community-centric response to the COVID-19 pandemic had caught significant media attention, including that of international bodies such as the World Health Organisation (WHO). Such empowerment of local governments is in line with international resolutions on disaster management.

Throughout the pandemic, Local Self-Governments (LSGs) have been crucial to the community’s safety and socio-economic well-being. Considering the many failures other states and countries have experienced with respect to COVID-19 management; it is prudent to analyse what made Kerala’s decentralised governance model work.

In this report, the Kerala Institute of Local Administration (KILA) traces the main steps taken by Kerala as part of its COVID-19 management strategy and explores the role of LSGs in Disaster Management.


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Experiences of Frontline Workers in Rajasthan and Himachal Pradesh during the Covid-19 Pandemic

In the advent of COVID-19, frontline workers (FLWs) such as Accredited Social Health Activists (ASHAs), Auxiliary Nurse Midwives (ANMs) and Anganwadi Workers (AWWs) found themselves at the forefront of combating the pandemic. In addition to regular healthcare and nutrition delivery, their revised responsibilities included screening for COVID-19, contact tracing, communication of preventative measures, adapting nutrition-related programmes, and doorstep delivery of maternal and child health services.

In this report, the Accountability Initiative (AI) at the Centre for Policy Research (CPR) highlights the oft-overlooked stories of government functionaries at the frontline of COVID-19 response since the advent of the initial lockdown.

The overall objectives covered in this report are:

  1. Understanding the evolving role of FLW workers during the pandemic and the impact of COVID work on their regular duties.
  2. Gaining insight into the processes and best practices for training, implementation and supportive supervision.

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Female Frontline Community Healthcare Workforce in India during Covid-19

Since the advent of the COVID-19 pandemic, 1 million Accredited Social Health Activists (ASHAs), 2.6 million Anganwadi workers (AWWs) and an entire cadre of Auxiliary Nurse Midwives (ANMs) have been at the forefront of the emergency health response system in India.

During the pandemic, these three cadres of healthcare workers managed tasks like monitoring and conducting syndromic surveys, disease surveillance, data reporting, public health messaging, delivering essential food and ration services, at the community level. They routinely clocked over 12 hours work days and were on call the rest of the time.

Despite being the backbone of India’s public health response, female frontline workers from across the country have reported being underpaid, undervalued, and alienated without any state support or protection.

This report explores the role played by ASHAs, AWWs and ANMs during the pandemic, by analysing the information gathered from interviewing 201 frontline health workers across the 3 cadres from ten states. It offers crucial insight into their increased burden of work, economic vulnerabilities brought by reduced income and delayed payments, absence of medical insurance and adequate state support, as well as their consequently deteriorating physical and mental health.

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Understanding the role of public health system reforms in combating COVID-19 pandemic in the State of Kerala, India

Over the past few decades, the health system in Kerala has undergone several reforms, including strengthening of service delivery systems on the ground level and active involvement of local self-government institutions (LSGIs) and community participation. Amid a global outbreak of SARs-CoV-2, Kerala has received international recognition for the health emergency preparedness it has shown owing to these reforms.

In this case study, the Health Systems Research India Initiative (HSRII) puts together a list of all factors that assisted the state in quickly and sufficiently containing the spread of the virus. By conducting a thorough literature review along with in-depth interviews of key officials at state and district levels, HSRII delves into programs like the Aardram Mission and Comprehensive Primary Health Care (CPHC) and the impact they have had on the state’s capacity to deliver free primary care to its people.

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