Rural India: Worst Hit in the Second Wave

–Kakali Das |

This is a rural report where we drag the focus away from the big metros, and discuss about the occurrences in the rural areas across the country. How not just for the pandemic, but the climate change too rural districts are the most vulnerable according to the reports. A report issued by the Centre for Science and Environment (CSE) titled State of India’s Environment 2021: In Figures, reads “Rural India is the worst hit by the second wave of Covid-19.” It, too, discussed about the shortage of doctors, radiographers, lab technicians in rural areas, and how India, alone, accounted for more than half of the daily global cases in 6 days and the peak due to a surge in cases in rural districts. There’s also conversation on MNREGA, and how it has witnessed massive payment lacks as well. How has rural India become the epicentre? To put it in perspective, the second wave in India started somewhere around mid-February, when the epicentres were merely Kerala and Maharashtra. Cases started escalating towards the end of April, and the analysis in the report shows that the shift from urban to rural has begun since then, and by May it has grasped rural India in its optimum. May is the month, when every second case globally was being recorded in India. According to the report, 48% of all the global cases occurred in the country, primarily, because of the sudden surge in cases in rural India. “Our analysis period was from May 1 st to May 23 rd , 2021, and in that we found that 53% of the new cases that transpired in May was in rural India. Logically, too, 52% of the deaths that have occurred in the month of May happened in the rural India. There was a sudden surge in the number of deaths because of the shift to rural India, and this is what we have discussed in our report,” Rajit Sengupta, Assistant Editor, Down to Earth Magazine, and one of the Authors of the Report said. When there is a mentioning of a surge in the number of deaths, May was the month when a peak of apparently four thousand daily deaths was reported. However, there were multiple reports showing how the number of deaths itself was underreported. Reportedly, India, until the end of May 2021 had around 300,000 deaths since January 2020, and in May, alone, 100,000 deaths out of the total occurred in rural India. Basically, one third of the total deaths in the country was witnessed in a month, and 52% of the deaths out of it occurred in rural India, according to the analysis. Moreover, the report, too, pinpointed a government data, updated until March 2020, where it focused on the rural health infrastructure, and found it to be extremely inadequate. The two cohorts to be noticed throughout are – firstly, the lack of adequate number of health infrastructures in rural India, and secondly, the acutely understaffed existing infrastructures, which, significantly, are the major reasons for the massive surge in cases when it shifted to rural India. In rural health infrastructure, there are three levels – one being the sub-centres at the bottom end, with the existence of no doctors, but other healthcare-workers. Alongside it, in the second level, there are primary health centres, basically, the foremost level where the rural India gets access to doctors such as, general physicians, and other elite healthcare workers.

The third level is the community health centres with the availability of the specialist doctors like Surgeons, Paediatricians, Gynaecologists etc. Considering the numbers, according to the government norms, one health community centre should cater to one lakh twenty thousand population, however, in March 2020 it was serving a population of one lakh seventy-one thousand. Similarly, at the primary health centre level, 30,000 is what one primary health centre should cater to, but in actual practice it is catering to a number of 35,730 populations. CSE has pointed out in its report that community health centres in rural India require 76% more doctors, 56% more radiographers, and 35% more lab technicians. Evidently, these healthcare institutes are highly under-staffed, indicating the massive requirements of the infrastructure at the ground level.

In terms of human resource shortage in the community health centres, there are 76% shortage of doctors in the entire healthcare system of the country, while signifying all states being equally problematic. However, the best state with relatively less shortage is Telangana, with 24%, according to the government data. Worst states include the North-eastern states such as, Mizoram, Manipur, Meghalaya, Assam, including the states like Maharashtra with a shortfall of 64%, Gujarat 99%, Haryana 94% etc. At the primary health centre level, the staff shortage is comparatively lower with 70% across India, where worst hit states being Chhattisgarh (51% shortfall), Jharkhand (24%), Ladakh (69%) according to the government data. With respect to rural versus urban divide on the distribution of vaccines, there are media reports suggesting that rural India isn’t receiving as much as it should. The general discourse, currently, is about the vaccine hesitancy in rural India, however, acute shortage of vaccines, too, can’t be denied. So, logically, the more remote the place is the more difficult it would be to receive the vaccines. To the unintended, the vaccination drive in India started with vaccinating only the frontline healthcare workers in mid-January. In March we had administered 51 million vaccine doses in the country, and in April it increased to 78 million, followed by the administering of a total number of 56 million vaccines in the month of May when the cases soared sky high. However, the government has now assured that new vaccine deals are being struck and the numbers of vaccine doses would increase in the future.

The report, too, focused on the problems with MNREGA, delayed payments, also reiterated the fact that the slowdown in rural areas would significantly impact the economy. MNREGA played a crucial role in the first wave of Covid-19 i.e. in April 2020, the month when the lockdowns were in place. There was a sudden drop in the demands for MNREGA which was explained by the fact that people weren’t able to go back to their hometowns. Then, in May 2020, there were a sudden surge with around 37 million people seeking for jobs under

MNREGA, which is one of the highest levels to have been witnessed ever. However, around April 2021 the numbers climbed up to 27 million as opposed to 13 million in April 2020, with around 27 million in May. MNREGA is dependent on the farm cycle – more people enrol under it during the off-season, and less during the on-season. Evidently, as far as the second wave is concerned, rural India is the worst hit. We require keeping a close watch on what’s about to transpire in the next couple of months to the least, and for now, to address the issue of the shortage of man-power in our healthcare system is of paramount importance.