Health System Strengthening and Building Resilience at the Community Level to Mitigate the Impact of COVID-19

The outbreak of coronavirus disease (COVID-19), first reported in December 2019 has continued to be a global pandemic with 3,409,220 deaths and 164,409,804 positive confirmed cases reported globally as of May 20, 2021 by WHO. By the same date, among the reporting countries, India has ranked first in terms of the highest number of confirmed cases in the last 24 hours and past 7 days. From April 2021, India has seen a sudden and unprecedented spike in COVID-19 cases with over 300,000 new cases being reported daily. As per the latest updates (20th May 2021) India has reported 26,022,499 confirmed cases and 291,112 deaths from COVID-19 in 35 States and Union Territories. As of May 20 2021, Rajasthan, one of the top ten most affected states in the country, has reported a total number of 897,193 confirmed cases, with 11,383 cases in the District of Baran and 173,589 in Jaipur. Similarly, Gujarat has reported a total number of 776,220 total confirmed cases, with 8223 confirmed cases reported in Sabarkantha. However, experts suggest that the actual number of positive cases and the deaths from COVID-19 might be higher and unaccounted due to a shortage of testing facilities, over-worked healthcare systems, and inadequate availability of beds, essential medicines, and Oxygen supply. As an immediate measure to halt the spread of COVID-19, affected states and cities have implemented a strict lockdown with only essential services available. As seen during the first nationwide lockdown in April 2020, this is expected to have a significant impact on the health, nutrition and financial status of the population at large. Action Against Hunger India conducted a Rapid Assessment Survey in May 2020 to understand the effect of the pandemic and the imposed nationwide lockdown on the vulnerable population. As per the findings, a majority of respondents across Action Against Hunger India’s intervention locations run out of income during lockdown. The population across India had very limited access to health and nutrition services, worsening their vulnerability. Additionally, the healthcare frontline workers were facing challenges in ensuring timely and effective delivery of services in a high demand scenario. To address these issues, Action Against Hunger India took relief measures to support the population and the healthcare system. While Action Against Hunger India relief efforts were ongoing to deal with the first wave, the country was impacted with a stronger second wave of COVID-19 with increased infectivity and high mortality, collapsing the health, nutrition and every other social protection system. To deal with this devastating scenario, a majority of the country’s healthcare resources are being diverted towards COVID-19 infection treatment and control, thus the vulnerable segment of the population is facing challenges in accessing the basic health care and nutrition services. With over 300,000 new cases daily, the health infrastructure has been under tremendous stress. Some of the immediate issues have been shortage of beds, oxygen supplies, medicines to name a few. This has been particularly challenging for India due its population volume and density. The modelling study published in The Lancet Global Health (Robertan et.al., 2020) had provided early estimates of the indirect effect of the COVID-19 pandemic on maternal and child mortality in low- and middle-income countries. The study suggests that in the worst-case scenario, where coverage reduction of 39.3 to 51.9% in maternal and child health and nutrition services and 50% increase in wasting over the period of 6 months will result in an increase of 9.8-44.7% in under-5 child deaths per month, and an 8.3-38.6% increase in maternal deaths per month across 118 countries. According to the study, in such a scenario, about the reduction in coverage of these services, India would be one of the top 10 countries that could have the largest number of additional child deaths. As rightly suggested by their model, India is now facing multiple challenges owing to the pandemic. These findings along with Action Against Hunger India’s on-field situation alerts to act in time and deliver interventions towards addressing these issues.