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VIEWPOINT
Year : 2022  |  Volume : 15  |  Issue : 3  |  Page : 309-312  

Community involvement in controlling COVID-19 pandemic in Maharashtra, India: Best practices and missed opportunities


1 Department of Community Medicine, AIIMS, Nagpur, Maharashtra, India
2 Department of Community Medicine, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India

Date of Submission16-Feb-2021
Date of Decision15-Mar-2021
Date of Acceptance15-Mar-2021
Date of Web Publication25-Jan-2022

Correspondence Address:
Sitikantha Banerjee
Department of Community Medicine, AIIMS, Plot-2, Sector-20 MIHAN, Nagpur, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjdrdypu.mjdrdypu_125_21

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  Abstract 


Community involvement is of utmost importance in the management of ongoing COVID-19 pandemic from compliance with lockdown, to the steps taken during easing restrictions, to community support through volunteering. Government of India used “Test, Track, and Treat” strategy to control the outbreak, which mainly focuses on strict legislative actions and capacity building. The strategies are predominately top-down, centralized, and government owned, where community participation and involvement were grossly missing. While visiting different high burden states of Maharashtra as members of central rapid response team, the researchers observed excellent community involvement models in some resource-poor settings, which were quite successful in controlling and managing pandemic at local level, and worth replicating in other settings. In this article, some of such evidences have been highlighted. This study also emphasized how community involvement could be more effectively used as a strategy to fight pandemic.

Keywords: “Test, Track, and Treat,” community involvement, COVID19


How to cite this article:
Kushwaha AS, Banerjee S, Bandyopadhyay K. Community involvement in controlling COVID-19 pandemic in Maharashtra, India: Best practices and missed opportunities. Med J DY Patil Vidyapeeth 2022;15:309-12

How to cite this URL:
Kushwaha AS, Banerjee S, Bandyopadhyay K. Community involvement in controlling COVID-19 pandemic in Maharashtra, India: Best practices and missed opportunities. Med J DY Patil Vidyapeeth [serial online] 2022 [cited 2022 Sep 29];15:309-12. Available from: https://www.mjdrdypv.org/text.asp?2022/15/3/309/336446




  Introduction Top


Community participation is an essential component of the primary health-care approach to attain health for all.[1] The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2, has significantly impacted the health system and economics of a vast majority of countries including India.[2] Maharashtra is one of the highest-burden states in India, where consistently high number of total cases and deaths have been reported.[3] In the state of Maharashtra, cases were initially reported from Mumbai and Pune, and gradually, it spread to all other districts. Attempts were taken by the Government of India to contain the pandemic using “Test, Track, and Treat” strategy, which mainly focuses on strict legislative actions such as lockdown, geographical quarantine, capacity building for testing and treatment, and enhancing surveillance.[4] Pandemic management in Maharashtra also followed the national guidelines and strategies. With the progress of pandemic, one important challenge faced by the administration was poor cooperation and resistance from the community in different parts of the country including Maharashtra.[5] Possibly, it could be because the strategies were top-down, centralized, and government-owned, with little community participation and involvement. Further risk communication was grossly neglected. Community ownership and involvement are of utmost importance in the collective response to COVID-19, from compliance with lockdown to the steps taken during easing restrictions, to community support through volunteering. Unfortunately, community involvement in this pandemic was suboptimal in India, except in limited settings. The researchers had the opportunity to observe these aspects as part of the rapid response team during the COVID-19 pandemic in its different stages throughout Maharashtra. They witnessed excellent community involvement activities in some resource-poor settings, which were quite successful in controlling and managing pandemic at the local level, and worth replicating in other settings. In this article, some positive evidence of community involvement and participation has been highlighted. It is also emphasized how community involvement could be effectively used as a strategy to fight the pandemic.

Community involvement in controlling epidemics

Literature reveals that the active involvement of community members is an essential prerequisite for controlling any large outbreak. Past experience of the HIV/AIDS epidemic also revealed that community involvement and risk communication improved uptake of HIV testing and counseling, improving access to treatment and reducing stigma.[6] Community engagement was also crucial in the response to Ebola virus disease in West Africa, for example, in tracking and addressing rumors.[7] The World Health Organization has highlighted the importance of community participation in controlling COVID-19.[8] In the United Kingdom, more than 1 million people volunteered to help the COVID-19 pandemic response till June 2020.[9] Review of strategies in countries where COVID-19 control is excellent, for example, New Zealand and Vietnam reflected fair community involvement.[10] Global health guidelines also emphasized the importance of community participation.[11] With communities onboard, we are far more likely to come up with innovative and tailored solutions that meet the full range of needs of our diverse populations.


  Best Practices Top


Community-based volunteers for awareness generation and surveillance

  1. In selected containment zones of Pune, Thane, and Aurangabad, community-based volunteers were used for contact tracing and community mobilization, and they were found to be working in collaboration with Accredited Social Health Activists and health functionaries
  2. In some rural areas of Kolhapur and Ahmednagar district, community-level groups of volunteers used to play a key role to monitor the movement of each and every person of their village/hamlet, which are still unaffected by COVID-19
  3. In some areas of Aurangabad, shopkeepers were provided pulse oximeter and thermal scanners to monitor oxygen saturation and temperature of residents, as and when required, whenever someone develops Influenza Like Illness (ILI) symptoms
  4. Some health-care workers who were COVID-19 infected and later got cured were found to be proactively getting involved as brand ambassador and spreading positive message to the community and within the hospital
  5. “Mazha Kutumb Mazhi Jawabdari:” it was a Maharashtra government drive to involve community to ensure surveillance and prevention of infection.[12]


Development of community-led facilities

Corona care corner in rural areas

Samudra Institute Corona Care Corner (CCC) at Talegaon Dabhade, Maval taluka, Pune district, India, was found to be an example of community-led development of COVID-19 care facility in a resource-poor rural setting. This was a fully functional CCC with the testing center where mild symptomatic patients are provided care free of cost. It has been developed in a hostel of a private teaching institute. Local private practitioners were actively involved in this project, not only in the free patient checkup but also by engaging themselves in its administration and supplying logistics. Along with regular health checkup, the staff were found interacting with patients in a friendly manner. The patients got involved in different activities, games, and amusements, and entertainments. Destressing sessions are organized every day for the patients with the active involvement of a local nongovernmental organization (NGO). The center was run by the financial support obtained from the local private organization as a part of corporate social responsibility along with the donation of local people and discharged patients. Local administration was actively supporting and coordinating the functions of the CCC.

Corona care corner in the urban slum area

SRA Scheme Viman Nagar COVID-19 Care Centre: this center was developed for admitting asymptomatic and mild symptomatic patients, especially to those slum dwellers who do not have separate room/washroom for keeping COVID-19-positive patients at their household. It was equipped with 24 × 7 doctor, nurse, and paramedics. Patients were continuously monitored with the provision of X-ray and blood test there. Oxygenated ambulance services were available round the clock. It was a very good example of public–private partnership. Doctors and nurses were supplied by a private organization (Bharti Jan Sangathan) free of cost, food being supplied by a faith-based organization (FBOs) (ISKCON), cleaning staff supplied by an NGO (DISHA), and overall funding is being carried out by Bajaj Foundation. Government was involved in overall coordination of the facility.

Involvement in tertiary care facilities

Dedicated dialysis centers for COVID-19-positive patients have been established by an association of doctors (nephrologists) in Mumbai with active support from the government.

Community-based intervention during lockdown

  1. Many NGOs and FBOs working in Mumbai and many other places of Maharashtra came forward to supply of food grains and cooked foods to the slum dwellers to minimize food insecurity during lockdown
  2. In Mumbai slums, many people predominately depend on community toilets. When the number of COVID cases started increasing in Mumbai slums, the residents themselves came forward and develop staggered timings for households to use community toilets in slums to reduce overcrowding
  3. Considering the possibility of inadequate food supply during the lockdown in tribal areas of Palghar, moderate and severe acute malnourished children were distributed special food packets by local volunteers with support from government
  4. As there was no bank, there in some tribal areas of Palghar, community-led alternative strategy has been adopted with the deployment of people to their household for providing banking services at the doorstep.



  Missed Opportunities of Community Involvement Top


When the number of cases and deaths were rapidly increasing in different states of Maharashtra, the administration felt that it was very difficult to manage the same with scarce and exhausted health workforce. The situation was further complicated by increasing community resistance reported in many parts of the state. It was strongly felt that a community-led government-supported approach could have been a better alternative compared to top-down management through Government machinery. Power and responsibility should be delegated to the community with supportive supervision by the government. A comprehensive public health approach should be used where the community will play a key role in early detection of cases, counseling, and improving health-seeking behavior, and ensuring early treatment initiation.

Community involvement in context-specific planning

Community representatives and opinion leaders should directly get involved in the development of context-specific microplan for the implementation of government strategies in different stages of pandemic.[10] Strategy should be decentralized with some flexibility in taking decision at the local level. One size fits all strategy is not suitable for the country such as India where different areas are in different stages of pandemic. A stratified approach has been suggested for different parts of state and districts for dealing with this kind of situation.[13] Similar approach was also advised by the WHO and other agencies.[14],[15]

Preventing stigma and discrimination

In India, the COVID-19 outbreak has provoked social stigma and discriminatory behaviors against people of certain religion as well as occupation groups and anyone perceived to have been in contact with the virus.[16],[17] Communities, including vulnerable and marginalized groups, can identify solutions: they know what knowledge and rumors are circulating and they can provide insight into stigma and structural barriers. The WHO also emphasizes the importance of community engagement as a strategy to prevent stigma and discrimination.[16]

Provision of essential services and drugs

We know that lockdown decreases the availability of essential drugs to high-risk population (hypertensive and diabetics), maternal and child health care, difficulty in transportation for someone in emergency, and many other essential services. Identifying and mitigating such harms require all members of society to work together.

Utilizing community-based volunteer and NGOs in early case detection and treatment initiation

Community-based volunteers could be utilized in active surveillance of vulnerable population in areas inside containment zones. They could be empowered with pulse oximeter and other essential logistics and will be made responsible for detection of the people developing ILI symptoms in their locality at the earliest. They can also work to monitor health status of asymptomatic/mild symptomatic patients under home isolation. This process would facilitate early case detection and treatment, which in turn would decrease complication and mortality. This strategy would reduce the burden on government machinery. In urban areas, administration carry out regular virtual meeting with representatives of residents welfare organization to strengthen community involvement. It was observed that different NGO and FBOs were working in a scattered manner in some restricted areas, within their capabilities to alleviate suffering of people during pandemic. In this respect, government could better utilize the opportunity and involve them in planning and implementation of strategy in a structured way.

Utilization of recovered/vaccinated persons

Recovered and vaccinated people can be considered as efficient workforce, as they are immune to this disease. Government should take this as an opportunity to directly involve them in care, management, and interaction with COVID-19-positive patients. They can be utilized in different ways:

  • They are potential candidates for plasma donation
  • They can be brand ambassadors for the city-at-large and will help decrease anxiety in the population. They can become a ray of hope for infected persons
  • They can be employed in contractual basis as attendants of COVID-19 cases, nonmedical hospital staff posted in COVID wards, helpers of police personnel, etc.
  • They can work as attendants of COVID-19-positive high-risk patients
  • Their experiences at hospital can be video recorded and displayed in public.



  Conclusion Top


Community participation is part and parcel of controlling any outbreak, and it is frequently overlooked while designing interventions in epidemics. Resources within the community were largely underutilized in the ongoing COVID-19 pandemic. The best practices described in this study could be replicated in other similar settings. Further, the suggestions mentioned could be suitably incorporated in the policy for better pandemic management in future. Involvement of community starting from context-specific decision-making, implementation of the strategy (contact tracing, early case detection, treatment facility development in collaboration with Government, etc.,), monitoring, and surveillance are key to effective pandemic control. The pandemic management, especially where participation of the community is ensured to contain the disease, adequate and sensitive risk communication, and making control program community-led and community-owned ably supported will pay better dividends.

Acknowledgment

We acknowledge the Department of Health, Government of Maharashtra for active support and cooperation during our visit.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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2.
Chatterjee P, Nagi N, Agarwal A, Das B, Banerjee S, Sarkar S, et al. The 2019 novel coronavirus disease (COVID-19) pandemic: A review of the current evidence. Indian J Med Res 2020;151:147-59.  Back to cited text no. 2
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3.
Coronavirus in India: Latest Map and Case Count. Available from: https://www.COVID19india.org. [Last accessed on 2021 Feb 10].  Back to cited text no. 3
    
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Bhaduri SD. The Criticality of Community Engagement. The Hindu. Available from: https://www.thehindu.com/opinion/lead/the-criticality-of-community-engagement/article31264494.ece. [Last accessed on 2021 Feb 10].  Back to cited text no. 5
    
6.
Community Involvement | Ending the HIV Epidemic | CDC; 2021. Available from: https://www.cdc.gov/endhiv/action/community.html. [Last accessed on 2021 Feb 10].  Back to cited text no. 6
    
7.
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Pacific WHORO for the W. Role of Community Engagement in Situations of Extensive Community Transmission of COVID-19; 2020 May 22. Available from: https://apps.who.int/iris/handle/10665/332172. [Last accessed on 2021 Feb 10].  Back to cited text no. 8
    
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A Million Volunteer to Help NHS and Others during COVID-19 Outbreak. The Guardian; 2020. Available from: http://www.theguardian.com/society/2020/apr/13/a-million-volunteer-to-help-nhs-and-others-during-COVID-19-lockdown. [Last accessed on 2021 Feb 10].  Back to cited text no. 9
    
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Gilmore B, Ndejjo R, Tchetchia A, de Claro V, Mago E, Diallo AA, et al. Community engagement for COVID-19 prevention and control: A rapid evidence synthesis. BMJ Glob Health 2020;5:e003188.  Back to cited text no. 10
    
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Rights in the Time of COVID-19 – Lessons from HIV for an Effective, Community-Led Response. Available from: https://www.unaids.org/en/resources/documents/2020/human-rights-and-COVID-19. [Last accessed on 2021 Feb 16].  Back to cited text no. 11
    
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Kushwaha AS, Banerjee S. Public health action for controlling COVID-19 pandemic in India: Way forward. Med J DY Patil Vidyapeeth [serial online] 2021 [cited 2021 Apr 22];14:14-20. Available from: https://www.mjdrdypv.org/text.asp?2021/14/1/14/303110.  Back to cited text no. 13
    
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Mearns S, Gayer M. Annex 1: IRC COVID-19 Risk Categorization Index and Classification. New York, US, International Rescue Committee; 2020.  Back to cited text no. 14
    
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Considerations for Implementing and Adjusting Public Health and Social Measures in the Context of COVID-19. Available from: https://www.who.int/publications-detail-redirect/considerations-in-adjusting-public-health-and-social-measures-in-the-context-of-COVID-19-interim-guidance. [Last accessed on 2021 Feb 16].  Back to cited text no. 15
    
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A Guide to Preventing and Addressing Social Stigma Associated with COVID-19. Available from: https://www.who.int/publications/m/item/a-guide-to-preventing-and-addressing-social-stigma-associated-with-COVID-19. [Last accessed on 2021 Feb 10].  Back to cited text no. 16
    
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