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COMMENTARY
Year : 2020  |  Volume : 64  |  Issue : 6  |  Page : 102-104  

Community preparedness for COVID-19 and frontline health workers in Chhattisgarh


Executive Director (Former), State Health Resource Centre, Raipur, Chhattisgarh, India

Date of Submission11-May-2020
Date of Decision12-May-2020
Date of Acceptance13-May-2020
Date of Web Publication2-Jun-2020

Correspondence Address:
Prabir Kumar Chatterjee
State Health Resource Centre, Kalibadi, Raipur - 492 001, Chhattisgarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.IJPH_467_20

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   Abstract 


At the end of April 2020, there had already been three million cases of COVID-19 in the world pandemic. Chhattisgarh might expect 90,000 diagnosed cases of COVID-19 in the end. The first step taken in March was to ensure a simple checklist of activities that needed to continue. Handbills were given with the basic information on the symptoms and what to do in the community. In urban areas, the lockdown affected the poorer section of the society, especially who are not having BPL card and no other means of availing necessary eatables. Issues that arose affecting regular activities such as tuberculosis and immunization. Residents of informal settlements are also vulnerable during any COVID-19 responses. Frontline workers such as Mitanins in the community are an important asset in the capacity building and preparedness strategies.

Keywords: Chhattisgarh, community health worker, COVID-19, emergency preparedness, pandemic


How to cite this article:
Chatterjee PK. Community preparedness for COVID-19 and frontline health workers in Chhattisgarh. Indian J Public Health 2020;64, Suppl S2:102-4

How to cite this URL:
Chatterjee PK. Community preparedness for COVID-19 and frontline health workers in Chhattisgarh. Indian J Public Health [serial online] 2020 [cited 2020 Aug 8];64, Suppl S2:102-4. Available from: http://www.ijph.in/text.asp?2020/64/6/102/285598




   Agenda Setting for Chhattisgarh Top


“(Re) commendations such as working from home has become the default function for workers all over the world. Following these guidelines has been a challenge in the Global North. As the pandemic expands to the Global South, the challenges are greater.”[1]

At the end of April 2020, there had already been three million cases of COVID-19 in the world. There were one million cases of COVID-19 in the United States, with a population of 300 million.[2] This was expected to double before the end of the pandemic.

If Chhattisgarh was to have a similar number of cases, it would expect 90,000 diagnosed cases in the end. These could be spread out across the state in the working areas of 70,000 Mitanins (community health volunteers, called ASHA in other states).[3] This outbreak would require testing for six times this number of suspects. Each Mitanin might need to ensure that eight tests were done for their communities to diagnose one or two positives in a Mitanin Mohalla/area.

This meant that every Mitanin (community health worker covering 60–100 families or 300–500 people on an average) should be in contact with all the families regularly. They needed to continue to offer services such as health education, referral of pregnant women, malaria testing, distribution of simple medicines such as paracetamol and ACT, as well as follow-up of tuberculosis (TB) and chronic patients on treatment. They are also a common first contact in cases of harassment in the home.

Preparing MITANINs for COVID-19 Emergency

The first step taken on March 20 was to ensure a government order to ensure that they could continue to function and meet.[4] Then, a simple checklist of activities that needed to continue was circulated by State Health Resource Centre (SHRC, which facilitates the Mitanin support structure) on March 24 with instructions to contact their Mitanin Trainers (MTs, called ASHA Facilitators) in small groups once a month.[5]

Guidelines about hand washing, physical distancing, and proper use of masks to prevent cough or aerosol spread were made. These were distributed through the District Coordinators and Block Coordinators to the MTs in March in meetings where they continued and through WhatsApp after that. The MT continued to meet the Mitanins in their areas (each MT has 20 Mitanins and a population between 6000 and 10,000). This allowed collection of health information and data on monitoring of functioning of subcenters and facilities.

Rural activities

Handbills[6] had been given with the basic information on the symptoms and what to do in the community (hand washing, physical distancing, and covering one's face when coughing). They were told that it was good to take protein foods (most Chhattisgarhis consume eggs and many take chicken when thy have the means). Some handbills were printed/photocopied and in some areas over WhatsApp for Mitanins to give IEC.

Mitanins also started by doing wall writing in their Mohallas/Paras and giving hand washing instructions to every family.[7]

Urban activities

In urban areas, the lockdown affected the poorer section of the society, especially who are not having BPL card and no other means of availing necessary eatables. SHRC decided to take initiative to focus at least in the urban area through Urban Mitanin Program (urban areas of 19 cities) to help out the poor people.[8]

Following types of people were identified in slum area:

  1. Those families who are not having BPL cards
  2. Daily wage laborers
  3. Rag pickers
  4. Migrant labors
  5. Elderly peoples having no support.


It was found that 24,000 people in slums across 19 urban areas had no ration cards. Hence, Social Welfare Department was contacted and urban Mitanins ensured food distribution through government, municipality, or donors (Azim Premji Foundation). The materials such as rice, dal, salt, soy bean, and vegetables were stored in the SHRC Office located in Kalibadi, and with the help of office vehicle, the materials are being distributed with the help of field staff in nearby Raipur area and then in other towns.

An outbreak of jaundice due to deficiencies in the water supply recurred in Raipur in 2020.[9] Urban Mitanins tracked cases, advised on safe water, distributed chlorine solution, and reported deaths. Regular meetings were held between urban MTs in small groups at the Raipur Office to ensure that the outbreak was controlled. This also served as a training in outbreak control. Raipur itself only had 39 cases of COVID-19 till the end of April.[10] Only one of these was sick (had more than simple cough and cold).

Mitanins found that there was some stigma when these patients returned home after quarantine at AIIMS, Raipur. They worked to dispel misconceptions and rehabilitate these people in their families and communities.

Groups of Mitanin visited urban areas enquiring about symptoms and person coming from outside and those without ration card.

There were 28 people who were COVID-19 positive in the small town of Katghora in district Korba.[11] All were family or neighbors or health workers who had come into contact with a person who had returned from outside. Surprisingly, the traveler was negative by the time the outbreak was discovered. Not a single case had any symptoms in this cluster. The area was rather congested. Mitainins helped a medical team to visit houses and take samples. In the surroundings, a Buffer Area was put up and Mitanins here went house to house to survey influenza such as illnesses and possible cases of serious acute respiratory infection (ARI) who were to be referred for testing. Masks were used by surveyors and hand washing was emphasized.

This had been done earlier in the early March in one area in a well to do area of Raipur, where the first foreign returned case of COVID-19 was detected. This area had no urban Mitanins of its own. Here too, the health staff went house to house to survey influenza such as illnesses and found five possible cases of serious ARI who were tested. All were negative. This moving of Mitanins to unfamiliar areas puts them at a possible risk. Further, they are not so well accepted, and so, it is not really recommended that they go out of their own work areas.

Challenges and Innovations

An issue that arose was multidrug-resistant TB cases not put on treatment after being diagnosed. This was communicated through the Mitainin support structure to Mohalla level to solve this.[12]

There was a drop in subcenter immunization in some districts in the early April in Raipur, Korba, Kawardha, Kanker, and Kondagaon. Outreach sessions were less affected in Kanker but decreased in Dantewada and Baloda Bazar.[13]

This was addressed by NHM through the frontline workers in Raipur.[14]

Dantewada responded in more detail – they put up a COVID-19 Health Call Center to monitor quarantine and home isolation. This call center directly connects with Auxiliary Nurse Midwifes, Anganwadi Workers, Panchayat Sachiv, and Patwaris to ensure better coordination and services. Basant the TADI fellow in Dantewada has been engaged in response to COVID-19. He is a part of the team. He is also coordinating through the call center to ensure institutional deliveries and to keep the pregnant women tracing for better health services.

The state took many social measures which were publicized. This PHRN list gives Chhattisgarh notifications and announcements relevant for communities affected by the lockdown so far.[15]

In recognition of the work by frontline workers, the State Health Department decided to give them each Rs. 1000 extra for 2 months (total outlay around Rs. 14 crores).


   Discussion Top


As other commentators have mentioned, those in villages and slums are at extreme risk both due to the virus and due to the economic and social effects of the lockdown. These can increase existing vulnerabilities. Administrative authorities at central and higher levels may overlook existing capacity in these communities. It is for the health workers to start or motivate panchayat members, Village-Health-Sanitation-Nutrition committees, and Mohalla and Mahila Arogya Samitis in such areas to plan for their own microcommunity; to ensure that those without ration cards or who have little means of support are identified; and to ensure that they get the required food, monetary, social, and medical support available from government or other sources.

Training of these volunteer committees needs to be implemented, especially on health issues. Several countries that learnt lessons from HIV and other previous pandemics were able to respond more effectively to COVID-19 and Chhattisgarh was able to leverage upon the experiences with water-borne jaundice, Japanese encephalitis, Swine flu and dengue.[1]

Frontline workers such as Mitanins in the community are an important asset in the capacity building and preparedness strategies for COVID-19.

Acknowledgment

We would like to acknowledge:

  1. Support by Samir Garg, Director, SHRC, who has contributed much of the material on which this based
  2. Staff of SHRC who contributed reports
  3. All Mitanins who worked in the slums and villages and whose meetings contributed much of the information
  4. NHM and Department of Health and Family Welfare, Government of Chhattisgarh, who support these programs.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Corburn J, Vlahov D, Mberu B, Riley L, Caiaffa WT, Rashid SF, et al. Slum health: Arresting COVID-19 and improving well-being in urban informal settlements. J Urban Health 2020;Apr 24;1-10. doi: 10.1007/s11524-020-00438-6. Online ahead of print.  Back to cited text no. 1
    
2.
COVID-19 CORONAVIRUS PANDEMIC. Available from: https://link.springer.com/article/10.1007/s11524-020-00438-6. [Last accessed 2020 May 10].  Back to cited text no. 2
    
3.
State Health Resource Centre 2019-20. Available from: http://shsrc.in. [Last accessed on 2020 May 02].  Back to cited text no. 3
    
4.
Health Workers to Continue Secretary on Corona to CMOH. Available from: http://pdf Letter Ref-2020/NS/S/Swasth 198. [Last accessed on 2020 Mar 20].  Back to cited text no. 4
    
5.
Mitanin ke Liye. Document circulated by SHRC pdf. [Last accessed on 2020 Mar 24].  Back to cited text no. 5
    
6.
Corona Virus Pamphlet Document circulated by SHRC. [Last accessed on 2020 Mar 16].  Back to cited text no. 6
    
7.
Personal communication. Samir Garg, Director SHRC.  Back to cited text no. 7
    
8.
Personal communication. Programme Coordinator, SHRC.  Back to cited text no. 8
    
9.
More Jaundice Cases Found; RMC Issues Health Advisory Hitavada Raipur City Line Pg 3. Available from: https://www.ehitavada.com/index.php?edition=RCpage&date2020-04-07&page=3. [Last accessed on 2020 May 02].  Back to cited text no. 9
    
10.
Media Bulletin Hindi_29042020. Available from: http://cghealth.nic.in/cghealth17/. [Last accessed on 2020 Apr 30].  Back to cited text no. 10
    
11.
Media Bulletin Hindi_30042020. Available from: http://cghealth.nic.in/cghealth17/. [Last accessed on 2020 May 02].  Back to cited text no. 11
    
12.
Document Received in Personal Communication by Email on 19 April, 2020.  Back to cited text no. 12
    
13.
Slide Received in Personal Communication by email on 19 April, 2020.  Back to cited text no. 13
    
14.
Target of Immunization Achieved Amidst Lockdown Hitavada Raipur City Line Pg 6. Available from: https://www.ehitavada.com/index.phpedition=RCpage&date=2020-04-28&page=6. [Last accessed on 2020 May 02].  Back to cited text no. 14
    
15.
2 CG COVID. Anahita Surya; JSA Chhattisgarh; 2020. Available from: https://docs.google.com/document/d/1IYZf_dW KfxJcJfAejl0watYhN0iKy6qN8pl_Hm0gjlc/edi t?usp=drivesd. [Last accessed on 2020 May 01; Last accessed on 2020 Mar 27].  Back to cited text no. 15
    




 

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