Updated: May 18, 2021 9:04:14 am
The Centre has, finally, drafted a blueprint to tackle the spread of the coronavirus in rural India. The guidelines, communicated to the states on Sunday, tick quite a few right boxes, especially with regard to linking village-level makeshift facilities with primary and community health centres and the relatively better-equipped hospitals at the district level. They talk of ensuring supplies of basic requirements of Covid care, including oxygen cylinders. The SOP correctly recognises the degrees of severity of the disease — it lays down protocols for isolating asymptomatic carriers and treating patients with mild and severe Covid symptoms. However, given the scale of the challenge, much more will need to be done.
The guidelines say that ANMs (auxiliary nurse midwives) will be trained to conduct rapid antigen tests. Such tests are useful emergency measures compared to the more complex RT-PCR (or swab) tests. They cost much less, give results in 15-30 minutes and do not require sophisticated laboratories. But with the chance of a false negative as high as 50 per cent, an antigen test is not the gold standard for Covid detection. The ICMR recommends the rapid tests to take the burden off laboratories, but it also stipulates a swab test for a person with Covid symptoms and a negative antigen test report. The Centre’s guidelines go along with the premier medical research body’s protocols. They are, however, silent on the urgent need to increase and upgrade diagnostic facilities — equip them with RT-PCR testing kits — in rural areas.
Reports, including in this newspaper, have highlighted how inadequate supplies and the country’s well-known digital deficit have hobbled the access of rural residents to vaccines. The SOP’s silence on a roadmap to increase the penetration of the vaccine in the countryside is glaring given that a large number of districts reporting more than 10 per cent positivity are in rural areas. With the pandemic increasing the work burden of ANMs, ASHA and anganwadi workers — they have been engaged in contract tracing, disseminating information and as vaccinators — the delivery of nutrition and other healthcare-related services has also been affected. With the guidelines now requiring these community-level workers to be at the frontlines of village-level pandemic control teams, their work could become even more onerous. The SOP does delineate the roles of PHCs, CHCs and district hospitals. But to take on the crisis, these rural healthcare centres will need more doctors and technical staff — ventilator operators, for instance. These demands cannot be met overnight. But keeping the damage of the pandemic to the minimum requires that no time is lost in making these investments.
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