In order to tackle the pandemic better, the Health Ministry has issued new guidelines for peri-urban, rural and tribal areas that have been adversely affected by coronavirus. As the second wave has devastated the rural areas with no infrastructure, the central government has directed the states to set up a three-tier structure with oxygen beds and other important medical equipment like N-95 mask, triple layer medical mask, gloves, sanitisers, pulse oximeters, thermometers, disinfectants etc.

A lot of issues pertaining to under reporting of cases and deaths from rural areas have been doing the rounds since the second wave. Several state courts have taken stock of the grim situation issuing important directions to increase facilities and testing. Panic and fear have also set in after hundreds of bodies were seen floating in the Ganga and some in Yamuna. Remote areas of Bihar, Uttar Pradesh, Madhya Pradesh, Gujarat are complaining about lack of beds, oxygen, medicines, ventilators and medical staff.

As per Government data of December 2020, a total of 2,371 Primary Health Centres (PHCs) have been constructed against the sanctioned 2,941 centres. Out of the sanctioned 28,150 capacity of Sub Centres for health, only 21,249 have been completed, with no update about the remaining 6,901 centres.

Out of 175 District Hospitals, only 148 have been constructed. For renovation/upgradation purposes, the government aimed at 3,227 hospitals but only 2,407 hospitals have been completed. Out of the grand total 23,225 sub centres, merely 16,548 have been renovated. Only 159 Sub District Hospitals have been constructed against the target 242 hospitals. For renovation, only 1,011 SDHs could be finished as against 1,238 sanctioned ones.  

The Government’s plan of a three-tier structure involves:

1. Covid Care Centre (CCC) to manage mild/asymptomatic cases

2. Dedicated Covid Health Centre (DCHC) to manage moderate cases

3. Dedicated Covid Hospital (DCH) to manage severe cases

Peri-urban and rural areas have been directed to plan a minimum of 30-bedded CCCs that may be set up in schools, community halls, marriage halls, panchayat buildings in close proximity of hospitals/healthcare facilities, or tentage facilities in Panchayat land, school ground, etc. Qualified AYUSH doctors/Final year AYUSH students/Final year BSc nurses may be considered to run the CCCs.

Then, the Primary Health Centre/Community Health Centre/Sub District Hospital in these rural areas will be the Dedicated Covid Health Centre (DCHC) for management of moderate Covid cases. The facility may also have a capacity of 30 beds. A separate block of Primary and Community Health Centres shall be designated as DCHC with separate entry, exit and zoning. Private hospitals will also be designated as these DCHCs. The guidelines state that all districts should be prepared to increase DCHC beds as per the case trajectory and expected surge.

To treat severe cases of infection, District Hospitals, other identified private hospitals or a block of these hospitals shall be converted as the dedicated Covid Hospitals (DCH). In addition, Sub-district/Block level hospitals fulfilling the requirements may also be designated as the DCH for the identified CCC and DHCC in their catchment area.

For testing, the Central government’s plan states that Community Health Officers (CHOs) and Auxiliary Nurse Midwife (ANMs) should be trained in performing rapid antigen testing. RAT kits should be provided at all public health facilities including Sub-centres/Health and Wellness Centres and Primary Health Centres.

Another response strategy adopted by the Centre for tribal areas include mobile medical units. As tribal areas pose additional challenges with minimum adequate facilities, the Central government has come up with the idea of Mobile Medical Unit (MMU) to facilitate access to public health care in tribal areas.

According to the data provided by the Health Ministry, as many as 479 out of 718 districts have reported a positivity rate above 10 percent. The actual numbers could be way higher. Madhya Pradesh has the maximum number of districts clocking above 10 percent positivity rate at 38 and Tamil Nadu at 37.

In Maharashtra, out of 36 districts, 33 have been reporting over 10 per cent positivity rate and Karnataka has reported 30 districts. States like Odisha and Uttar Pradesh have reported 27 and 14 districts respectively. The infection rate has also soared in West Bengal with 23 districts affected and Assam with 24 districts. Rajasthan also has 27 districts with similar infection rate.

Other States data is as follows:

The new guidelines of the Health Ministry may be read here.

Related:

Uttar Pradesh: Bodies in the river, more buried in the sands, tell tales of Govt apathy
Bihar’s odious and short-sighted response to Covid-19
Are obituaries in Gujarat newspapers a better indicator of real Covid-deaths?
Death due to lack of timely medical aid is a violation of right to life: Patna HC
Around 140 bodies found in river Ganga, officials yet to confirm them as Covid deaths

The post Nearly 500 districts record soaring Covid positivity rate, Centre draws up three tier structure appeared first on SabrangIndia.

On April 20, as the country welcomes the first phase of lockdown relaxation, Maharashtra took its first tentative steps to resume economic activity in a staggered manner across the state. The revival plan has been laid down in a series of notices issued by various government departments.

One such circular was issued by the office of the Chief Engineer Development Plan. It lays down revised guidelines for permission of construction activity in the area that falls under the purview of the Municipal Corporation of Greater Mumbai. Permissions have been granted for:

1. All urgent pre-monsoon related works

2. Construction of works in construction projects, within limits of municipal corporations and municipalities, where workers are available on site and no workers are required to be brought in from outside (in situ construction). However, in MCGM and in PMC with the permission of Municipal Commissioner.

When it comes to pre-monsoon related urgent work in all areas except containment zones, the following guidelines apply:

For all precautionary works which are required to be carried out before monsoon for all structures (constructed or under construction), construction of retaining walls, or work of shore piling etc. to protect against landslides, waterproofing of terraces and such exposed areas, completion of basements and other subsoil works, shall be permitted to commence, provided such works had commenced prior to March 14, 2020, and were required to be left as it is, due to commencement of lockdown.

The circular states, “For aforesaid work, transport of all goods is allowed under clause 12 of the revised guidelines issued by Government Supervisory staff, machine operators shall also be permitted be (sic) travel and attend the site, from their place of residence every day. They will however not (be) allowed to use public transport for the purpose. Workers shall also be permitted to be brought to site from their place of residence, provided proper arrangement for their staying at site is made and they are not required to travel to place of work on everyday basis.”

The above restrictions on using public transport for travel are rather curious given how few people own vehicles. The onus has therefore been placed squarely on the construction companies to arrange transportation, which if they are unwilling or unable to arrange renders workers jobless. Also, the insistence of making stay arrangements for workers at the site instead of extending them the same courtesy of to-and-fro travel as given to supervisory staff and machine operators, appears to have an anti-poor bias.

While it is true that many construction workers lead a nomadic lifestyle pitching tents and living in makeshift shanties near construction sites before moving on their next projects, many other migrant labourers live in slums in rented accommodation with their families. They depend on daily transport to and from the construction site and this is usually arranged for by various labour contractors who pick up labourers daily from specific spots where they gather every day. This issue has been completely ignored in the circular.

It also appears to restrict the movement of women construction workers unless they agree to leave their original places of residence and agree to move to the construction site with children in tow. Construction is one of the many industries where female workers engage in hard physical labour alongside their male counterparts.

Also, while both father and mothers should be equally responsible for caring for their offspring, traditionally mothers have been the primary caregivers of children. Small babies and toddlers are a common site at all construction sites, often found hanging from makeshift cradles even as their mother carry bricks on their heads. 

The new guidelines appear to have completely overlooked this important matter, given how children have lower immunity and are therefore more susceptible to infections. Or perhaps it just wants the men to report to work while their wives stay at home caring for the children?  

In case of all other construction work i.e unrelated to urgent pre-monsoon construction, similar guidelines apply except no workers will be permitted to be brought from outside. This is also slightly problematic given how many migrant workers had already left for their home villages in panic after the lockdown was announced, and while they were either left stranded in different places or forced to return, not all may have made it back to their construction sites and would therefore lose out on work opportunities.

The circular also lists the following mandatory requirements at the construction sites:

1. Thermal scanning of everyone entering the site any time of day should be done. If anyone has reading more than predefined value, then he should not be allowed to enter the site.

2. Congestion at any location, specially at entry and exit place should be avoided. Suitable arrangement shall be made, for maintaining segregating distance between workers.

3. All workers should wash their hand at the point of entry, before entering the place of work, before eating. Suitable arrangement for the same should be made at the site.

4. All workers must cover their mouth and nose with cloth or a mask.

5. All Common area such as Labour camp, canteens, toilets, entry/exit gate, should be cleaned on daily basis, and disinfectant should be sprayed twice a week.

6. A doctor should visit the site at least twice a week and examine each worker and render medical assistance if required.

7. No one shake hands with anyone.

8. Separate arrangement for sick worker (isolation) should be kept ready.

Even in all of the above the administration’s myopia regarding children of construction workers, and by extension primarily the concerns of their mothers, is glaring. There is no requirement for the visiting doctor to render services to the children. There are also no guidelines about day care facilities for these children or how social distancing would be enforced among toddlers and crawling babies even if the construction company took the initiative to organise a creche facility.

The entire circular may be read here:

Related:

New guidelines by MHA allow agri and fisheries after April 20, encourage online teaching
MHA exempts MFP and NTFP from lockdown

The post Did MCGM guidelines about resumption of construction activity ignore female workers and their children? appeared first on SabrangIndia.