The COVID-19 pandemic has revealed the catastrophic consequences of the public health system remaining largely underfunded in India. A nationwide study on three vulnerable groups during the pandemic published recently said: “Public health measures are rarely apolitical, and, as the situation in India shows, can be experienced as forms of exclusion and repression for vulnerable groups of people.” The study, titled “Mitigating the COVID-19 pandemic in India: an in-depth exploration of challenges and opportunities for three vulnerable population groups” and published in Equality, Diversity and Inclusion: An International Journal in June 2021, focused on three specific groups: migrant labourers, children and refugee and/or displaced groups.
According to the study, improving social health care and poverty alleviation in India are not very expensive tasks: Kerala, Tamil Nadu, Karnataka and, to some extent, States such as Goa and Punjab, have put in place systems that helped absorb the worst shocks of the pandemic. It has suggested that the government of India constitute a pan-India council, much like the one on Goods and Services Tax, and encourage States to share their models on social infrastructure, health care and poverty alleviation. However, the study noted, this did not mean that what worked in one State will work in another and the solutions will need to be contextualised in order to be sustainable. Such a council should also debate the effectiveness of the public distribution system, it said.
According to the study, all levels of governance should be involved in decision-making to ensure that hunger is tackled; jobs are ensured; health needs are catered to; and social stigma is addressed sensitively.
It pointed out that while the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA) still remains the most relevant piece of legislation to ensure that the poorest get at least 100 days of work in a year, it proved inadequate during the pandemic because of long periods of enforced lockdown.
Policies and schemes
The study examined specific policies and schemes to see how successful they were in reaching people. It shed light on a) the most urgent needs that need to be addressed by population group; b) the variety of State-level responses as well as best practices observed to deal with mitigation issues; and c) opportunities for quick relief as well as more long-term solutions.
It combined desk-based research and in-depth interviews with experts in specific fields. The desk research, based on a thorough Internet search, was conducted by three researchers at the Tata Institute of Social Sciences (TISS) in Mumbai. The data collected comprised information from official government organisations, press conferences of Union Ministers, Chief Ministers and senior officials, and tweets from official handles, all related to COVID-19 mitigation efforts, nationally and at the State level, between March 1, 2020 and April 27, 2020.
Also read: Children as victims of the pandemic
For the qualitative part of this study, 10 in-depth interviews were conducted with professionals and lay experts in the field of public health administration, policy development (national or State level), science, or development aid (for instance, non-governmental organisations, or NGOs), who had been working at the grass-roots level with one of the vulnerable groups in focus in this study.
These experts were identified on the basis of their seniority (with at least 10 years’ experience) and the extent of their involvement in or knowledge about the developments relating to the COVID-19 pandemic in India.
States’ initial responses
At the beginning of the pandemic, which became evident in March 2020, the study observed that States used different logistics and policies to distribute aid. Delhi, for instance, increased general ration quotas for specific groups of people by 50 per cent, while Telangana, Tamil Nadu, Haryana, Punjab, Rajasthan and Meghalaya paid Rs.1,000 each to labourers registered under the Construction Labour Welfare Board. Jammu and Kashmir, Kerala, Karnataka and Odisha offered rations for eligible beneficiaries.
States such as Tamil Nadu, Telangana, Karnataka, Jharkhand and Maharashtra opened up specific shelters, camps and/or free food points/kitchens/canteens to support the poor. Rajasthan aimed to provide relief for families affected by COVID-19 with social pensions, in addition to paying Rs.1,000 per month per family.
Most States started providing free food at fair price shops for up to six months in some cases; some have extended this up to November 2021. West Bengal and Uttar Pradesh provided free grains to 8.3 million widows and disabled persons, while Tamil Nadu provided packages of rice, dal and oil to unorganised workers. States such as Delhi, Odisha and Madhya Pradesh supported students in various ways to reduce their stress. For instance, Delhi provided money for Internet data while Odisha issued midday meal coupons.
Also read: Lockdowns’ burden on children
Finally, the Central government enhanced most of the existing policies under the MGNREGA either by releasing funds in advance and/or by supplementing them with additional financial support.
The question before the study was: how successful was the implementation of these measures and policies and to what extent did they reach the targeted beneficiaries?
Migrant labourers
The COVID-19 pandemic revealed the atrocious living conditions of migrant labourers in the country and exposed the government’s lack of attention to the factors, which pressured millions to migrate on foot to their homes in rural areas, which also led to many deaths.
For decades, factors such as unemployment and crop failure forced millions of rural residents, particularly those belonging to the Scheduled Castes (S.Cs), Scheduled Tribes (S.Ts) and Other Backward Classes (OBCs), out of their villages in various States.
For instance, a rapid study conducted in Odisha after the lockdown by the Centre for Migration and Inclusive Development (CMID), an organisation based in Kerala, and Gram Vikas, a development organisation in Odisha, revealed that at least one out of three households had a history of migration for labour in the past 10 years, and that most of them were S.Cs or OBCs. Most of the migrants worked outside their own State for wages ranging from Rs.100 to Rs.200 a day in States such as Kerala, Tamil Nadu, Karnataka and Goa.
During the lockdown, the CMID tracked 95 migrants who were earlier included in a study, by phone, to determine where they were residing. The responses showed that in April 2020, about 54.6 per cent of this group had returned to their original villages after a long journey, mostly on foot. Most of them had arrived shortly after the lockdown, while some had returned during the early days of the pandemic in February. Others were still at their workplaces (35.8 per cent) and the rest (9.5 per cent) were not traceable. Most had heard about COVID-19, but were ignorant of the preventive measures to be taken or the symptoms of the infection.
Since the migrant labourers returned home, despite the fact that they could not afford travel by train or bus, there was greater pressure to earn a living in the villages.
In general, the study said, the government should have enhanced MGNREGA and other labour-related policies to increase the purchasing capacity of the poor. Unfortunately, in April 2020, only 20 per cent of the people who were provided work in 2019 were guaranteed to receive wages under MGNREGA. Some labourers received an enhanced payment, but the highest amount was only Rs.220 a day, which was not enough for a family. Work under MGNREGA is limited to 100 days a year per person in a family.
A migrant from an Uttar Pradesh village who was employed in Maharashtra and who was forced to return home explained that he had no option but to arrange for his travel back to his village. His employer did his best to support him financially in the first phase of 21 days of the lockdown, but could not do so later when the lockdown continued. In addition, it was next to impossible for him and other migrant workers living with him to maintain ‘social distancing’ and maintain ideal hygiene in their poor housing facilities. He said: “There was a great uncertainty about how long the lockdown would be in force, and survival in my city, without any monthly income flowing in, was too expensive.”
Also read: Education in the times of the pandemic
Drawing on the results of the situation in Odisha, the study determined that only about 20 per cent of migrants who planned to return to rural areas were able to sustain themselves. This fact shows the need for cash transfers to migrants who are stranded, as well as to those who are do not receive any other support, at least to survive the period of lack of work (estimated to be at least three months). The study said that tele-counselling, or providing long-distance information, could also be an important immediate solution.
Finally, the study noted, flexible loan systems and imparting skills training would offer migrants better livelihood options.
Children in low-economic contexts
Financial stability in the family is just one of the many factors that directly and indirectly affect children, but, as experts in this study emphasised, the COVID-19 pandemic magnified the importance of financial well-being in families.
According to the experts, children growing up in low-income contexts were badly affected by a diverse set of problems, which were not fully addressed even before the pandemic.
Experts in the study said that issues such as child labour, early marriage, malnutrition, trafficking and exposure to sex work, as well as domestic violence (physical, sexual and psychosocial abuse) were likely to worsen in the coming years. Besides, they said, inequality between children with access to education through the Internet and television and those who have to attend school was also likely to increase owing to the lockdown. According to the experts, it is important to realise that children will be better protected if their family is protected. Hence, they believe that measures such as economic revival, protection under labour laws, and cash transfers to vulnerable families should be given greater priority than ad-hoc support programmes for children.
An expert at a national institute said that children did not need psychological support right now. Their families needed economic support; if they could still not manage to take care of the children, then the families should be offered some sort of alternative option, such as temporarily sending their children to child care centres.
The expert added that existing schemes providing nutrition, such as ‘one meal a day’ and ‘pre-school feeding’, should not be discontinued but offered through means such as home delivery or supply of grains and other food supplies to families. According to the expert, the amounts should be sufficient and supplied consistently, which, according to the people interviewed for the study, were lacking.
Also read: COVID fuelled world hunger
Regarding policies and schemes that might work for children and adolescent girls, most experts were sceptical about the capacity and willingness of the government to improve the situation. They stressed that children would be better protected in the long term if social workers had the wherewithal to easily reach them and undertake careful risk assessments. According to them, there was a need to build infrastructure and train staff and decision-makers in child welfare committees in order to support families that were at risk of abusing their children in one form or another.
Refugee groups
Refugee groups and internally displaced people (IDPs) without legal permanent leave to remain in the country are regarded as a high-risk group amid the spreading pandemic. The experts in the study were mostly from Tamil Nadu and provided detailed information on how the situation had changed for refugee groups in the State, including Sri Lankan Tamils, Rohingyas, and Tibetan refugees. The problems mentioned earlier affected these groups too, but there were important differences between the degree of help these groups can receive from local governments and civic organisations. The experts thus raised particular concerns about refugees who were dispersed in the cities and were currently residing outside the designated camps.
Many refugees lost the option of earning a regular income for work done outside the camps; painting, for instance. Most painters were previously earning about Rs.1,000 a day, or Rs.15,000-20,000 a month, from painting houses and apartments, places of worship or offices. Now, they did not have these options and were dependent on what the government gave them.
The non-camp refugees were mostly self-employed, working as water-can suppliers, photographers, assistants in service apartments, brokers and real estate or matrimony agents, or were involved in informal work as painters, tailors, and so on. Except for their savings, they have no other form of social security. Most of these refugees live in urban areas in rented houses and send their children mostly to private schools.
Expert opinions
The expert opinions presented in this study, focusing mainly on the hardships experienced by migrant labourers following the pandemic and subsequent lockdowns, pointed to the general neglect of informal labourers that has prevailed in India for some time. The massive migration witnessed in India, with over 50 million people travelling back to their native villages, will continue to put an enormous strain on labour supply in urban areas, as well as a constraint on trade and production levels that are necessary to maintain the economy.
The experts consulted in this study said that the government’s measures to curtail the pandemic, without necessarily preparing the ground for those who would be deprived of their means to sustain their families, did not acknowledge the vital role that informal workers, including S.C.s, S.T.s and OBCs, play in sustaining the country’s economy. They said that the tendencies to ignore the poor as irrelevant revealed a chasm that already existed between the higher- and lower-income classes.
Indeed, as the data in this study also showed, the actions of the Central government, as well as the majority of State governments, were mostly concerned with curtailing the pandemic from a biomedical or evidence-based perspective, using various measures of control to keep the public from meeting each other by observing ‘social distancing’.
Informal workers and their families, already among the most disadvantaged before the pandemic, were the worst hit by the burden of ‘social distancing’. Refugee groups and IDPs became more vulnerable in the wake of ‘social distancing’ practices and lockdowns, as they were already living at subsistence level before COVID-19 and were barred from accessing aid facilities (see also UNHCR, 2020). In general, while COVID-19 is often referred to as the ‘great leveller’, the experience of ‘social distancing’ in India showed that existing inequalities due to historically practised ‘vertical distancing’ were exacerbated as a result of ‘neutral’ social distancing measures (Gopalan & Misra, 2020).
Other scholars have put forward, as a partial solution, the concept of a universal minimum income in India (e.g. Pulla et al., 2020), which might be not be feasible for a country with a high number of poor people and rapidly growing economic problems (Shah & Jani, 2019).
Also read: Migrant workers marooned in cities
The participants in this study most often suggested the need to make an effort to acknowledge the interdependence of people of all income levels in India, and to rediscover, strengthen and leverage the way people rely on each other for their existence (particularly during a pandemic). Such ideas have also been argued in relation to the SDG [Sustainable Development Goals] agenda (see, for example, Filho et al, 2020) and global health systems (Shamasunder, Holmes & Goronga et al, 2020). The latter suggests that a new paradigm of global health should be imagined, guided by real collaboration, solidarity and equity. Similarly, several scholars and others have argued that the term ‘social distancing’ should be replaced by ‘physical distancing’, allowing for “solidarity, responsibility and cooperation, as well as social closeness” (Kumar, 2020).
According to the study, it has been demonstrated that social distancing, lockdown and curfews prevented people from helping their neighbours. It went on to state that activists, students and families should be allowed to support those in need in every way possible. It also said that innovative means should be established to monitor support given to those who are isolated, as being socially connected helps in times of crisis (including by providing food, groceries, transport, emotional support, and, as mentioned by one of the experts, information and decision-making power).
The study also said that the government can take a cue from the experience of mobile health services and other services provided through mobile applications and networks and explore opportunities to help the public, as most people, including the poor, have a mobile phone, or access to one.
The study was conducted by Prof. Joe Thomas and Nupur Kulkarni from WPU-MIT, Pune; Prof. Joske G.F. Bunders-Aelen and Emma Emily de Wit E.E. from Athena Institute, VU University, Amsterdam; and R.K. Radhakrishnan, Associate Editor, Frontline, and PhD candidate, VU University, Amsterdam. It can be accessed at: https://www.emerald.com/insight/content/doi/10.1108/EDI-09-2020-0264/full/pdf?title=mitigating-the-covid-19-pandemic-in-india-an-in-depth-exploration-of-challenges-and-opportunities-for-three-vulnerable-population-groups.
References
Filho, W., Brandli, L.L., Lange Salvia, A., Rayman-Bacchus, L. and Platje, J. (2020), “COVID-19 and the UN sustainable development goals: threat to solidarity or an opportunity?”, ‘Sustainability’, Vol. 12 No. 13, page 5,343
Gopalan, H.S. and Misra, A. (2020), “COVID-19 pandemic and challenges for socio-economic issues, healthcare and national programs in India”, ‘Diabetes and Metabolic Syndrome: Clinical Research and Reviews’, Vol. 14 No. 5, pages 757-759
Pulla, P. (2020), “Covid-19: India imposes lockdown for 21 days and cases rise”, BMJ, Vol. 368, m1251
Kumar, K., Mehra, A., Sahoo, S., Nehra, R. and Grover, S. (2020), “The psychological impact of COVID19 pandemic and lockdown on the migrant workers: a cross-sectional survey”, ‘The Asian Journal of Psychiatry’, Vol. 53, 102252, doi: 10.1016/j.ajp.2020.102252
Shah, K.K. and Jani, D.G. (2019), “A preliminary survey of the theoretical and practical aspects of UBI and assessing its feasibility in the context of the Indian economy”, ‘Arthshastra Indian Journal of Economics and Research’, Vol. 8 No. 4, pages 47-55
Shamasunder, S., Holmes, S.M., Goronga, T., Carrasco, H., Katz, E., Frankfurter, R. and Keshavjee, S. (2020), “COVID-19 reveals weak health systems by design: why we must re-make global health in this historic moment”, ‘Global Public Health’, Vol. 15 No. 7, pages 1-7
UNHCR (2020), IOM, UNHCR Announce Temporary Suspension of Resettlement Travel for Refugees, available at: https://www.unhcr.org/news/press/2020/3/5e7103034/iom-unhcr-announcetemporary-suspension-resettlement-travel-refugees.html
