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Covid On Site Capacity Building

Response to COVID-19

Supporting government in effectively managing the COVID-19 response in India's villages

Why

COVID-19 poses the risk of a potential rural epidemic, due to a distinct set of complexities that face rural India. The government needs active support to effectively implement its COVID-19 response across villages

What

Capacity building for frontline workers, bridging critical supply gaps, mobilising communities for COVID vaccinations, ensuring continuity of critical maternal and child health services

Where

Madhya Pradesh

2021 COVID-update

OUR RESPONSE TO COVID-19 | May 2021

The sheer scale and speed of the COVID surge spreading across India has left us all heartbroken. The government is making valiant efforts to tackle the issue, but much support is required in terms of strengthening health facilities, training frontline health workers, ensuring sufficient safety gear, fulfilling medical supplies, ramping up vaccination drives, and so on.

Building an effective system response to COVID-19 in rural India is critical; ignoring India’s villages could build up an invisible COVID surge, that will come back to hurt everyone. Because, in a connected world, we are only as strong as our weakest link.

Since the start of the pandemic in March 2020, Antara Foundation has supported government’s COVID-response on various fronts. In 2020 alone, we extended our capacity building efforts to COVID-management, covering ~2 million people in ~2,000 villages through a community of ~2,600 frontline workers, and provided on-site support at health facilities. We adapted our interventions to ensure improved identification and tracking of high-risk COVID populations (e.g., elderly people, pregnant women, people with co-morbidities). We helped government with monitoring and supervision of the response efforts. Additionally, we worked on ways to ensure continuity of critical maternal and child health services.

In the next 6-12 months, even as India rolls out an ambitious vaccination program, rural areas will continue to see the fallout of the COVID surge. In the next few weeks, our work will cover 40,000 frontline workers and health staff, serving more than 10 million people in 6,800 villages across five districts in Madhya Pradesh. We will work on three key initiatives:

  1. Bridge supply gaps for health workers and facilities – PPE, thermometers, oximeters, batteries and other critical supplies
  2. Build frontline workers' capacity – on COVID-19 screening, prevention, counselling and vaccination, through virtual training sessions, on-site handholding and remote support
  3. Mobilize community demand for vaccination – create and distribute informational materials, recruit local changemakers in key gram panchayats to address vaccine hesitancy

In the coming weeks, we will learn and adapt. Future efforts may include expansion to more districts, supporting COVID testing, emergency care kits for high-risk pregnant women and children, and more local partnerships. We want our COVID support to have meaningful and lasting impact on overall health systems strengthening, i.e., to equip the public health system to deliver quality health services sustainably, and not to create a parallel system or stopgap measures alone.

Covid Box

More than 780,000 units of supplies have been distributed so far to 34,000+ health staff, covering 6,800 villages and 12,700 health facilities (as at Sep 2021)

Learn more about our previously carried out COVID-response initiatives, below

AAA Platform for COVID-19

Intervention Summary: Three frontline workers deliver maternal and child health services in each village – the ANM (a nurse-midwife), the ASHA (community mobiliser) and the Anganwadi worker (nutrition overseer) – together referred as the AAA. Each of the AAA has distinct but related roles, and they serve the same beneficiaries. However, all too often, they do not collaborate enough. The AAA platform solves this through three key activities – creation of village maps, micro-planning, and regular review meetings.

Our conversations with frontline workers and district administrations revealed a need for greater data-sharing and collaboration for various COVID-19 related tasks they are carrying out. We adapted the solution to identify, monitor and timely manage individuals and households at greatest risk of contracting and carrying COVID-19 (e.g., infants, pregnant women, migrants, elders, people with co-morbidities).

Covid Gif 2

Using village maps to mark high-risk COVID-19 individuals, and identify high-risk zones in the village

The AAA mark households with various high-risk codes for COVID-19 (e.g., M-In for migrants who have returned to the village, 3D for women in their final trimester of pregnancy, 60+ for the elderly population), and collaboratively plan targeted efforts for these groups.

Example: AAA Platform for COVID

Using AAA Platform to manage 3rd trimester pregnant women during COVID-19

Pregnant women in their final trimesters require special counselling and monitoring in the COVID-19 context, to prepare them for a safe institutional delivery. It is essential to plan, well in advance about the nearest suitable health facility as per the risk-status of pregnancy and whether the woman has COVID-19 symptoms. Assigning a COVID hospital to an asymptomatic pregnant woman and vice versa can be disastrous for both the mother and child, as well as other patients in the facility.

The AAA platform enables collaborative identification and monitoring of final trimester women for COVID-19 symptoms, planning regular visits, ensuring proper counselling and preparing logistics for delivery at the appropriate institution.Using the village map, the AAA can also track COVID-positive individuals around the pregnant women’s houses, and advise them to take necessary precautions.

Such joint action using the AAA platform’s simple innovations can save lives of numerous mothers and newborns.

Maternal and child health

The nationwide lockdown, while crucial to contain the pandemic, severely impacted critical maternal and child health services, resulting in a huge backlog of pending routine immunisations of children, ante-natal check-ups of pregnant women, growth monitoring of children, and others. Omission of such services carries the potential to severely affect metrics such as infant mortality, maternal mortality and malnutrition levels among children – issues that India has already been grappling for years.

We worked towards ensuring full resumption of all maternal and child health services in our intervention geographies, taking utmost care in following the COVID-19 safety protocols. Most of these health services are primarily delivered through monthly Village Health and Nutrition Days (VHND) in each village in rural India. VHNDs are led by the ANM (who typically manages four to five villages), supported by the village’s ASHA and Anganwadi Worker. Our work ensured proper VHNDs happen across villages through two key initiatives -

VHND checklist

We created a comprehensive checklist of essential processes and practices for conducting a VHND to ensure safety of frontline workers and beneficiaries. The checklist is used by frontline workers and government supervisors, and ensures safe VHNDs by checking for site-preparation (e.g., handwashing facilities, ventilation, social distancing measures), correct practices being followed during the session (e.g., use of masks, staggered presence of beneficiaries), availability of COVID-19 related supplies (e.g., thermometers, oximeters, awareness material), and so on. In one of the districts we work in, the checklist was officially issued by the district administration, and was scaled even in geographical areas we don’t have direct presence in.

Vhnd Checklist Extract

Extract from our VHND checklist

On-site capacity building

Our program officers conduct site visits to different villages on VHNDs. We used these visits to handhold frontline workers in ensuring proper site-preparation and practising COVID-19 protocols – for example maintaining social distancing, appropriate use of masks, hand-washing, staggered presence of beneficiaries, etc. We also guided them in planning additional efforts to cover beneficiaries missed during the lockdown.

Covid On Site Capacity Building

On-site capacity building of frontline health workers by our program team on proper conduction of Village Health and Nutrition Days during COVID-19

  • Vhnd 1
  • Vhnd 2
  • Vhnd 3
  • Vhnd 4

More photos from Village Health and Nutrition Days from our program geographies

COVID-19 capacity building

Frontline health workers have been tasked with critical COVID-19 work such as – spreading awareness on prevention and control, identifying potential cases, addressing misconception and stigma, supporting contact tracing and quarantine implementation. The success of the government’s COVID-19 efforts hinges largely on frontline workers’ capabilities to perform these tasks well. However, given the novelty of the virus, ensuring timely and adequate knowledge is a challenge.

Our field observations highlighted several areas that require focused attention. We trained different cadres of health workers through virtual meetings to mitigate the knowledge and skill gaps, focussing on the priority areas identified. We also handholded frontline workers in person during site visits by our program team members.

Covid 19 Capacity Building

Snapshot of a virtual capacity building training of frontline health workers on COVID-19, being conducted by the Antara Foundation program team

Key topics covered by us in the trainings include –

  • Understanding the symptoms of the virus
  • Prevention and control of the virus
  • Special care required for high-risk groups (e.g., elderly, pregnant women)
  • Management of symptomatic cases; contact tracing process
  • Protocols for home quarantine
  • Tackling stigma associated with the virus, including myths and misconceptions
  • Correct detection procedures – temperature measurement using infra-red thermometers, and oxygen saturation measurement through pulse oximeters
  • Frontline worker safety protocols while handling suspected cases

Example: Capacity building on tackling stigma

Supporting government in filling critical knowledge gaps of frontline workers on tackling stigma

Myths and misconceptions about COVID-19 often lead to stigma against affected patients, health workers, migrant workers, and so on. Marking households with quarantined patients can also have social stigma attached to it. This leads to cases being concealed, reported late, and makes response efforts more difficult. We trained frontline workers on the right ways to manage stigma in the populations they work in – for example, avoiding usage of terms like “suspected case” or “victims”, sensitising people correctly, and so on.

Monitoring and supervision

Robust monitoring and reporting of data are critical for effective planning and implementation of the COVID-19 response. We supported district authorities in creating comprehensive and easy to use monitoring formats for different COVID-19 response activities. Below are two examples:

Migrant tracker

We incorporated a migrant tracking format as part of the new ASHA diary (designed through TAF support, and scaled across Madhya Pradesh). In some areas where we work, we supported district administrations in enhancing their migration tracking formats.

Screening format

We supported district administrations in Madhya Pradesh by creating monitoring formats for frontline workers for the 15-day “Kill Corona” campaign launched across the state in July 2020. The campaign involved active fever screening across the district, and appropriate management of symptomatic cases.