The development sector in India has always been at the forefront during any disaster. True to their calling, many NGOs have proactively responded to the Covid 19 pandemic. From providing medical supplies to food distribution for health workers, migrant populations, daily wage workers and the underprivileged who have been abruptly impacted by the lockdown, the sector has found ways to support the communities that can affect or are affected by the situation. However, given the fact that this is a medical disaster of unforeseen proportions, and with challenges and demands for intervention emerging as the disease spreads its grip on communities, interventions at present must focus on the immediate phase of this disaster. Fronting this mammoth challenge are our public healthcare workers many of whom would expectedly be overwhelmed by this medical challenge, facing something like this for the first time.
 

Protecting health care workers and workers in health care settings: These are two different set of workers at a hospital. Health care workers include Doctors, Nurses and other medical staff. Whereas workers in healthcare setting include the ancillary and support staff such as canteen staff, waste management, maintenance, security staff etc. Nonprofit organisations, foundations and trusts have quickly come forward to help provide medical supplies such as Personal Protective Equipment kit, sanitizers, gloves etc. for frontline health workers. This is the basic but most critical intervention that directly impacts the health of the workers.  It also often gets compounded by the market supply capacity being overwhelmed. 

Of equal importance is the necessity to equip workers in health care settings with appropriate education on handling a highly infectious disease, keeping in mind that many of them have never experience such a situation. In many hospitals, the sudden need to divert most of the staff towards preparing isolation wards and gearing up for inflow of patients has meant very little time available to focus on upgrading skills and knowledge on Covid 19 protocols, do’s and don’ts etc.  For example, a security guard at a hospital is the first person who comes in contact with visitors of the hospital and needs to know what precautions he/she needs to take along with adequate information on the steps to be followed from the time the Covid suspect patients approaches the hospital, directions to be given, and managing persons accompanying the patient.  During such briefing sessions with support staff, we have found them to raise very basic yet pertinent queries on Covid19 and its care protocol, and the realization that providing correct answers goes a long way in empowering these workers Importantly, these workers also need to be equipped with protective gears. Hence, the efforts should be to support them in all manner possible.  

Infection Prevention Control (IPC) measures: IPC is essential to stop transmission and contain an outbreak. These are largely medical measures and processes in a hospital.  Not all organisation may have the wherewithal or expertise to undertake this. However, it will be pertinent to mobilise the doctors within the hospitals or from outside to do this. There may be cross infection in hospitals caring for patients with infectious diseases, and hence it is important to ensure that the entire staff in the hospital is equipped materially and knowledge wise to undertake IPC measures. An activity as simple as helping in putting up posters on hand hygiene steps at strategic location in and around the hospital can go a long way in reinforcing lifesaving messages. These are simple, economical interventions that can help in arresting the spread of infection in a hospital setting. 

Community health workers and workers engaged in essential services: While the medical interventions for Covid 19 patients take place in hospitals, the community health workers have been tasked with undertaking ‘contact tracing’ to identify and screen people who would have possibly come in contact with positive patients or suspects. This is a mammoth task given our population density and diversity.  A list of people is charted out who need to be contacted, screen and mobilised for further medical investigation. These interventions are undertaken in communities and are rigorous in nature and require social mobilisation skills and remarkable patience. This puts these frontline community workers at risk of infections.  Equipping them with both materials and knowledge is an emergent need.  Adequate attention is required for this intervention as it helps in arresting the community spread of this disease which will be a key battle in the fight against Covid 19. 

Equally important are workers, who are engaged in provision of essential commodities and services as such waste management workers, transporters, grocery shop owners etc. Police and traffic personnel should also be equipped. 

Risk Communication related to Covid 19: Risk Communication is a two-way loop with the affected population and responders to ensure that communication and messaging is getting to the people that need it in a way they need to hear it. Hence, the messages in media for general public may need to be contextualized or localized without altering the core messaging or changing facts. E.g. Messages for respiratory etiquette may need to be customised depending on the target audience.  These groups can be general public, health care workers, patients, relatives of the patients, vulnerable groups such as migrant workers, people living with diseases, differently abled, and children with special needs.  This is where NGOs can play a pivotal role in changing health behaviour and health seeking behaviour of the beneficiary groups all the while ensuring these messages reach them in a manner they understand and can relate to. Mass messaging for general public or media announcements are often not sufficient or tailored to communities at high risk or the vulnerable groups that the social sector organisations engages with on a daily basis.

Community engagement and behaviour change: 

This crisis has also highlighted how healthcare and hygiene practices are critical irrespective of the cause an organisation works for, and how messages on improving health and hygiene practices should be integrated in campaigns in the best manner possible. Health indicators affect all other aspects of life and this can’t be overlooked.  Teaching seven steps of hand washing in a vocational training centres or during SHG meeting is as critical as telling children how to follow these steps. 

Precautions in the field: 

Many organisations are now involved in provision of food and distribution of medical supplies directly. In such a situation it becomes extremely important to follow steps to ensure large gathering do not take place. Staggered distribution while maintaining adequate physical distance, ensuring hand hygiene practices and promoting and maintaining respiratory etiquettes must be insisted upon during such interventions all the time ensuring that the staff engaged in such activities are themselves well protected and are aware of the dos and don’ts involved during such activities. 

This list is not exhaustive in nature and more learning will evolve with time and on ground experiences. Covid 19 pandemic will also require midterm and long term interventions in terms of livelihood restoration, strengthening health care systems, continued medical education for health care workers etc. will become relevant as we progress.