Maharashtra continues to reside in its rural areas. In the wake of the pandemic, protecting lives and health therein is the need of the hour. As a new wave of Covid spreads throughout Maharashtra, the millions residing in the rural and semi-rural parts of the state are bearing an increasing burden of the pandemic-led devastation. Unless policymakers act decisively in the coming months, the impact on lives and livelihoods in rural Maharashtra will be severely impacted. Addressing rural healthcare challenges requires a multidimensional approach – policymakers need to consider not just healthcare delivery, but also the broader socioeconomic determinants of health to transform healthcare in the hinterland.
At the beginning of the pandemic, cases and deaths were largely concentrated in metropolitan areas. However, as Covid progressed, and the migration of workers began to their villages, even rural areas were no longer exempt from the pandemic’s debilitating effects. Maharashtra has strong urban-rural linkages, and so it is all the more necessary to take special precautions.
As expected, highly diverse rural communities have witnessed more deaths per capital than their relatively homogenous counterparts. In India, Covid has spread from the urban to the rural areas, with older adults and those with underlying medical conditions facing increasing risk for developing symptoms. With a large chunk of the relatively healthier and younger working-age population having migrated to urban areas, rural areas have now become particularly vulnerable to the spread of Covid.
Health and socioeconomic disparities are interrelated, and associated with a heightened likelihood of contracting Covid. Given social distancing requirements, the likelihood of infection is greater in communities facing housing issues – which largely includes the economically marginalized. Food and nutrition security in many rural areas is compromised, and that is a key factor affecting the development of the immunity required to fight Covid. Compounding socioeconomic vulnerability with rural deprivation results in even higher incidence of these risk factors.
While rural hospitals are not currently experiencing the dangerously high occupancy rates reported by urban hospitals, prevention is better than cure. The development of healthcare infrastructure in rural areas needs to be given top policy priority, as should the delivery of vaccines to frontline healthcare workers therein. Rural areas have a greater share of certain high-risk populations, but face more structural and social barriers impacting vaccine distribution and adoption.
Covid has spurred the broad and rapid adoption of telemedicine in urban areas, but the hinterland tells another story. This gapis attributable to infrastructural challenges as well as individual behaviours and preferences. The government needs to convince dissenting voices in rural areas, that all the Covid-induced changes are necessary for their own long-term benefit. Ultimately, policymakers will need to balance near-term objectives with long-term steps to transform the rural healthcare system. Maharashtra, in particular, needs to act decisively on this front.