Rajannapet village is India’s first 100 percent COVID 19-resilient village. This sleepy, blink-and-miss village is as devoid of basic health care as any you would find in India. Yet, the whistle-stop hamlet, located some 147 kilometres north-east of Hyderabad in Rajanna Sircilla district of Telangana, successfully turned the tide of COVID-19. It achieved the distinction thanks to Project Madad, a unique partnership involving the coming together of the local communities, the Panchayati Raj Institutions, a group of concerned diaspora and the state government.
On 31 July, Rajannapet achieved the unthinkable COVID-resilience status with first dose vaccination of 1,328 eligible adults in a marathon four-day campaign following a concerted weeks-long effort. In the run up to the full vaccination result, the project primed the Gram Panchayat-led volunteer force of rural healthcare workers, many of them village volunteers of the Mahila Sangam — the local-level women’s thrift and skills collective — keen to counter the COVID-19 misinformation and raise vaccine acceptance among the villagers. As the second wave of the pandemic raged across rural Telangana, lives needed to be saved in places where people stood no hope in hell to be connected to quality health services in real time. The mission demanded no less.
New York-based Raja Karthikeya, a peacekeeping specialist with the United Nations is the galvanizer-in-chief at Project Madad. Early on in May 2021, distressed by the news of rapidly escalating COVID-19 infections back home, Karthikeya set out to make a difference even if it was to be in just a handful of the most underserved parts of Telangana, his home State.
He knew that while help would somehow reach the urban settings thanks to the intensive media spotlight on the pandemic, the virus would quickly eat into parts of the countryside that have languished in chronic development and media neglect. Fast-tracking knowledge of the simple yet globally-proven COVID-19 best practices through the rural healthcare delivery system, for years in deep decline, was the key.
Karthikeya lost no time in mobilizing a team of diaspora doctors in the US — many of them his school and college buddies and fellow alumni from Nizam College, Hyderabad — who had excelled abroad in the pandemic response. Other non-medic volunteers were similarly fired with the desire to respond meaningfully to stem the vicious second wave of Covid in the rural outbacks of their home state. From India, there was Balram Reddy, Raghu Nandan, Hameed Patel, Kaivalya Rayaprolu, Devishobha Chandramouli and Vaibhav Jain. The group was led by Dr Subbarao Inampudi. Things had to be arranged and put in motion. Each one of the team-mates had to be briefed and galvanized in real time, in a way that they gave their all from the word go. With the team in place, Raja wrote to the state Chief Minister, K Chandrashekar Rao, offering the services of the diaspora doctors in building local-level awareness about Covid-appropriate behaviour and seeking the mandatory approval to help government efforts by conducting a door-to-door surveillance and vaccination drive. This was followed up with calls to S Narsing Rao, Principal Secretary to the CM and other officials in the CM’s Office. To flag off the initiative, it was agreed to pick a village in Rajanna Sircilla district where a cluster of villages had been adopted for intensive development support by the dynamic IT minister of the State, K T Rama Rao, son of the state CM and widely billed to be the heir to the throne in Telangana.
A key strategy involved empowerment and education of rural healthcare workers on Covid-friendly precautions to be propagated in the village. The team got down to business, losing no time in touching base with a handful of Registered Medical Practitioners (RMPs) in some of the rural areas of the state. The RMPs, though unrecognized in the bureaucratic scheme of things, play a pivotal role in being the frontline responders during health emergencies. Dispensing basic treatment to the villagers, especially in the backdrop of a system chronically deficient in genuine medical professionals in rural areas.
After multiple sessions with the RMPs and district health officials, the doctors knew exactly where the gaps lay in the pandemic response. Once the initial assessment of the COVID-19 situation in Rajannapet was completed, the interaction was escalated to include, initially, two doctors from the neighbouring Karimnagar district, to validate the assessment and to have them included as part of the grounds-up response.
A comprehensive eight-week training programme was rolled out for health workers and village-level volunteers drafted for undertaking household surveys and awareness building. In the process, the training lent new energy to the stagnant Village Health Committee led by the Sarpanch, the Panchayat ward members, registered health workers, ASHA workers, ANMs and other volunteers. To ensure that no one was left behind, the project made sure that this forum, called the Covid Crisis Team, represented the caste calculus of the village.
Getting your hands dirty in the caste-riven politics of the countryside would not be easy. In the predominantly Dalit village of Rajannapet, M Shankar the village Sarpanch became the key conduit in putting together a multi-disciplinary team, making sure women in sufficient numbers were included as part of the capacity enhancement and outreach initiative.
Lakshmi Namilikunda, 41, says since she became a part of the response team, not only has she learnt all that needed to be learnt about how to deal with COVID-19, she has become more aware about the development vision of the village. “I now know, the government has endeavoured to bring water to every home. We never thought this would be possible during our lifetime”.
Most women members of the COVID Crisis Team are bidi workers, earning a daily wage of 160 rupees. Padma, 38, a resident of the sprawling Dalit settlement in the village is doubly accursed. Married off at 15 to Venkateshwaran, an auto-rickshaw driver, Padma was homeless from the day she set foot on her in-laws’ place. Her father-in-law was thrown out from their ancestral house by his brother following a dispute, with a compensation of 50,000 rupees.
With Shankar, the village Sarpanch, I visited Padma and her mother in-law in their sparse but spotless hutment. Grief writ all over their ragged faces, the two women first showed me the garlanded pictures of Padma’s two children. Jaundice snatched away her daughter, Sirisa, when she was just five.
Her 16-year-old-son, Sivakrishna, on whom rested the mantle of family expectations was shaping into a fine young lad, adept at sports and martial arts. At the height of the COVID second wave, the boy one day complained of a sharp abdominal pain followed by an unbearable feeling of heartburn. With only an RMP at hand by way of medical help, it seemed like an uphill battle to get the young boy the medical attention he needed without any delay. Sensing the seriousness of the case, the RMP advised the hapless parents to admit the boy in the private Ashwani hospital in Yellareddypet village, eight kilometres away. Siva died on the way to the hospital.
Having lost both her precious children and neither a roof over her head nor any land to her name, Padma did not even qualify to receive the ex-gratia relief of 5,000 rupees that the Government of Telangana had advanced to below-the-poverty-line families that own small farm holdings that could not be cultivated because of the pandemic-related lockdown restrictions.
When life deals you a series of curve balls, you either keel under or rise with resolve to defeat adversity the best you can. Not the one to waste her life in self-pity, Padma dealt with grief with uncommon strength and forbearance. When COVID ran through the village, Padma took on the role of the team clerk in the COVID Response Team, keeping other women volunteers on toes and making sure each house in the village was surveyed for infections and vaccination.
Padma took on the task of conducting house-to-house surveys of 120 families. From morning until 10 pm in the night, over three days from 22 to 24 July, she was part of the ten teams deployed by Project Madad to conduct the village-wide outreach involving all 423 households. No payment was made to the survey teams. “My service for my village”, was the slogan and spirit embraced by the volunteers.
Chiranjeevi, the Mandal Panchayat Development Officer tells me that he was the first in the block office to take the vaccine in February 2021. This rid the entire local bureaucracy of the fear and hesitancy of the vaccine.
Rajannapet recorded just two COVID-19 deaths. Back in April 2021, at the height of the second wave, over a 3-hour session, doctors in the US briefed a few hundred workers about the causes of the spread of COVID and the benefits of known precautions including hand hygiene, masking, social distancing, and, above all, vaccination. These sessions were repeated every Saturday for four weeks.
Simultaneously, a gate was erected and manned at the village entrance where every visitor would be tested with a self-testing kit. Meanwhile, the ASHA workers and ANM workers had tested the entire village by the end of May 2021. A total of 20 cases were found to be Corona-positive. These cases were put under strict home quarantine. Nearly 20 migrant villagers, with a particular focus on those living in one-room accommodation, were sent to special isolation centres set up at the district headquarters for 15 days.
The teams collected data on the total number of members in each family and how many family members were vaccinated, and how many eligible members still needed to be vaccinated. Making use of simple, science-based charts in their own vernacular language the teams empowered the village folk with new COVID data and information with a view to help the villagers overcome their hesitancy towards the vaccine.
“I would tell the undecided family members that ‘Look, I got vaccinated some time ago and am totally fine.’ I would ask them, ‘What are you waiting for? Why are you afraid?” Padma says she even motivated her aged mother-in-law to vaccinate. This motivated other older women in her neighbourhood to come forward for vaccination.
The village-wide vaccination drive was completed from 25th July to 31st July. Earlier, during the months of May and June, the Gram Panchayat received supplies such as face masks, sanitizers, Corona self-testing kits and pulse oximeters. The supplies were placed in multiple points of public contact such as schools, Mahila Sangham office, the village health centre, Anganwadi Centres and the Panchayat office.
Rajannapet has other firsts to its credit. It is the first village in the entire district to be declared Open Defecation Free (ODF); a frontline water conservation village where an elaborate water harvesting system has been put in place so that wastewater is being conserved to increase the water table; the first village that went 100 percent cashless during the demonetization drive. It is the first village to have 100 percent electricity and 100 percent LED lights in use. Back in 2018, the Gram Panchayat was the recipient of a Rupees 10 Lakh (a ‘Lakh’ is a hundred thousand) award for best performance in Swacch Bharat Abhiyan (the Central government’s drive to clean up the country) and the implementation of the National Rural Employment Guarantee Scheme (NREGS). It is hardly surprising then that the village came up tops in COVID response as well.
Gasikanta Ravi, 26, decided to work as a social worker after completing a Masters Degree in Pharmacy from Osmania University, and working for a while with Aurobindo Pharma, a private sector pharmaceuticals manufacturing company. He is the nodal officer for Rajannapet. In forsaking a thriving career as a drug inspector, he was inspired by the need to contribute talent and skills to the capacity-starved rural parts of his home state.
Ravi says that before Project Madad came to Rajannapet, there were more COVID cases here than in the adjoining villages. Ravi was earlier posted in Gola Palli village, a relatively large-sized village compared to Rajannapet. He says what marks out Rajannapet is its hands-on Panchayat leadership that has enabled cooperation from the word go. “Even though people are financially well-off in Gola Palli, there is no appetite for external advice,” he says. “It takes a dynamic Sarpanch to own and run with innovative interventions and to create an eco-system for coordination across multiple agencies active at the village level.” Ravi believes that the adoption of Rajannapet as a model village by a politician as influential as KTR has also been a decisive factor in giving the village its high-profile success.
Vichidi Kishen Reddy, 68, a retired Postmaster from the adjoining Almaspur village who has been following the COVID intervention project closely says even as the COVID situation was getting under control in Rajannapet, his village was full of rumours about the perceived negative effects of the vaccine. “Most people in Almaspur thought they would either die or be paralysed. No wonder very few in the village came forward to receive vaccination”, Reddy tells me. Even the supplies were hardly adequate for a village of over 500 homesteads.
A beaming Shankar, the village Sarpanch of Rajannapet, himself a Dalit from the Madiga caste, says the door-to-door education will continue until COVID ends. Even today, the COVID Crisis Team members continue to fan out among the households to keep a tight vigil and notice any changes in the household disease profiles. They report to the Sarpanch about the state of wellness in the village, reporting even mild symptoms and updating the COVID situation based on self-testing kit reports.
The COVID-19 pandemic which has disrupted the lives of billions of people worldwide, overwhelmed both healthcare systems and development spending and hit the global economy hard can only be bested by a sustained preventive effort. The Rajannapet experience illustrates the definitive and quantifiable virtues of a public-private-community partnership for India’s stagnant development landscape in the chronically under-governed remote, rural and disadvantaged parts of the urban and peri-urban landscape. Project Madad opens the door to a cohesive, conjoined and coordinated development model that goes well beyond addressing the COVID-19 major public health catastrophe in a chronically under-served rural setting. Policy wonks in NitiAayog would do well to take notice.
(The writer is an aid worker, UN communications expert and author of “Humans on the Run – of exiles and asylum”. He is a contributor to Cuckoo News. Views expressed in this article are the author’s own and do not necessarily reflect the views of www.cuckoo-news.com).