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Insights into Editorial: How to stall COVID’s march in rural India


Rural population in India:

According to the Census of India, rural populations are comparatively older, placing them at a higher risk of contracting the COVID-19 infection.

They also live much farther from hospitals than their urban or suburban counterparts and a majority of them list access to good medical care as a major community problem.

As the current pandemic has stretched an already overburdened medical infrastructure, other healthcare services such as reproductive and child health, healthcare for the elderly and other curative services have taken a backseat.


The country-wide lockdown imposed by Prime Minister Narendra Modi from March 25, 2020, impaired the lives of many urban migrants who lost their jobs overnight.

With all modes of public transport being suspended, urban migrants had no choice but to walk on foot to their native places. Journalists, called it a “gigantic movement in Indian history.”

After many cities lurched under its calamitous impact, the novel coronavirus has unearthed a new hunting ground in rural areas.

With several migrants returning to their native places, there has been a trend reversal.

The rural areas of many districts are now reporting an upsurge in the number of confirmed cases of novel coronavirus disease (COVID-19).

The World Health Organization’s chief scientist, has also expressed her concern, stating that rural India is the next coronavirus hotbed.

Highest influx of migrants directly related to heavy spike in the number of cases:

Uttar Pradesh, West Bengal, Madhya Pradesh, Bihar, Assam, Odisha and Jharkhand, that are now witnessing a heavy spike in the number of cases, are the states that have received the highest influx of migrants.

The rural areas of Rajasthan and Karnataka have also started to record an escalation in the number of cases.

Nearly 6.7 million migrants returned to 116 districts in six states from urban centres, according to preliminary data compiled by the Union Ministry of Skill Development and Entrepreneurship.

Of them, about 4.4 million or two-thirds returned to 53 districts. Bihar topped the six states, with 2.36 million migrants returning to 32 districts, followed by Uttar Pradesh, with 1.748 million returning to 31 districts.

Dismal rural healthcare infrastructure:

  1. The public healthcare infrastructure is dismal in rural India, characterised by a chronic shortage of medical professionals including doctors, nursing staff, paramedics as well as hospital beds and equipment.
  2. The COVID-19 pandemic presents a special challenge due to inadequate testing and isolation facilities in rural India.
  3. Moreover, there are high levels of non-communicable diseases (for instance diabetes, hypertension, etc), infectious diseases (tuberculosis, diarrhoea, etc) and malnutrition in rural areas.
  4. Healthcare services are quite distant for many villages in several districts, especially remote ones.
  5. This is coupled with a lack of transportation in rugged terrains that may exclude many from seeking timely COVID-19 testing and treatment.

Solution: Strengthening the National Rural Health Mission:

  1. Launched in 2005, the NRHM, now the part of National Health Mission, seeks to provide effective health care to the rural population by strengthening public health systems for efficient service delivery.
  2. It seeks to provide effective health care to vulnerable population groups in rural areas by improving access, enabling community ownership and demand for services.
  3. The pandemic presents an opportunity to realise the true potential of the existing National Rural Health Mission (NRHM) and its associated budget allocation.
  4. Expedient efforts for effective management of COVID-19 in rural India should be done under the broad umbrella of NRHM.
  5. These efforts should be done in a strategic manner so as to strengthen health infrastructure and service delivery mechanism in the process.
  6. Since more than 12 percent of India’s rural population accessed PHCs or outreach health service delivery points, there is a need to rapidly develop a robust referral system from PHCs to CHCs / rural hospitals and the nearest COVID-19 testing and treatment facilities.
  7. The strategy may include clustering and increased coordination among four-five CHCs / rural hospitals accessible by road to strengthen testing outreach, with one of them being the COVID-19 RT-PCR testing node.
  8. Arrangements of RT-PCR testing kits, reagents and associated equipment for such CHCs identified for the purpose will be in interest of better management of COVID-19 in rural areas.
  9. Training of health personnel in CHCs needs to be provided at the nearest COVID testing centres.
  10. The rural population will greatly benefit if a vehicle from the nodal COVID-19 CHCs could visit the two nearby CHCs on one route for pre-defined timings on fixed days of the week to collect samples for RT-PCR tests.
  11. On alternate days, the vehicle could cover the other one or two CHCs. There needs to be coordination and a referral and COVID-19 reporting mechanism in place between PHCs and CHCs about the testing day and time so that contacts of confirmed cases and suspected COVID-19 cases can be referred efficiently.

Way Forward: Decentralised governance:

A holistic approach needs to be adopted by the administration if the spread of coronavirus to rural areas has to be curtailed.

Pre-planning and a decentralised administration, with effective decision-making and implementation powers placed in the hands of the Panchayats is necessary.

The Gram Panchayats should be equipped with measures for handling breakouts. Quarantine centres need to established and managed efficiently, private and local doctors should be trained for COVID-19 handling and management.

Adequate measures should also be in place to ensure that there is no stigma and discrimination against COVID-19 patients or their families.

Awareness campaigns should be organised to increase awareness regarding self-care and sanitation facilities.



A recent study by the Massachusetts Institute of Technology warns that India might be the worst-affected nation by coronavirus by the end of winter of 2021, with nearly 0.287 million cases surfacing every day in the country.

If the cases keep increasing at the current rate and the spread of the infection to the rural areas is not kept in check, the above-mentioned forecasting might prove itself true and this could prove disastrous for India and its already-stretched healthcare system.

If this is to be prevented, strategic attempts to isolate the rural areas as much as possible should be made and concerted efforts need to be put in place to ensure that rules are adhered to and healthcare facilities are provided.