Opinion: Why we need a holistic response to the secondary impact of COVID-19

It is critical for all of us to keep an eye on the emerging needs and challenges as we put a lid on the pandemic, like livelihood support and mental health support.
 A child looks into a camera while wearing a mask
A child looks into a camera while wearing a mask

We are in the middle of a massive health and humanitarian crisis and civil society has stepped up to address every gap in the current health infrastructure that markets and governments have not been able to meet. While there has been a huge focus on oxygen, Anshu Gupta from GOONJ has rightly and evocatively argued that the crisis is not just of oxygen but of food for so many people. And while relief measures are in full swing, the conversations around vaccination (the paranoia, the supply and deployment) have also begun across the country and are executed at varying speeds based on the income and influence of those getting vaccinated.

While both relief and vaccination are very important, it is critical to envision the world that we will inhabit once we put a lid on the current pandemic. The secondary impact of COVID-19 is already playing out across the country and years of progress are being washed away. It is critical for all of us to keep an eye on the emerging needs and challenges that will sweep the entire nation since we are fast spiralling into that future. I have outlined eight areas that will need strong and sustained focus for us to mitigate the adverse impacts of the crisis.

> Holistic primary care: The current crisis has deprioritised critical primary healthcare needs on the ground including maternal and child health activities (antenatal visits, vaccination) which can result in intergenerational health and economic impact. There has also been a significant impact on the health seeking behaviour of populations suffering with chronic health conditions such as tuberculosis and diabetes. Our disease specific, single agenda approach to healthcare cannot meet the needs of the post COVID society. A robust primary care is critical for us to have any effective response to the third wave that will significantly impact children (and thus mothers).

> Mental health support: Unlike primary health, there is a complete absence of a national level infrastructure to address issues of mental health. Communities on the ground lack the vocabulary, awareness, access and engagement around this issue. At the same time, the prolonged crisis has had a significant impact on people resulting in higher incidence of depression and cases of self harm and violence. There is a massive need to imagine and execute on mental health at scale across demographics and geography.

> Child protection and wellbeing: Despite all its inadequacies, school has always been the safest place for a child. A child not in school always runs myriad risks including substance abuse, physical abuse, homelessness and trafficking. Conversations with organisations working in child protection highlighted increasing cases of children running away from home, who are often trafficked the moment they set foot in a city. Unexpected deaths of both parents has resulted in an informal model of adoption that puts children at significant risk. Reimagining our engagement with children, be it at schools or in communities, that is anchored on their safety and social and emotional wellbeing is critical as they seek to find their childhood post the pandemic.

> Financial security: Even before the pandemic, 65% of all out of pocket expenditure was due to healthcare. The current pandemic has made it worse and pushed many families to dip into any savings that they may have had or take loans from the informal money lenders. While there are conversations on Insurance, I have written in the past about the challenges in making it work for the poor and possible ways it can be leveraged. Given a depleted exchequer and dim financial outlook, the government is not expected to announce any relief at large scale. The immediate financial risks faced by families hence are daunting and will need actual cash in hand with very low overheads.

> Livelihood enablement: This segues to the next challenge of ensuring livelihood enablement. Unlike the sledgehammer nationwide lockdown, local lockdowns have allowed for economic activity to continue. However, the livelihood impact on many segments is real owing to the slowing down of the economy, health impact on workers, reduced spending across all sections of society and limited mobility. Multiple initiatives addressing different segments have to be launched to both spur growth and create equitable economic opportunities for women and men.

> Waste Management: One of the topics that hasn't been discussed as much as it should is the enormous amount of bio waste that is being generated due to the current crisis and the complete inability of the backend systems to deal with it. We continue to carry significant risks as the increased bio waste makes its way to the landfill. Our waste management systems are already broken but the health and environmental impact of bio waste of this magnitude can be significant unless addressed proactively.

> Learning continuity of children: Much has been said about the complete loss of learning that teachers will face when students come back to school after two years of limited to no learning. There has been ample evidence of the ineffectiveness of current online models in ensuring learning outcomes at scale. The coming months are critical to pilot innovative personalised models of learning that involve communities, bridging the digital divide to ensure equitable learning access and a learning model that is optimised for the current constraints.

> Gender Equality: There has been increased incidence of child marriage as girls have not been going to school. Issues of violence against women have been on the rise. As Sohini Bhattacharya has strongly argued, we need to place gender equality at the centre of rebuilding efforts to "build back equal", and do that while being fully aware of the increased risks that women will face in the post pandemic world. A holistic response to gender equality across education, health, livelihoods and overall agency is critical. And this begins with equitable access to vaccination for women.

As I write this, I am aware of the gloomy picture that I am painting. Efforts are already afoot in each of these areas to solve problems at scale by organisations, collaboratives and public-private partnerships. In the coming weeks, we will pick on each of these areas and delve deeper into possible solutions. It is important for us to recognise that these are all pressing problems and we do not have the luxury of solving them sequentially. We will need more of everything in the post pandemic world — more resolve, more innovation, more funding and more than anything, the will to not just survive but rebuild better so that we don't dial back when the next crisis hits us. And cliched as it may sound, the answer to that is in Sustainable Development Goal 17 of the United Nations at the centre of the circle — which is partnerships across the board towards achieving these goals.

Rathish Balakrishnan is a co-founder and Managing Partner at Sattva Consulting. Views expressed are the author’s own.

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