By Melari Shisha Nongrum and Nandaris Marwein
The Covid pandemic hit the state of Meghalaya in early 2020. The public panicked as the unknown virus was said to be fatal. We were all in our homes when frontline workers risked their lives to ensure that basic systems of food, water, health, safety besides others functioned. A very important section of the frontline workers, who ensured that people who returned were quarantined, the poor and the needy received the basic ration and the community followed the standard operating protocols, were the community-based traditional institutions, the Dorbar Shnong. Though much has been written about their role in the management of COVID-19, especially in the first and second wave, yet in this article, the aim is not to only highlight their role during the Covid response but to also learn from their experience to further the cause of public health issues in the state.
To understand this, we interacted with a number of people who were part of the Covid-19 response teams in their communities across 18 villages in four districts. It was observed that in 10 communities, the Dorbar Shnong, which is the main body for traditional governance in the community, was actively involved in the management of Covid pandemic although it was not working on its own. The youth and the women, including ASHA workers who are referred to as Seng Samla (youth) and Seng Kynthei(women) respectively, were also assisting the Dorbar Shnong. In the other eight villages, a new committee was formed which consisted of women, youth and some members of the Dorbar Shnong, usually known as Covid Management Committee. It was interesting to find that in most communities, the community leaders inducted youth (both females and males) and even self-help groups to the committees. A young man of 22 years from Loompyrdi Iongpiah, West Jaintia Hills said “I think the Covid Management Committee has done well to curb the spread of the virus in the community”. A community member of 46 years from Lyngkyrdem, East Khasi Hills district said “All I can say is that the Dorbar Shnong, Covid Management Team and the ASHA workers have played a big role during the pandemic, they really helped to curb the virus”.
The main roles that these community-based institutions played, whether it is the Dorbar Shnong itself or the Covid Management Committees, were mainly but not limited to setting up of the quarantine centres and isolation centres, maintenance of these centres, distribution of food to needy families, public announcements of SoPs and even creating WhatsApp groups to enhance the reach of information about SoPs and ensuring that the community follows the protocol of social distancing, wearing of mask and sanitizing especially in shops, during the death of a family member and other events in the community and even assisted in the arrangement of transportation for covid patients.
The roles played by these institutions helped the government to reach to its citizens with information, food and other supplies in such difficult times. The experience of the community-based institution handling a public health concern is something that we can learn to prepare ourselves better in the event of another epidemic or pandemic in future or even to enhance community-based response for public health concerns.
Clarity of roles and responsibilities
The district administration and Block Development Officer were in communication with the headmen of their areas. They had a clear mandate of what they wanted the Headmen and his team to do in their villages. Though knowledge about the virus was rather ambiguous, yet what was needed to be done was clear. This enabled the headmen to garner support from his community to do the needful. In our context in Meghalaya, we see that there are a number of community-based committees which are mandated by the government for different schemes. For example, the Village Health Sanitation and Nutrition Committee has been constituted for collective action on issues related to health and its social determinants at the village level. According to the National Health Mission, there are nine well-defined roles of the VHSNC. However, according to our regular interaction with members of the VHSNC in different villages in the state, they are not clear of their roles and the only activity that is usually observed being taken up is cleaning drive. The potential that the VHSNC can bring a positive change in the village is immense but the lack of clarity of roles and responsibilities of such a committee results in them not being able to optimally fulfil their roles. Thus, clarity on the roles and responsibilities of members of any community-based institution through long-term capacity building is of utmost importance.
Clear communication
Clarity of roles and responsibilities is accompanied by a clear communication between the concerned department and the community-based organisation. The SoPs issued from time to time during the pandemic were clear and community leaders could make announcements based on the notifications which worked during the pandemic.
Such channels of communication which are fast, effective and clear need to be found so that committees understand their roles and responsibilities.
Proper funding
Volunteerism is a good value and practice. But, to be able to carry out the activities in the community, funds are required. During the pandemic, the government had decided to give a one-time payment of Rs 5000 for setting up quarantine/isolation centres in their communities. This enabled swift action from the communities. Similarly, for other community-based organisations, if action is expected, funds should be provided promptly. Taking the example of VHSNC, Rs 10000 is supposed to be given annually for its activities but this does not happen. A social audit exercise in a village in Umsning Block reveals that the VHSNC has not received the funds fully for the financial year 2021-22. This amount needs to be provided promptly to these committees to enable them to function effectively.
Involvement of youth and women
During the pandemic, the Covid Management Committees or the Dorbar inducted women and youth into these committees. This has ensured the effectiveness of these committees as perspectives and reach to the public is also enhanced with inclusion of youth and women in decision making.
Ownership and responsibility
The pandemic was everyone’s concern. As the community leaders expressed that there are certain difficulties if some sections of the community do not cooperate, yet as the larger majority of the community has felt the importance of adhering to the SoPs, this has improved the adherence during the peak of the pandemic. The community leaders took the onus on themselves to see that people in their communities were cared for, from a medical point of view and also from the perspective of food security during such hard times. A village leader from Mawthadraishan Block stated “I had to go to the market to purchase rice not only for myself but for my people in the village”.
Public health cannot be attained without tackling the social determinants of health at the level of the individual and collective. The potential of the Dorbar Shnong and other community-based institutions to enhance health outcomes is immense.We can use the learnings from the Covid pandemic to understand the critical components required to work with community-based institutions so as to attain better health outcomes in our communities.
(Melari Shisha Nongrum is an Associate Professor, Indian Institute of Public Health, Shillong)
(Nandaris Marwein is an Assistant Professor, School of Social Work, Martin Luther Christian University)
(“This research/reporting was supported by the Thakur Family Foundation. The Thakur Family Foundation has not exercised any editorial control over the contents of this research”)