The First 100 Days: How Has COVID-19 Affected Poor and Vulnerable Groups in India?

"...health promotion for the most vulnerable was largely an afterthought."

Poverty, structural inequalities, and other characteristics make India vulnerable to the effects of COVID-19 and related mitigation measures. Indian civil society organisations have mobilised to support the emergency. For instance, Gram Vaani is a network of voice-based community media platforms working to build awareness, counter misinformation, enable community feedback, and link those in need to critical services. Used by rural and low-income populations, the platform can be accessed with any simple mobile phone. Based on people's experiences recorded and shared on Interactive Voice Response (IVR) system operated by Gram Vaani, this article provides an evolving portrait of the health, economic, and social consequences of the COVID-19 pandemic on vulnerable populations in India. The analysis focuses on 100 days early in the pandemic: from March 13 to June 20 2020.

As noted here, one of Gram Vaani's key functions is to offer basic health promotion for individuals excluded from other information sources. Individuals availing the services of the Gram Vaani COVID-19 response network represent the economically poorer segments of society, choosing a communications medium that is free of cost and does not require access to the internet, a smartphone, or literacy. Meanwhile, government COVID-19 awareness messaging focused on communications channels oriented to the middle and elite classes such as television, internet, and newspapers.

The researchers developed a conceptual framework to monitor the effects of the COVID-19 pandemic and response measures based on the human right to health and the United Nations (UN) Sustainable Development Goals (SDGs). They analysed awareness-related content developed by the Gram Vaani COVID-19 response network partners, termed studio-generated content (SGC). To analyse user-generated content (UGC), they summarised the raw data and recoded data to represent the SDGs.

In its first 100 days, the platform logged over 1.15 million phone calls, of which 793,350 (69%) were outbound calls offering SGC related to COVID-19 information, awareness-building, and service linkage. Analysis of 6,636 audio recordings by network users (inbound messages) revealed struggles to secure the basic necessities of survival, including food (48%), cash (17%), transportation (10%), and employment or livelihoods (8%). A mapping of issues raised by callers to deficits in attaining the SDGs revealed the following top 5 shortfalls: SDG2: zero hunger (48%); SDG1: no poverty (15%); SDG11: sustainable cities and communities (basic living conditions, such as transport, electricity, housing, and cooking fuel: 13%); SDG16: peace, justice, and strong institutions (problems with corruption and difficulties in accessing government relief measures: 7%); and SDG3: good health and well-being (7%). Patterns of SDG deficits differed by gender; for example, female callers expressed more frequent concerns over food shortages.

In short: "Audio recordings made by network users spoke of profound distress over struggles to secure the basic necessities of survival. Analysis of these recordings shows that, for a large segment of the Gram Vaani COVID-19 response network callers, stringent public health measures to counter COVID-19 compromised the right to health by threatening its essential determinants and entitlements....With the sudden announcement of a lockdown,...migrant workers found themselves overnight with no source of income and no means to travel back to their homes....They soon ran out of food and cash....Many of these harms, including violations of human rights enshrined in the Indian constitution, could have been substantially mitigated through a better consideration of the needs of the marginalized."

In particular, the researchers outline preexisting development deficits and weak social safety nets, such as the fact that migrant workers are unable to avail themselves of the benefits provided by India's Public Distribution System (PDS). For an effective pandemic response and recovery, these gaps must be addressed through inclusive policy design and institutional reforms, according to the authors. For example: "Moving forward, there is a need for documentation of workers especially in the unorganized sector, as a gateway to ensure access to portable welfare benefits, unemployment benefits, skills-based job matching and employment-based social security such as workplace health insurance..."

In conclusion: "The COVID-19 pandemic is both a crisis and an opportunity to reimagine more just institutions and policies. The voices of the marginalized must become central to this dialogue."