In Maharashtra, the epicentre of India’s devastating second wave, several NGOs and civil society organisations have been at work to combat the pandemic – by spreading awareness about precautions, by helping the slum-dwellers book appointment for vaccine, by providing meals to the marginalised and in many more ways.

At 12 vaccination centres along with the Pune municipal corporation, the Centre for Youth Development and Activities (CYDA) has so far managed to administer more than 40,000 doses. Helped by two support staff at each centre the ‘Yes to Vaccine, No to Ventilator’ campaign in communities has helped bring people out of hesitancy and take jabs but vaccine shortage has stalled the drive lately. There is continuous requirement for oxygen, ventilators and beds and Remedisivir throughout the day.

Despite WHO advice to IMA against Remdisivir and government mandating that it is to be prescribed only though hospitals, that medicine continues to be prescribed by doctors, says Mathew Mattim, secretary, CYDA. “We have calls coming from people who are ready to pay any amount for it even when the government has said doctors should not prescribe it and it will be given through hospitals. Is this not black marketing where the rate ranges from Rs 4,000 to Rs 40,000 and now we also have duplicate medicines? Without any instructions coming from the collector or the health department it is total failure.”

He says that people who have lost family members to Covid-19 are unable to pay rents and go out to work. They need help with securing the necessities. “We have entire families which are wiped out by the coronavirus or a lone surviving member is on ventilator in hospital with a three-year-old child.”

He also says that there needs to be coordination between home and hospital quarantine centres with doctors, as families of Covid patients are self-medicating. “Some 20-25 tele-doctors should be available to address doubts on symptoms as many people are coming very late for hospitalisation. Such information needs to be disseminated and awareness on CAB (Covid appropriate behaviour) needs to be reinforced and speeded up by administration.” Mattim says that the administration at the top must involve specialists like eminent epidemiologists and virologists to guide and support the system so that issues on ground are identified and tackled.

With people like daily wagers not having money to buy food, CYDA will be providing 15-day ration to them and as things are slowly getting into place civil society is also coming forward to help. Those who have recovered are now being encouraged to donate blood plasma.

CYDA Pune has distributed dry ration kits to migrant workers and daily wager, soaps, masks, helped with hospital beds, set up help desks, helped 23 people receive plasma and medicines, helped migrants get jobs, and set up community vans. It has also been working in Satara, Nashik and Nandurbar among other places in Maharashtra during the second wave.

In the second wave, CACR with support from NSE Foundation and MahaPeconet is distributing packed meals to patients and their kin through dabbawalas (giving them livelihood too in the lockdown) on EECO vans at KEM, Tata Memorial and Wadia hospitals and also giving ration kits and masks in ‘red light’ areas of Kamathipura, Kherwadi and other pockets like Malvani, Kaamraj Nagar and Ramabai Colony in Mumbai. About 5,800 soaps have been distributed in the Chota Sion vaccination centre and NESCO Jumbo centres.

CACR has been working with commercial sex workers, transgenders and rag-pickers. “As these people do not have identity cards like Aadhaar card, PAR card or voter card, they have been left out of vaccination and not getting any help. With the curfew, commercial sex workers’ income has come down and due to the fear of debilitation post vaccine, they are hesitant to get vaccinated,” says Nitin Wadwani, founder and CEO, CACR.

“We tell them that a Covid-infected customer will pass on infection and that will be graver so they must take vaccine as early as possible. The problem is due to the shortage there are huge queues at JJ and Nair hospitals which are closer to their locality and for them to go again and again is a problem. With huge queues starting at vaccination centres right from 5.30 am and shortage of vaccine it can be a potential breeding ground for infection,” he says.

For vaccine, as registration is mandatory through CoWin and Arogya Setu apps but a large part of slum and marginalised population does not have smartphones; so volunteers help them register via their own smartphones. Registration numbers and slots are then shared with those who are to go for vaccination. With BMC schools as the focus area of CACR, drawing an analogy with online education for BMC school children post lockdown, Wadhwani says not even 20% children get online education as there is usually a single working smartphone in a family today and with lockdown imposed financial difficulties there is no balance or data pack in mobiles.       

CACR with UNICEF has been urging BMC to have segregated lines and info on availability on vaccines and numbers of vaccinations to be carried on a single day. “While the SOPs have to come from the government as of now there are no crowd management guidelines from MCGM for registered, walk-ins, fist dose, second dose, posing a big difficulty. It will be best for the government to reach out to people at large a day in advance and update on the availability of vaccine through social media or other mediums. Whatever available needs to be channelised properly and equitably distributed. We have given many suggestions to BMC; it has taken some steps and we do expect some changes soon,” he says.

He also says that the situation was overwhelming last year and migration was huge, but this time CACR is working in specific pockets where need is genuine. With high numbers of cases this time, around 25-30 volunteers are going door to door in pockets and help desks have been set up inside communities.

With a collective of NGOs on a single platform duplicity is avoided as the NGOs work as per their specialty. All work is done on a single and structured platform with government officials, tech partners, and corporates coming together in a collaborative approach.  

Volunteers at Triratna Prerna Mandal have been running a ‘Chalta Bolta’ vaccination and CAB awareness campaigns on autorickshaws with help desks set up in the H East and H West wards, which have seen high caseloads of infections.

“WhatsApp influencing was a huge challenge but community outreach has helped us reach 1 lakh people get jabs in the city of Mumbai. More than 700 people have been vaccinated in the last few days and people are now willing to get vaccinated. Once the vaccination desk informs us about people coming for vaccinations we connect with hospitals on availably of vaccines and fix appointments,” says Aniket Jadhav, Program Head, TPM, adding they are getting huge help from citizens, local MLAs, councillors, shakha pramukhs, karyakartas and ULBs for providing oxygen, ventilators, medicines and beds and it is very essential that CAB is followed. TPM also shared videos of people who have taken jabs and none has said they faced any health complication. As a gesture of appreciation TPM gifts them a soap bar.

The Alert Citizen Forum (ACF) has been working with faith-based organisations (FBOs) to spread the message in communities. Recordings on removing misconceptions on vaccination and CAB have been given to these FBOs for dissemination through loudspeakers in their premises. Local mandals too have been roped in to spread awareness, help desks set in slums and chawls between Vile Parle and Malad with Chalta Botla autorickshaws for CAB, door to door online vaccination registrations and getting senior citizens to reach vaccination centres. The ACF has helped more than 90,000 people get vaccinated. Food packets and dry rations have been delivered to more than 200 families and at least six antigen testing camps arranged.
     
While there is less migration as compared to last year, Niranjan Aher, founder president, ACF, says “Hunger is driving people out of their homes as daily wagers, naaka kaamgars and domestic workers are going out to earn some money. Most families have four to six members with children and senior citizens and they are largely surviving on a single meal of dal and rice daily.”

Some housing societies need Covid tests every 15 days and this poses a challenge as without symptoms they cannot get a test and moreover they don’t have money to get tests. “Many senior citizens who are not getting their second dose of jabs due to shortage are asking us why 18+ population has been allowed jabs,” says Aher.

Similar to the first wave, Maharashtra became the first state to witness the second wave which started from the eastern parts of the state in mid-February and shifted to urban pockets and metros. Within two-three weeks infections had increased from 10% to 30%. More than 6,00,000 active cases contributed to India’s 20% of total caseload. Out of the country’s top 10 districts in terms of the highest caseloads, five were from Maharashtra. But since April, Mumbai, Pune, and Thane have been able to substantially reduce the infection rate.
 
However, at least 23 rural districts in Maharashtra, mainly from hinterland and tribal areas, continue to report more than 20% infection rate and 60% of present active cases are from the rural belt. Even as the state is fighting the second wave, it is now preparing for the third wave which according to experts will affect more children.
 
The health  infrastructure in country unable to deal with calamitous situation has collapsed leading to shortage of oxygen, ventilators, beds and medicines  and only two vaccines  available in the country. The center is struggling to provide vaccines to states.          
As on May 7, 2021, total of 90.30 lakh doses were available with states and UT’s out of which Maharashtra had 484287 doses. More than 18 million beneficiaries have been vaccinated against covid-19 in the state  facing severe shortage of vaccine doses. After repeated complaints for repeated glitches in CoWin app Chief minister Uddhav Thackeray has asked PM, Modi to provide a separate application.
Since mid-March, Maharashtra covid relief and response platform called MahaPeconet a coalition of more than 75 partners including, corporates, government bodies and also volunteers  has outreached 5 million people across cities and 8-10 districts  in Maharashtra addressing  vaccine hesitancy and reinforcing CAB with 7 partner organizations supported by Unicef Mumbai.
 
The coalition has been working in the regions of MMRDA (nine municipal/urban corporations and 9 municipal councils including Mumbai covering a population of 22.5 million), PMRDA (Pune metropolitan region and development authority with two municipal corporations and three containment boards with population of 8.5 million), Nagpur and Nashik.

Community outreach, field activations, crowd management, vaccine help desks, vaccine quiz, face-to-face and public messaging, reinforcing CAB in slums and housing societies of Mumbai, Pune, Thane and Nagpur, converting 125 wash basins to elbow operated for under-treatment Covid patients at the Nesco Jumbo facility are some of the interventions done recently. Supplies of ventilators, beds, oxygen concentrators etc. are in pipeline.

“So far MahaPeconet has assisted 11,11,622 people in getting vaccinated. With 77,902 social mobilisers on the field and 236 vaccination help desks, ration kits and cooked meals have been distributed, helping 11,314 people,” says Yusuf Kabir, water, sanitation, hygiene (WASH) specialist, DRR and emergency focal point, UNICEF, Maharashtra.
 
Kabir says autos have been used for awareness campaigns covering 2,030 km reaching out to 10,82,822 people. As many as 59,589 medical and non-medical supplies like masks, soaps, oximeters, oxygen concentrators, vitamins, sanitisers, face shields etc. have been donated, benefiting 86,532 people.
 
“A slip in CAB during the unlock from September onwards led to the second wave. Panic, fear, shortage of medicines, oxygen, beds vaccine and huge fatigue on the government as well as frontline workers has tremendously impacted the second wave. It is extremely important to follow SMS (‘safe distance, mask up and soap use’). Climate-induced disease spikes are clear now. Covid has also brought in certain understanding and opportunity to build back for better future with anticipatory governance which is a vison, a contingency plan and teaches you how to handle emergency situations. It is not long term. It is short and medium term,” he adds.

With Covid-19 exposing several fault lines, MahaPeconet aims to focus on giving traction to WASH (water, sanitation, hygiene) in vulnerable and poor communities through IEC and promoting behavioural change like provision of micro loans for water purifiers, toilet use, and demand for potable water. It will further facilitate sustained collaborations between organisations with strong fund base and those with intensive volunteer network even during normal times, and build up success of online trainings and social mobilisations so that frontline workers adapt to digital technology, scale up tried and tested technology for data collection and reduce digital divide, scale up and identify capacity building of women leaders and consistent implementation and regular practice  of learnings  derived in the post-pandemic world.