On the forms, contributions and impacts of community mobilisation involved with Kerala’s COVID-19 response: Perspectives of health staff, Local Self Government institution and community leaders

Abstract

Background Kerala, a south Indian state, has a long and strong history of mobilisation of people’s participation with institutionalised mechanisms as part of decentralisation reforms introduced three decades ago. This history formed the backdrop of the state’s COVID-19 response from 2020 onwards. As part of a larger health equity study, we carried out an analysis to understand the contributions of people’s participation to the state’s COVID-19 response, and what implications this may have for health reform as well as governance more broadly. Methods We employed in-depth interviews with participants from four districts of Kerala between July and October, 2021. Following written informed consent procedures, we carried out interviews of health staff from eight primary health care centres, elected Local Self Government (LSG, or Panchayat) representatives, and community leaders. Questions explored primary health care reforms, COVID responses, and populations left behind. Transliterated English transcripts were analysed by four research team members using a thematic analysis approach and ATLAS.ti 9 software. For this paper, we specifically analysed codes and themes related to experiences of community actors and processes for COVID mitigation activities. Results A key feature of the COVID-19 response was the formation of Rapid Response Teams (RRTs), groups of lay community volunteers, who were identified and convened by LSG leaders. In some cases, pre-pandemic ‘Arogya sena’ (health army) community volunteer groups were merged with RRTs. RRT members were trained and supported by the health departments at the local level to distribute medicine and essential items, provided support for transportation to health facilities, and assisted with funerary rites during lockdown and containment period. RRTs often comprised youth cadres of ruling and opposition political parties. Existing community networks like Kudumbashree (Self Help Groups) and field workers from other departments have supported and been supported by RRTs. As pandemic restrictions eased, however, there was concern about the sustainability of this arrangement as well. Conclusion Participatory local governance in Kerala allowed for the creation of invited spaces for community participation in a variety of roles as part of the COVID 19 response, with manifest impact. However, the terms of engagement were not decided by communities, nor were they involved more deeply in planning and organising health policy or services. The sustainability and governance features of such involvement warrant further study.

Formulating a Community-Centric Indicator Framework to Quantify One Health Drivers of Antibiotic Resistance: A Preliminary Step towards Fostering ‘Antibiotic-Smart Communities’

“…In this context, the investigators chose Kerala as the site to pilot the indicator framework since the setting is ideal for community engagement projects. Kerala's state government is also supportive of community engagement initiatives given its history of community engagement [19,20]. This exploratory project was undertaken in a panchayat in the state of Kerala, India.…”

Formulating a Community-Centric Indicator Framework to Quantify One Health Drivers of Antibiotic Resistance: A Preliminary Step towards Fostering ‘Antibiotic-Smart Communities’

“…In this context, the investigators chose Kerala as the site to pilot the indicator framework since the setting is ideal for community engagement projects. Kerala's state government is also supportive of community engagement initiatives given its history of community engagement [19,20].…”