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Mainstream, Vol XLVII, No 39, September 12, 2009

Swine Flu, Panchayats and NRHM

Saturday 12 September 2009, by Bidyut Mohanty


Nowadays the swine flu has created a health scare among the Indian population. It is still confined to the urban areas. But eventually it is likely travel to rural areas. Given the background of villagers’ apathy in health matters the flu in all probability will take a larger toll. Since the local government institutions are functioning well and programmes like the National Rural Health Missions are working in conjunction with panchayats it will be worthwhile to start the awareness programme on swine flu so that people visit the public hospitals as soon as they notice the first symptoms. Special gram sabhas should be convened to give the special message on swine flu by the ASHA and other health functionaries. As a result the fatality rate is likely to get minimised.

Swine Flu

Swine flu, or pig plague / hog cholera has originated from the fact that this virus has the same gene as that of the pig. But pig is not the only source of contacting the infection. It spreads from human to human. ( Its name ‘swine flu’ was changed to H1N1 because the former was not acceptable to a certain community.) It is a kind of influenza but it has created a lot of scare among our people because if delayed in diagnosing, the disease leads to primary and secondary infections and then results in death. Hence the panicky reaction has started.

So much so that a couple of days back the masks disappeared from the shops. People flocked to the hospitals at the first signs of cold. They stopped going to the malls and cinema halls. The Maharashtra Government closed all the schools and even the famous dahi handi festival was not attended by many. It was also apprehended that the Ganesh festival would be celebrated on a low key.

(Similar reactions were seen when it started in Mexico and travelled to Egypt and China. In Mexico all schools and public places were closed. Ports and airports were closed to outsiders. It was done for a fortnight. In China, on the other hand, the foreigners having any such symptom were dealt with firmly. In Egypt it led to mass scale slaughter of pigs! Even in the USA, the President as well as the Department of Health aired public messages not to get panicky. All these happened when the flu began.)

Comparison with the Great Influenza of 1918

Even though so far it is prevalent in the urban areas it is very likely that the disease would migrate to the villages. Recently, the HT (August 23, 2009, New Delhi edition) reported that the flu like fever is prevalent in small towns like Beed and other places. But the doctors do not consider that to be swine flu since there is no history of mobility from abroad. But it may so happen there could be migration from the infected areas like Pune as well. It is likely because past epidemics like plague and the Great Influenza (1918) started in urban areas but migrated to the rural areas. If it could migrate in the nineteenth century when the mobility was limited, now there are greater chances of moving to the rural areas because the link between the two is breaking down very fast.

The pandemic of 1918 killed a large number of tribals at that time because they could not figure out what was wrong with them. The Census Superintendent of Bihar and Orissa Report, 1921 wrote extensively on this. It was reported that the Santals ate water soaked rice and kept on sitting under the sun when they caught the fever. In the process they died in large numbers. The economic impact of the 1918 pandemic was enormous. Some economists wrote that the foodgrain output of India declined because of shortage of labour. The decade 1911-1921 was marked by very high deaths and internal migration. The total population of India had became less than that of the previous decade. The demographers describe 1921 as the Great Divide since after that year the total population of India did not look back .If one analyses the death rates of the Annual Sanitary Commission (later on Public Health Commission) Reports for that decade, one finds that the female death rate was higher that that of males due to fever.

Of course things have changed somewhat now but health consciousness among the rural people is still very low. Health takes a low priority if it is fever. They first try the home remedy without consulting the allopathic doctor. The tribal community still goes back to its traditional Dishuri to get rid of the evil spirit. Coupled with that the level of hygienic awareness is relatively low. Even in urban areas one sees people spitting and throwing mucus on the road freely. (One wonders what will happen on the occasion of the Commonwealth Games? Will the Delhi Government take stern measures as was done by the Chinese Government?) So in all probability the fatality rate due to swine flu may turn out to be quite high.

Can Panchayats Help?

The panchayats have come into force in 1992 with an objective of bringing good governance to the door-step of the people. There are three million elected representatives of which more than one million are women. In the 1992 Act the panchayats have been devolved with 29 subjects under the 11th Schedule. One of the subjects is to look after health issues. Recently the panchayats have got relatively more teeth because of schemes like the National Employment Guarantee Act or Scheme (NREGA/NREGS), National Rural Health Mission (NRHM) and Right to Information Act (RTI). Each panchayat has to convene the gram sabha to select beneficiaries for the NREGA. Recently the Central Government has made it mandatory that unless the panchayats have district level planning they are not going to ge any money.

Besides, the provisions of the NRHM clearly spell out the role of panchayats in dealing with health issues to which we will come a little later. So the panchayats can convene special gram sabhas to spread awareness about the swine flu and it may prevent the spread of the disease on time.

Of course it is well known that nobody cares about the gram sabhas if they are not the beneficiaries. But the field study conducted in UP and MP (UNDP) show that once the women leaders become conscious of the health issues they take these up quite earnestly. This is because women play a vital role insofar as the health of the family members is concerned. It is particularly so if the children become ill. (Evidence shows that swine flu affects the children more.) For example, the Janani Suraksha Yojana (JSY) is working well in Ghazipur district of UP because the sarpanch net-work is quite keen on that. Similarly the Sakhi Pahel in Dewas district was quite keen to have a special mahila sabha so that they could air their grievances. In the mahila sabha they demanded to have drinking water first followed by electricity. Similarly the ISS study on HIV and AIDS and the role of panchayats in Tamil Nadu showed that once the women leaders became aware of the nature of the problem, they tried to create awareness among other women. So many examples can be multiplied to show that if the women members of the panchayats could be sensitised, they will start the awareness campaign in right earnest.

National Rural Health Mission (NRHM)

In 2005 the Health Ministry initiated a health scheme which is known as the National Rural Health Mission. Because it has a slight different emphasis than that of the earlier scheme, it will be worthwhile to spell out some of the clauses to know as to how it is working.

* reduction of child and maternal mortality,

* prevention and control of communicable diseases,

* access to integrated comprehensive primary health care.

There are other objectives such as promotion of traditional health system, universal access to public health care services to food, sanitation and hygiene.

We should also discuss the strategies which they adopted to achieve the above goals.

• train and enhance the capacity of PRIs to own, control and manage the health services,

• health plan for each village through the village committee of the panchayat,

• promoting access to improve health care at household level through the female activist (ASHA).

• strengthening the existing PHCs through better staffing, and human development policy, clear quality standard, better community support and untied fund to achieve the target.

Of course the PHCs are still under-stuffed and function in unhygienic conditions. Besides, the line of communication with the remote village of Chandrapur in Koraput, Orissa is very faulty since one has to cross several rivers and hills to come to the PHC. There are many such villages through-out India.

However, in 2008 the progress on the NRHM showed that there has been some improvement in reduction of maternal and infant mortality through the use of existing health institutions to deliver the babies. The study of UNICEF and CARE India also showed that women are availing the existing health infrastructures at a higher rate than before. Hence the infant mortality rate has declined even in the remote areas of Orissa. So much so that the critics of the NRHM point out that it is meant only for women in the reproductive age group and other health considerations have been ignored.

Now the time has come when the health functionaries such as ASHA, anganwadi workers, and the panchayat members can come together and start awareness programme on swine flu to impress upon the village people of the deadliness of the disease. In this way can one try to reduce the intensity of the fatal disease well in time.

The author is the Head of Women’s Studies, Institute of Social Sciences, New Delhi. She can be contacted at

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