Maharashtra has the highest COVID-19 cases in the country and the government is taking a slew of measures to flatten the curve. We speak to Mr. Yusuf Kabir, WASH specialist and emergency focal point for UNICEF Mumbai, who is at the forefront of the containment efforts to find out about their efforts towards water, sanitation and hygiene (WASH) in urban and rural areas especially to tackle COVID-19 spread.

What is UNICEF’s response to Covid-19 in Maharashtra?

UNICEF has been working on WASH for almost 70 years now, but this crisis has called for rapid action to ensure behavior change. The National Disaster Management Authority (NDMA) has invoked the Disaster Management Act 2005, which ensures uniformity in measures taken across the country. So, what we are doing in Maharashtra is consistent with what is happening across the country under the guidance of Ministry of Health and Family Welfare (MoHFW), Government of India with technical support from the World Health Organisation (WHO).

Two pillars of WASH intervention are being rolled out towards immediate response under COVID-19 control: (i) Risk communication and community engagement and (ii) Infection prevention and control. These are relevant to both health facilities as well as community/households.

To begin with, we have joined hands with the Health and Family Welfare Training Institute, Government of Maharashtra (GoM) to train more than150,000 Front Line Workers (FLWs) including Swachch Grahis, Jal Surakshaks, Accredited Social Health Activists (ASHA), Anganwadi Workers (AWW), Auxiliary Nurse Midwife (ANM), Lady Health Visitor (LHV) and Multi-Purpose Workers. The modules that were created by MoHFW have been translated to Marathi and contextualised by adding certain elements. Under WASH, the key areas of training include handwashing, explanation of Covid-19, community disinfection, community surveillance, respiratory hygiene, cough diagram, ensuring safety of FLWs under exposure, and disseminating hygiene and environmental sanitation messages and behaviors to communities for preparedness and prevention.

How is this training being carried out given the large number of frontline workers and restricted movement during lockdown?

We are conducting the training virtually using Zoom and ECHO platform as a tool to ensure social distancing norms are followed. UNICEF’s own Interactive Voice Response (IVR) based software RapidPro is being used for messaging to understand WASH practices. We are also getting inputs from communities using tools like U-Message to design the messaging and interventions better based on their Knowledge Attitude and Practices (KAP). In addition to this, we are also collaborating with other partners working in Maharashtra like WaterAid India, RedR India, etc., to understand the field realities.

How has UNICEF worked with NGOs during these times?

Self-help groups set-up under the Maharashtra State Rural Livelihood Mission (MSRLM) have started producing cloth-based masks, hand sanitizers and disinfectants. We are also producing masks, sanitizers, disinfectants at local levels in collaboration with NGO partners. For instance, Swayam Shikshan Prayog in Osmanabad district is working with communities to produce cloth masks based on guidelines given by MoHFW. There is a shortage in terms of essential materials to produce hand sanitizers. Disinfectants, such as sodium hypochlorite, are being sprayed in community zones by Gram Panchayat functionaries post training.

We have acted in response to the situation right now, but it might be good to think about getting these produced on a regular basis. For instance, National Accreditation Board for Testing and Calibration Laboratories (NABL) under the Water Supply and Sanitation Department, GoM can as a part of Jal Jeevan Mission start producing hand sanitizers and disinfectant solutions. This can be done along with routine water quality testing. A supply chain can be created through self-help groups, which also ensures their livelihoods. As long as the norms and guidelines set by the government are met, it should be done now onwards as a preventive measure for an imminent pandemic. In the long run, these products can be promoted much like the support to self-help group run sanitary napkin making units wherein the Government of India and the Bureau of Indian Standards (BIS) had come up with standards and guidelines.

What is the situation of shelter camps in Maharashtra?

Most of the cases are located in Mumbai, Thane, Panvel, Navi Mumbai, Kalyan, Pune, Sangli, Kolhapur and a few more pockets of Marathwada and Vidharbha. There are more than 200 temporary shelter camps functioning across the state run by the government and over 7,00,000 people are housed in these camps. UNICEF is in the process of developing a shelter management protocol in partnership with GoM following the NDMA and Sphere Guidelines and adapted to the Covid circumstances. Additionally, a rapid assessment is being done in some of the areas with a NGO partner on nutrition, food security, social distancing, child education, water availability and logistics to manage supply and demand in these times.

What do you think are some challenges in the medium and long term? And how can they be resolved?

Because of lockdown, there is a shortfall in the availability of tankers. Drought is approaching fast in several parts of the country. The GoM has already listed tanker services as an essential service since the lockdown. Due to lockdown, there is not much withdrawal of groundwater for agriculture and industry. Once the lockdown gets over, the government may come up with a stimulus package in terms of agricultural subsidy, MGNREGA, enhanced subsidy on electricity for agriculture, high yielding seeds, horticulture etc., with an effort to revive the rural economy. This might lead to more aggressive over extraction of groundwater, putting pressure on existing water supply schemes to use water for productive needs, which may further compromise the sustained sanitation and hygiene behavior and sustainability of functional household tap connection during the lean period.

It is important to focus on the source sustainability aspect that the Jal Jeevan Mission stresses on in order to prevent slip back in coverage. Villages that are tanker-fed, lying on overexploited aquifers or having water quality problems should be prioritized in the first phase. Within Jal Jeevan Mission guidelines, there is a special chapter on disaster management and this is the time to activate that as what we face today is a major humanitarian crisis. Funding for source strengthening could be leveraged from the 15th Finance Commission.

It is also important to prioritize schemes to focus on vulnerable groups like marginal and landless farmers, people in shelter camps - especially in rural areas. After all, rural areas face many more shocks and hazards than urban areas, which are faced with heat wave, flood and droughts. In doing so, we of course cannot ignore WASH, health and nutrition anymore.

How does the work on COVID-19 tie in with the WASH work UNICEF has been doing?

There is a direct and immediate connect between our long-term WASH work and the current COVID-19 mitigation work.  Everyone is talking today about the 6-step hand washing processes with soap in critical times and multiple actors are reinforcing this behavior. So, this is the right time to build community resilience and long-lasting behavior change through effective communication.

We have also been designing innovative solutions for public handwashing infrastructure such as elbow-operated stations, pedal-operated non-touch hand wash models to prevent the spread of contamination. The design is publicly available for anyone to use and produce. Some manufacturers have picked up some designs and are trying to produce models that are cost effective, sturdy and efficient in the context of Maharashtra.

In the long-term, we should also start looking at how existing programs like Swacch Bharat Mission or Jal Jeevan Mission can incorporate pandemic preparedness, including through their communication strategy to communities on handwashing and environmental sanitation while using frontline workers like Swachhagrahis, Jaldoots and strengthen the service delivery bodies like Gram Panchayats and Pani/ Nigrani Samitis.