Vijay Kumar Gaba: vaccination

Showing posts with label vaccination. Show all posts

Wednesday, June 8, 2022

ASHA – A ray of hope

A recent media report highlighted remarkable reduction in the infant mortality rate (IMR) of India. India’s IMR improved from 47 in2010 to just 28 in 2022, bringing it closer to the global average of 27. (see here)

Much contrary to the popular perception, India achieved one of the best Covid vaccination rates in the world. As per the latest available data close to two billion doses of Covid vaccines have been administered, defying all the logistic challenges.

These are just two success stories from India’s public health sector. Recognizing these remarkable achievements, the World Health Organization (WHO) recently honored more than a million Asha Workers of India for their commendable public service, especially during the pandemic.

It is rather unfortunate that not much of the urban population is even aware of the existence of Asha (the frontline health workers). Many mistake Asha workers for Aanganwadi workers. Even though millions have “liked” the pictures of Asha workers administering Covid vaccines to people in remote places, sometimes walking for many kilometers, not many seem to have bothered to learn more about them.

ASHA stands for “Accredited Social Health Activists” – “community volunteers” engaged under the National Rural Health Mission (NRHM). The designated Asha worker is the first port of call for any health related demands of deprived sections of the rural population, especially women and children, who find it difficult to access health services. These workers create awareness on health and its social determinants; mobilize the community towards local health planning; promote good health practices; and provide a minimum package of curative care. (learn more)

‘Stories of Change”, a report published by the NITI Aayog, in collaboration with Center for Social Behaviour Change (Ashoka University), highlighted some of the brilliant stories of changes that are happening in the hinterlands, away from media headlines and social media gossips.

These are the real stories that reinforce faith in the bright future of India; much more than a startup with virtually no business model (or even any real revenue) raising a few million dollars at a billion dollar valuation to get “unicorn” status. These stories explain what a small but brilliant innovation could bring meaningful change to many lives.

In my numerous travels across the length and breadth of the country, I can certainly vouch that these true stories are not only inspirational, but also deeply insightful. These stories highlight an original Indian model of frugal innovation and entrepreneurship – the Gandhian model of Swaraj (self-reliance with dignity).

The following is a gist of three simple stories from hinterlands, reproduced from the cited report “Story of Change”, highlighting how small simple solutions can handle complex problems.

PARI – (A pilot program for Diarrhea management in Bihar

Pari (fairy), a plastic inflatable doll with two openings, one at the top and the other at the bottom, is used to educate villagers about diarrhea that kills many children every year. A frontline health worker (FLW) pours water into the top inlet to inflate the doll to show what a healthy baby looks like. Then she releases the water by opening the outlet at the bottom, which deflates the doll to demonstrate what diarrhea does to the body: causes dehydration. When the FLW plugs the second opening and pours ORS into the doll, the water does not leak out. She explains that in order to solve the problem, it needs to be ensured that the outlet at the bottom has been plugged. When the child is administered ORS and zinc supplements, it acts as a plug to the bottom outlet thereby retaining vital fluids that can be absorbed by the body.

Pari has been used in Bihar for over two years across eight districts. In 2018, the Government of Bihar committed funds to scale up Pari to all 38 districts of Bihar. Results showed that among women exposed to Pari, appropriate knowledge of diarrhea management was three times higher and the use of ORS and zinc was almost two times higher than women not exposed.

Mobile Kunji (Guide) – Aid for awareness on family planning, pregnancy and child care

Mobile Kunji is a multi-media job aid (Kunji means key or guide in Hindi) designed for use by FLWs when they counsel families. It has two components: a deck of colour-coded cards with illustrations and related key messages for each stage of pregnancy or post natal care, and an audio component accessed via mobile phone. Each card carries a unique, seven-digit number or mobile short code that the FLW dials from her mobile phone, playing a piece of pre-recorded audio content for the family she is visiting. The audio content is delivered in the voice of a fictional doctor character, Dr. Anita, who brings credibility along with her great and very localised bedside manner. Moblle Kunji helps standardise the FLWs' dellvery or the key messages, reducing inconsistency and significantly improving interpersonal communication.

Evidence shows that conversations between FLWs and families last twice as long when Mobile Kunji is used,and families trust FLWs who use Mobile Kunji more than those who do not.

Kilkari – Mobile health update for mother and the child

Kilkari (Hindi for a baby's gurgle) delivers weekly, time-sensitive audio information about reproductive, maternal, newborn and child health (RMNCH) directly to families’ mobile phones, from the fourth month of pregnancy until a child is a year old.It aims to improve families' knowledge and uptake of life-saving preventative health practices. Kilkari supplements the counselling visits that FLWs make, by providing a regular and more consistent source of timely, relevant information for families, reaching families that are otherwise left out, and addressing issues that FLWs hesitate to discuss. As of March 2019, Kilkari had reached almost 10 million users across 13 states in the country. Subscribers cited Kilkari as a private, comprehensive, credible source of information on family planning and the service contributed to building health equity by conveying information to women in marginalised communities, whom ASHAs may not visit.

Friday, May 28, 2021

Rural demand may not disappoint for long

In past couple of months a number of research reports have expressed concerns over the rural demand in the wake intense second wave of pandemic and subsequent lockdown of economic activities. Some consumer facing corporates have also expressed similar sentiment in their interaction with analysts and investors. The popular views seems to be that unlike last summer, when the rural demand remained resilient despite a wider and stringent lockdown, this year the demand may not show similar resilience. Wider and deeper spread of infection this time is one of the primary reasons behind these concerns. Rising stress in household and unorganized sector is also expected the discretionary spending in check.

In this context, there are few points that need to be noted by investors before forming a negative view on consumption theme.

Record production in crop year 2020-2021

Firstly, as per the third advance estimates for the 2020-2021 crop year, the agriculture ministry has expected record foodgrain production for 5^th consecutive year. India's foodgrain production is estimated to rise 2.66 per cent to a new record of 305.43 million tonnes in the current crop year 2020-21, on better output of rice, wheat and pulses amid good monsoon rains last year.

In the non-foodgrain category, the production of oilseeds is estimated at 36.56 million tonnes in 2020-21 as against 33.21 million tonnes in the previous year. Sugarcane production is pegged at 392.79 million tonnes from 370.50 million tonnes in the previous year, while cotton output is expected to be higher at 36.49 million bales (170 kg each) from 36.07 million bales in the previous year.

Given the remunerative pricing and higher volume of crop conventionally augur well for the overall rural income.

Normal monsoon forecast for 2021

The India Meteorological Department (IMD) has forecasted a normal monsoon for 2021. As per IMD’s latest forecast, Southwest monsoon, starting in June, is expected to be normal at 98 per cent of the Long Period Average (LPA).

This week, the widely-respected Australian Bureau of Meteorology (BOM) has also ruled out the likelihood of the rain-disrupting El Nino phenomenon over the next six months. Meteorologists say that a low probability of El Nino is certainly good news for the monsoon, although the complex weather system depends on many other factors.

A good monsoon usually means another year of good bumper farm production and consequent positive impact on the rural economy and consumption demand.

Second wave weakening and economy unlocking

In past one week, the second wave of pandemic has shown a clear tendency to decline. Further improvement is expected over next couple of weeks. It is likely that the mobility restrictions may begin to ease as the Kharif sowing season approaches. It is therefore likely that the income loss and spending curbs (due to mobility restrictions, health concerns, curtailed marriage spending etc.) seen in 1QFY22 may not spill over fully to the next quarter.

Indubitably, full reopening of economy and normalization of household spending may take at least 3 to 4 more quarter, till a significant proportion of the population is inoculated. Consequently, the economic growth for FY22 earlier projected to be in the range of 11-12%, may get constricted to 7-8%. This implies that Indian economy will attain the FY20 level of economic activity only in 2F2022 only.

My personal assessment of the rural and some semi urban areas in UP, MP, Punjab, Haryana, and Chhattisgarh is as follows:

· Household finances have been damaged across the state, especially in the lower income group families. Lower income and medical expenses have eaten up savings and overall debt level has risen (most of it informal or friendly). The expenses on education and health have risen for a common household. For 5% households these trends may be structural due to loss of life or permanent employment. Lenders (formal or informal) will have to share some burden of this in near term.

· The consumer confidence for discretionary spending is materially lower. However, two wheeler and smart phone/tablet may not be discretionary in most cases. Clothing, jewellery, home renovation, wedding, etc are some of the discretionary items that may cut material cuts. Down-trading in staples, personal care, shoes, home appliances, personal vehicles is also clearly visible.

· The credit worthiness of an average household has diminished. The personal loan segment has been witnessing maximum growth in past few years. A slowdown in this segment may be inevitable.

· The demand for farm input remains robust. Farm credit disbursement however may have slowed. The worst impact is from contraction in farm credit from informal sources. How efficiently this conundrum is resolved, may have material impact on the growth of rural economy. Implementation of farm laws in letter and spirit would be critical in resolving this situation.

· The loss of life is unfortunate in any case and under any circumstance. In rural area, the Covid fatality rate is materially more in second wave as compared to the first wave. However, given the disguised unemployment and underemployment, the economic impact may not be as severe as many analysts might be anticipating. Not more than 5% households in rural areas have borrowed money to get treated at private facility in towns.

· Pandemic has actually resulted in upgrade of healthcare facilities in many tier2/3 towns and villages. Hopefully much of this improvement will stay post pandemic also which will be a major positive for rural economy of India.

· In rural and semi urban areas there is resistance to vaccines. Much of this resistance is result of misleading propaganda by ignorant, mischievous and/or malevolent elements. So far the institutional effort to counter this misinformation campaign in grossly inadequate. Recover would largely depend on how fast we convince people to get vaccinated and actually vaccinate them.

Based on my assessment I would not be too worried about consumer staples beyond couple of quarters. A material correction post 1QFY22 results could actually be a good entry opportunity. I would be extremely cautious about retail lenders, especially unsecured loans, and sale of premium vehicles. Appliances sales may miss this summer season, but might see a near normal festival season post monsoon.