Role of local Governing Institutions in Community-based Management of Covid-19 Pandemic in Two States of South-India: Mixed Method Cross-Sectional Study

Background: COVID-19 pandemic has highlighted the critical role of community engagement and local health governance inimpact mitigation and for enhanced preparedness. This study assessesthe role of elected Gram panchayat representatives (Sarpanches) and linked volunteers; and explores the enablers and barriers for community-level management of COVID-19 and uptake of vaccination in the two states of Southern India – Andhra Pradesh (AP) and Telangana state (TS). In addition, this study also looked into the availability and utilization of COVID-19 related care and routine clinical care and Maternal and Child health services. Methods: A cross-sectional study using mixed methods was conducted in two districts of AP and TS: Quantitative semi-structured telephonic interviews with 183 Sarpanches and volunteers; and Qualitative in-depth interviews with Sarpanches, volunteers, patients who recovered from COVID-19, and lactating mothers. Results: Participants from TS had mean knowledge score 6.4 (5.8, 6.9) whereas participants from AP reported a mean score of 5.5 (4.9, 6.1). The study findings suggest a significant association between socioeconomic status and educational level with knowledge. 74% of participants practiced wearing masks and 59% washed hands whereas 91% were vaccinated. Sarpanches ensured community compliance for COVID-19 appropriate behaviour and vaccination; and supported the COVID-19 control activities. Most of the COVID-19 patients reported feeling stigmatized even after recovery. Most beneficiaries preferred government-run facilities for any healthcare. Mothers were however, dissatisfied with services in government hospitals and reported high out-of-pocket expenditures in private hospitals. Conclusion: The study established the crucial role of Sarpanches and volunteers in COVID-19 response. It is important to build their capacities further for better community-based preparedness. Primary healthcare facilities need to be strengthened to provide uninterrupted services even during any disruptive events such as a pandemic like COVID-19. Key Findings: 1. Local government representatives (Sarpanches) and linked volunteers from TS were found to have higher mean knowledge scores compared to AP and a significant association as found between socioeconomic status and educational level with knowledge. Sarpanches and volunteers played an important role in community-based management of the COVID-19 pandemic by creating awareness regarding CAB, motivating the community for vaccination and providing support for isolated and quarantined patients. 2. Most respondents preferred government health centres and hospitals for COVID-19 related care and primary health care services such as MCH services as they were more accessible and trustworthy. Key Implications: 1. While local governing bodies and linked volunteers have been engaged in delivery of social development schemes, the COVID-19 pandemic has helped us understand their potentialin promoting positive health behaviors and delivering essential health services among the community. Regular sensitization of these bodies will empower them to implement Public Health and Social Measures (PHSM) for pandemic control more effectively. 2. Government healthcare services should be strengthened for pandemic response and mitigation as they were found to be preferred universally for their accessibility and quality of care.