“A large-scale rural community-based intervention for Covid-19 resilience and risk reduction in Western part of India: A retrospective impact evaluation (Preprint)

Abstract

Globally, especially in the lower middle-income countries (LMICs), rural populations had higher susceptibility to the negative impact of the Covid-19 pandemic due to lower levels of community awareness, poor hygiene, and lower health literacy accompanying pre-existing weak public health systems. Consequently, various community-based interventions were engineered in rural regions worldwide mitigate against the COVID-19 pandemic by empowering the people to mount both individual and collective public health responses against the pandemic. These interventions were predominantly driven through the principles of community engagement through dedicated village level volunteers that coordinated government and administrative action to enable the delivery of need-based assistance to the village communities. Furthermore, technology-based interventions through social media communication, short message texts, and pre-recorded voice calls were frequently utilized to improve community awareness and preparedness during the pandemic. However, till date, there is paucity of information on the effectiveness of any large-scale community intervention in controlling and mitigating the effect of the Covid-19 pandemic especially from the perspective of LMICs.

This retrospective impact evaluation study was conducted to evaluate the effect of a large-scale rural community-based intervention, the Covid Free Village Program (CFVP) on Covid-19 resilience and control in a rural population in India. Principles of village empowerment, volunteerism, community mobilization informed the intervention with techno-managerial support by a grassroot non-governmental organization.

The intervention period lasted from Aug 2021-Feb 2022 and the impact evaluation from April-May 2022. Data were collected from 3500 sample households from villages across intervention (Pune district) and comparison (Satara district) arms using two stage stratified random sampling through face-to-face interviews followed by developing a matched sample using propensity score matching methods.

We did not observe any significant change in the overall Covid-19 vaccination coverage due to the implementation of the CFVP. Furthermore, the number of Covid-19 deaths in both the sampled populations were very low. However, participants in Pune compared to Satara had a significantly higher combined Covid-19 awareness index by 0.43 points (95% CI 0.29-0.58). Furthermore, the adherence to covid appropriate behaviors including handwashing was 23% (95% CI 3%-45%), and masking was 17% (0-38%) higher in Pune compared to Satara. The probability of the availability of routine medical services, continuing routine child immunization, routine antenatal services, and medicines for chronic diseases had significant higher odds in Pune compared to Satara. Furthermore, the probability of observing Covid-19 related stigma or discrimination in their locality was 68 percent lower (CI=0.133-0.191) in Pune compared to Satara.

The CFVP contributed to improved awareness and sustainability of Covid appropriate behaviours in a large population although without evidence of higher Covid-19 vaccination coverage or reduction in mortality, signifying potential applicability in future pandemic preparedness especially in resource constrained settings.

Not Applicable