The only thing that can be even remotely considered as a silver lining in this pandemic is the stark and unrelenting spotlight shone on persistent gaps in healthcare in India. While those within the health system valiantly fought to provide the best care possible within limited resources, the fact remains that the system itself is grossly inequitable, especially for underserved pregnant women and children.

Inequitable health care system

Even today, 3 women die every hour because of pregnancy-related complications. Only one of five pregnant women get complete antenatal coverage while 18% infants have low birth weight, leading to complications that prevent them from realising their full potential. Adding to this is the acute shortage of medical staff. India has 37.6 health workers for every 10,000 people, against WHO’s minimum recommendation of 44.5.

The sheer size and scale of India’s problems requires an equally bold response, one that can serve its huge population and remain resource-light. Technology, thus, promises a powerful solution

Ramesh Padmanabhan, ARMMAN’s CEO

Promise of Tech-enabled Solutions

25-year old Anita stays at a Mumbai slum. During her fourth month of pregnancy, when she went for a checkup at the nearby hospital, she was enrolled in ARMMAN’s mMitra program. She started receiving bi-weekly pre-recorded mMitra calls on her phone, in her mother tongue. mMitra calls guided her on important vaccination milestones, provided nutrition-related information, and made her aware of danger signs and symptoms. Mobile technology allows this potentially life-saving and critical information to reach each woman, something not feasible at an overcrowded hospital. 2.5 million women like Anita have been enrolled in mMitra, making it one of only five such scaled mHealth programs across the world.

Rapid Response of Tech-Solutions during COVID

When COVID-19 struck, as a pregnant woman living in a slum, Anita was especially vulnerable. Thus, when she started getting additional mMitra calls with COVID-19 specific information, she paid close attention and followed the advice regarding sanitization and social distancing. This helped her as she couldn’t access a hospital for regular care as it was converted to a COVID hospital and there was limited public transportation to go to another centre. Technology enabled ARMMAN to reach 300,000 women and 800,000 health workers within a few days.

“Touch” Integration Critical in Tech-Solution

Technology by itself is inadequate and requires a strongly interlinked “touch” model to be effective. In her ninth month of pregnancy, Anita started experiencing acidity and frequent headaches.She reached out to Shital, ARMMAN’s hospital supervisor, for advice, who connected her to a doctor at its free Virtual clinic. The doctor diagnosed it to be a consequence of high blood pressure- a high-risk condition that requires monitoring. Anita’s blood pressure was immediately checked and brought under control with timely intervention. While mMitra calls were critical, access to a doctor and the hospital supervisor’s support was just as crucial during this daunting time.

Importance of Contextualised Tech-Solutions

With technology, it’s also tempting to deploy a cookie cutter approach, which has challenges in a country as diverse as India. “An mMitra, working well in an urban slum with good network connectivity, may falter in tele-dark tribal areas like Palghar that is just 4-hours drive from Mumbai. Here, a stable network is limited to certain public spaces in the larger villages, with smaller hamlets often falling off the connectivity grid. Telephonic coverage is almost certainly not available in the kitchens at the back of the houses or in the cowsheds where women generally spend most of their day,” mentions Mr. Padmanabhan. Thus, pregnant women and children are supported with door-step healthcare through ARMMAN’s Arogya Sakhi project. Frontline health workers from the community are trained to provide home-based preventive care. They counsel women on topics like nutrition and vaccinations, perform diagnostic tests, screen for high-risk factors and ensure early referral. They are aided by a tablet with an application-based decision support algorithm which acts as a database and flags off any high-risk conditions, thereby alerting the health worker of any possible complications during pregnancy and infancy. The technology is designed to function in a low-bandwidth setting and mobile hotspots created for limited access to data.

Danger of Technology Exacerbating Inequities

Although technology is a great enabler for transformation, it can also act as a barrier by deepening divides and exacerbating existing inequities. For example, digital-first solutions will not work where people lack access to even a basic mobile phone, or with a large migrant population that frequently changes its number. Here, it is imperative to adopt an equity lens while designing tech-enabled solutions to ensure that technology does not end up excluding the most vulnerable and marginalised i.e. the very group of people the intervention aims to uplift. It is also crucial to understand the interventions of other civil society organizations in the area, and explore possible avenues of collaboration to achieve the most effective outcomes.

The “tech plus touch” model can go a long way in addressing systemic gaps, but implementing truly impactful and equitable health initiatives requires multi-stakeholder input, innovative approaches and a design that keeps the mother and child at the centre of all solutions.

When the lockdown was first imposed in March 2020 and everything was shut down, rural and remote India was the worst hit. Unlike the urban populations, people from rural and remote locations in India didn’t have access to fast-speed Internet connectivity, many of them did not possess a digital device per household member or have access to the many mobile apps that made the stay-at-home a little more bearable for their urban counterparts. Transitioning to online banking, grocery and food delivery or work from home didn’t come as easy to them.

This population was not just unable to access services but was also ignored by the systems largely, leading to their further marginalization due to reverse migration, loss of livelihood, poor access to health care, reduced access to food supplies and disconnect from educational opportunities, among others. In 2021, the situation was worse. With the pandemic entering Year 2, rural and remote populations saw their economic capacity dip even further, their quality of life deteriorate even more and their access to basic and essential services made almost impossible.

Access to essential services

When the COVID19 pandemic began in 2020, the focus of government, civil society organisations and other stakeholders was to curb the spread of the virus through imposition of lockdowns and increasing awareness. The Digital Empowerment Foundation (DEF) too focused on creating awareness about Covid appropriate behaviour and ensuring access to sanitisers and masks last year. This year, however, the focus was more to ensure communities have access to their essential services, which had been rather abruptly disrupted during the first lockdown.

Several organisation have been using their experience and leveraging their networks and programmes to respond to the needs of the communities they serve, such as running helplines, ensuring access to food and healthcare services. We too responded to these challenges by leveraging our available Internet-enabled community-based digital infrastructure resource centres. These digital resource centres, which were operated and managed by young people from the community trained by us and called SoochnaPreneurs, acted as local service hubs. DEF’s SoochnaPreneurs, while ensuring all safety precautions, facilitated access to financial services for those with bank accounts, enabled access to government entitlements for those who relied on public schemes and benefits, and turned into classrooms for those who were missing out on regular schools.

It is worth noting that during the second wave young people’s participation and leadership has been integral to tackling local issues. This group, which faces great uncertainty and anxiousness about its education and livelihood aspirations, have been torchbearers in their communities when it comes to raising awareness around Covid-appropriate behaviour, vaccine hesitancy and ensuring their communities have access to essential services. We, too, witnessed this.

Our young SoochnaPreneurs ran hyperlocal relief work and resource mobilisation on the ground. This involved a barter system of sorts in the villages of India, to allow exchange of surplus ration supplies. Some SoochnaPreneurs, who had a large network on their social media, ran fundraisers online to reach out to well-wishers outside of their villages and districts, and encouraged them to donate cash via digital wallets like Google Pay and banking apps. One such SoochnaPreneur, Mohd Arif, managed to raise INR 25,000 for the people of Nuh in Haryana. This helped him support hundreds of people in his village by supplying rations to families, pay for mobile data of children to attend school, and ensure medical supplies for those struggling to access any. Arif succumbed to Covid a few months later but not before leaving behind a legacy of giving and caring in Nuh.

Access to healthcare services

Funders, bi-lateral and multi-later agencies have also been collectivizing young people both online and on the ground to champion various causes related to COVID. One such example is UNICEF’s Young Warriors Coalition, a partnership to catalyse a pan-India movement to mobilise and arm 5 million “Young Warriors” to combat COVID-19. With the support of UNICEF, our SoochnaPreneurs or Covid Warriors managed to reach 35 lakh individuals online — via instant messaging and social media platforms— with their messaging to tackle the pandemic. Additionally, a partnership with DocOnline enabled these young men and women to provide village residents with online video consultations at a time when even basic healthcare was hard to find, let alone Covid-related treatment and care.

Access to educational content

Young people’s access to education has also been severely impacted due to the pandemic. Continued school closure and transition to online classes has led to disparate and restricted access and loss of learning. In DEF’s experience, while relief work continued, we heard from several communities that education was a pressing concern for their children. Several organisations in the country have been working tireless to ensure children’s education is not disrupted through access to services or resources, and even through the availability of infrastructure. At our end, to solve for the digital divide, we saw our responsibility in leveraging our networks on social media and messaging platforms to raise about 5,500 used laptops and mobile phones. These crowdsourced devices were then used to create 500 community access points (common facility centres) at the village level for school-going children so that they could access online educational content during the lockdown.

Access to livelihood opportunities

The pandemic has put major strains on the development sector in India with many CSOs and NGOs facing challenges in terms of funding and supporting communities on ground due to restrictions on mobility. However, several funders and philanthropists around the world have mobilized additional funds and allowed flexibility in existing funding to support organisations and the communities they work in through this time.

We need to understand though that change does not happen not overnight. While an organisation can offer immediate relief, it can often take a while for the impact to sustain or for change to be actioned. For example, between 2010 and 2015, DEF had trained some 500-odd young boys and girls in digital literacy in the town of Chanderi in Madhya Pradesh. And we recently found out that at least 80 households in Chanderi had managed to sell at least one product online during the second surge by leveraging social media and eCommerce platforms. This shows that even efforts we made almost a decade ago have allowed some families to sustain themselves during the pandemic. Similarly, our efforts at creating a pool of SoochnaPreneurs who can support their community members in these times of crisis will help some of the most marginalised communities stay afloat as we eventually recover from this pandemic.

Today, access to a smart device and fast-speed Internet has become a necessity to access quality educational, livelihood, governance, financial and even entertainment content. Considering the intense adverse effect that digital divide has created across rural India amid a pandemic, many organisations like DEF have been strongly advocating to make smartphones affordable and Internet accessible for all homes. Funders, too, need to step up and see hardware and connectivity as key investments towards change. It is imperative for the government to consider digital access as a fundamental right and make provisions in welfare schemes to make the Internet available for vulnerable and marginalized communities.

—

Digital Empowerment Foundation is one of the 10 organisations that has been covered as a case study in the report titled ‘Buffering Now’, published by the 10to19 Dasra Adolescents Collaborative. This report spotlights organisations that have had a head start when it comes to leveraging digital technologies in a pre-Covid world, and thus sharing learnings and recommendations for organisations that want to adopt to digital tools and technologies amid the pandemic to serve their communities.

Photo Credits: Digital Empowerment Foundation 

The last year and a half has been hard on everyone. People are feeling isolated, deserted and lost. And it’s no different for adolescents and young people. However, what makes it harder for them in a lot of ways is that there aren’t enough people to hear them out. This has pushed them into a state of despair and hopelessness.

At Dasra Adolescents Collaborative (DAC), we have been able to understand this from our interactions with young people over the last couple of months. Between mid- May and now, we’ve spoken to nearly 200 young people from rural and remote parts of Jharkhand, Bihar, Rajasthan and a few other states about the impact of Covid-19 on their lives, the disruption it has caused, and how they are coping with it. Through these sessions with the young people, we have heard that a lot of them are shifting between emotions such as:

• • • Boredom due to lack of engagement with peers or opportunities to go out

    • Anger due to lack of control over the situation and the consequences

    • Anxiety due to lack of clarity about the future

    • Despair due to lack of hope for a bright future

Young people are worried about the opportunities they have lost and may continue to lose over the next few months or even years with the devastating long term effects on the economy; there is fear about the continued spread of the virus, it’s variants and the possibility of a third wave; there are myths, rumours and misinformation about the efficacy and availability of the vaccine; and there is disappointment towards the government in how they’ve handled the situation in some parts of the country.

India’s young people are not alone in struggling with these feelings and fears. Globally, the pandemic has been extremely harsh on young people. According to the UNICEF Annual Report 2020, released last month, 1 in 7 children and young people has lived under stay-at-home policies for most of 2020.

Up to 94% of students worldwide have been affected by school closures at the height of the pandemic.

At least 1 in 3 schoolchildren has been unable to access remote learning while their schools were closed. Around 10 million additional child marriages may occur before the end of the decade. Disruptions in food systems and health and nutrition services could leave 44 million children hungry. As many as 142 million additional children were estimated to fall into monetary poverty by the end of 2020 and lack access to social protection.

This avalanche of data points should not scare us, but it should worry us. Unfortunately, the pandemic and its consequences have had financial, physical, social, emotional and psychological impact on the lives of young people. Even as they struggle with these emotions, they feel left out from conversations and decision making processes that impact their lives. We as community members and development practitioners can support young people through the challenges they’re faced with.

While it is true that practitioners who have been in the sector for a time long may rightly feel that we know what’s best for them. We must ask ourselves what could be the value add of hearing from young people themselves what’s best for them? What harm would it do if we heard directly from them on their challenges, needs and aspirations? Maybe what we hear from them validates what we already knew, but maybe there is something new that we hear or something that we hadn’t thought about.

As a nation and sector that talks about the strength and the need for investment in our large young population, we must also trust them to make decisions for themselves, and ensure that we create and hold platforms and safe spaces for them to voice their opinions. There is an urgent to engage with young people and allow them to speak their minds freely. We need to create safe spaces for them where they can raise their concern, feel heard and have their queries answered.

This has been part of our learning at DAC too, over the last few years. Every year, we are taking a step forward to be more inclusive and engage with young people in a meaningful way. The Ab Meri Baari campaign, which started in 2019, was the first step in that direction. Since then, we’ve come a long way; and the pandemic, especially, has made it even more crucial for us to ensure that young people have platforms to share their views, to get answers to their questions and that we, at DAC, involve them when we make decisions that may impact their lives. Keeping this ethos in mind, this year we’ve committed to establishing a Young People Working Group, to include their perspectives on challenges and solutions for DAC’s immediate and longer-term COVID responses. Keeping young people’s voices at the core of programming is more vital now than ever before, as they have the deepest understanding of their own needs and challenges, and can support in identifying and executing the most effective solutions to address these as we focus on rebuilding a more hopeful world for young people.

We’re finally starting to prioritize young people’s mental health and well-being. However, we still have a long way to go. In the meantime, we need a perspective shift towards mental health.  

Awareness and action to address mental health issues are growing rapidly in India, with the need for increased awareness and better mental healthcare services at the fore. However, these conversations often leave out the critical demographic of young people. As a result, they remain largely  under-addressed when it comes to mental health.  

Presently, every fifth Indian is aged between 10 and 19. Adolescence is a particularly vulnerable period, owing to the significant developmental and psycho-social changes that characterize it. Adolescents’ lives are shaped by this transitionary phase as they enter adulthood, marked by new and unprecedented social and emotional experiences. It is also often overlooked that this stage is one of increased vulnerability to mental health issues , owing to rapid changes in peer relations and interests, physical and biological changes, and ambiguity in various aspects of life, ranging from education to career prospects and the future. The National Mental Health Survey (2015-2016) indicated that over 9.8 million teenagers between the ages of 13 and 17 live with depression. Often precipitated by social and cultural stressors, young people’s mental health issues are rarely identified and poorly addressed and can have significant and lasting consequences.  

That there is social and cultural stigma around mental illness is well-known. Misinformation around mental health accompanied by limited resources to adequately treat it are commonplace. The pandemic has significantly exacerbated the existing mental health challenges among young people. A study conducted by the 10to19: Dasra Adolescents Collaborative (10to19) in June 2020 indicated that young people have reported increased rates of  depression, anxiety and thoughts of suicide over the course of the pandemic. Of the 111 responding organizations, over 46% of organizations found that young people were experiencing fear and anxiety, and 41% of young boys and girls reported feeling afraid for their futures.  

More recently, a consultation conducted by the 10to19 Collaborative with young people gave voice to some of their most urgent mental health concerns. Over a year since the pandemic began, young people continue to experience various stressors, exposure to which has left them feeling disconnected from their peers and their regular lives. During the session, nearly all young people echoed that they currently feel despair and anxiety, whether about the pandemic or, in fact, about their future in the years to come. 

Most young Indians are still facing the impacts of long-term social isolation and experiencing their world digitally – or worse – are completely cut off from their education due to skewed and uneven access to the internet. Removed from otherwise nourishing environments, they are now left without livelihoods and access to critical resources, leaving them with unanswered questions of what the future will hold.  

Where do we go from here? 

The accounts shared by young Indians highlight the complex, multi-faceted emotions that they are experiencing; from fear due to the pandemic, to despair and anger when faced with unraveling its long-term consequences on their educations, livelihoods and family lives. However, despite the anxiety, loss and grief that have defined the past few months, they have also shared important stories of resilience and learning, highlighting the new skills they have built and the creative ways in which they’ve learnt to connect with one another and their families.  

We are still only just beginning to understand the ways in which COVID-19 has impacted a generation of young Indians. The pandemic has severely affected education and job prospects, leaving a vast number of young people with pressure to provide for their families. Long-term isolation is also likely to hamper young people’s social skills, leaving them unable to connect with peers or adults or to build adequate coping skills. Young women continue to bear the burden of care work, often without access to education and at increased risk of child or early marriage. The toll of these factors on young people’s mental well-beingis likely to be immense; iIt stands to reason, then, that we must shift our approach to mental health programming, addressing it intrinsically in everything that we do.  

Much like we address gender sensitization, it is imperative that we adopt a lens of mental wellbeing when designing and implementing programs, reminding ourselves that young people’s health cannot be isolated from every other facet of their lives. It is only then, that they will be able to not only seek gainful employment – but also sustain it. That they may make informed and active choices about their bodies and wellbeing, and that they can 

This lens needs to be holistic and integrated into our understanding of youth-centric programming, giving them patience and compassion as they navigate a difficult time globally and in their own lives. The responsibility of this shift lies on all of us – civil society, the government, funders, and their families – to unlearn the disinformation of the past and ensure that India’s adolescents have access to a better, brighter future. 

Brief Overview 

The 10to19 Dasra Adolescents Collaborative (DAC) and EnterChange Innovations (ECI) organized a youth consultation with 60+ young people on 10 July, 2021, with a view to understand the impact of the Covid-19 pandemic on the youth. ECI is a youth engagement partner for DAC, and is a leading organization that engages youth on matters of sexual and reproductive health and sexual rights. 

This session, which engaged young people from Rajasthan and Bihar, was the second consultation in a series of engagements with young people. The first consultation with young people was hosted on June 10, 2021, and engaged participants from Jharkhand.  

The objective of these youth consultations is to bring together young voices on one platform, to hear directly from them about their challenges and needs amid a global pandemic, and to learn how are they dealing with their mental health in these stressful times. The conversations though were particularly broken down into two areas — Understanding the emotions that the youth are going through and the coping mechanisms they’ve adopted to deal with them; and understanding their concerns and questions that have stemmed from the living in the pandemic. 

Key Highlights 

Based on the discussions and activities, it was understood that the youth are primarily feeling and shifting between four emotions: 

• Boredom due to lack of engagement with peers or opportunities to go out 
• Anger to the lack of control over the situation 
• Anxiety due to lack of clarity about the future 
• Despair due to lack of hope for a bright future 

Based on a survey carried out during the seminar with the participants, about 87% of the youth accepted to be feeling constantly anxious and pessimist about their future due to the interruption in their education. As many as 68% of the participants said they’re sad, and the last year and a half has pushed them into a stressful place where they’re feeling suffocated. About 53% of the surveyed youth accepted that they find themselves feeling helpless at times, which leads to anger; and 49% of the participants are struggling with boredom due to the frequent lockdowns, restrictions on movement and ambiguity of their future.  

Evidently, interruption of education, loss of family income, lack of clarity about the future, increased in domestic abuse and forced child labour were the key stressors for the young people, besides of course the direct impact of the virus on people’s health. Education, however, stands as the top stressor. Adopting the modalities of online education has also been difficult for the students, especially given the limited access to smart devices and reliable Internet connection. The break in their education, they fear, is sure to affect their chances at higher education, competitive exams and practical learning opportunities, including internships and on-the-job learning.  

The direct and indirect consequences of the pandemic has also left the young with several questions about the virus, the vaccine, their families and their future. Some of the key concern areas for the youth were found to be around (See annexure for a complete list of questions): 

• The efficacy of the available vaccines and myths around it 
• The impact of the pandemic on education and future careers 
• The support provided by the government for families who have lost their source of income in the pandemic.

Last year, the 10to19 Dasra Adolescents Collaborative, through the ‘Lost in Lockdown’ report, studied the ways in which the lockdown and pandemic affected the various essential and developmental aspects of the lives and well-being of young people. This report explored themes of education, livelihoods, social isolation, mental health, exposure to violence, reproductive health and child marriage, as well as access to food and health services. The study surveyed 110+ non-profit organizations serving vulnerable adolescents across the country and served as a collation of their insights and experiences- and the accounts we heard only further validated that the pandemic has severely affected adolescents and young people.

We appreciate that each organization that we work with or have worked with is working intentionally and tirelessly in this time of adversity. We commend organizations for staying on the path of impact and still finding ways to support employees and communities and also take on relief work where needed. As the 10to19 Dasra Adolescents Collaborative, we find ourselves in a position to be able to bring together some of these campaigns and efforts, collate learnings from across stakeholders, and create spaces to convene partners to continue discussions and work on each of our visions and goals for the communities we serve. At a time when most of us are grappling to devise and deploy solutions to this crisis, we believe that coming together and learning from each other is critical and valuable.

In this spirit, we are sharing below some early movement and updates, which we hope are just the beginning of a longer, sustained series of collaborative and supportive efforts –

• #BackTheFrontLine Initiative: Through this initiative, Dasra is working to mobilize support for 100 locally-led NGOs that are leveraging their deep experience on the ground and bold, community-centric and nimble approaches to drive impact at the very frontlines of India’s COVID-19 response. We have already mobilized USD 6.3M. In the coming weeks, we will scale this initiative up towards achieving that 100 NGO target.
• Amplifying community and on-ground needs: Continuing the ‘Voices from the Ground’ series from last year, we will keep up the practice of convening and consulting with NGOs, Government stakeholders, experts and adolescent girls to hear from them about the need of the hour. As part of this series, we have already initiated conversations with the Central and Jharkhand state governments to best understand where we could support and identify gaps to bring in support from our partners. We aim to keep our approach participatory and collaborative and will continue to engage 500+ Community of practice organizations and multiple funders and young people as we try and respond to emerging needs.
• Systems Change through learning & Collaborative Solutioning: To ensure we continue to centre the voices of our NGO partners working on the frontlines, we have begun to meet with a small group of partners to listen, learn and share from each other’s experience of grappling with the situation. As next steps, we will send across a survey to this group, and will also meet with a larger group of partners in the first week of June. Please do let us know by replying to us if you would be interested to be a part of these discussions. We hope these meetings will become a space for candid, real-time ideation and peer learning so that we can collectively serve our communities in the most relevant and effective ways possible.

We hope this information was helpful, and please reach out to us at 10to19community@dasra.org with questions or interest in any of the above. Take care and stay safe!