During the first and second waves of the COVID-19 pandemic in India, strict lockdowns limited the spread of the disease. However, the lockdowns also prevented people in many communities from accessing essential services, such as medical and mental health treatment, and essential goods including food and pharmaceutical and medical equipment. This lack of access was especially severe for people living in urban slums who rely on daily wages to survive.
The Society for Nutrition, Education and Health Action (SNEHA), based in Mumbai, acted quickly to deliver interventions to the city’s most vulnerable people. Starting in March 2020, SNEHA adopted technologies such as online meeting platforms and communications tools on smartphones to to enable its large network of volunteers and staffers to ensure continuity of essential services and provision of counseling and psychological assistance to low-income people across the Mumbai metropolitan region.
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The Society for Nutrition, Education and Health Action (SNEHA) paired its deep roots and long community relationships with innovative technological tools to deliver essential services to a locked-down public. For instance, SNEHA used technological tools such as smartphones and web-based applications to mobilize more than 8,000 community volunteers to provide training and support services to frontline health workers and boost community awareness of non-pharmaceutical interventions (e.g., handwashing, mask usage, and other hygienic practices). Volunteers also provided basic mental health and psychological assistance via telephone and internet and distributed food and other rations to families in need. By leveraging this new approach to outreach, SNEHA has served more than 1 million people during the COVID-19 pandemic.1 How can you replicate/implement this promising practice?Use Technology to Link Individuals to Public Health and Social Safety NetsSNEHA’s work during the COVID-19 pandemic was guided by three main principles: 1. Enabling connectivity for its volunteers. The organization provided tools such as high-speed internet, and data packs to volunteers and loaned smartphones to adolescents who needed them to participate in its programming. 2. Leveraging the web applications that make virtual engagement possible and link people to each other and to the information they need to thrive. SNEHA trained volunteers to use smartphone platforms such as Zoom, WebEx, Google Meet, and WhatsApp (as well as the telephones themselves) to achieve widespread dissemination of messages on COVID-19 prevention and mental health support and reach out directly to vulnerable groups such as women and children, strengthen public health capacity, and track progress and performance.2 3. Providing technology support and security for its team. Rather than hiring a new team of people who already knew how to use, maintain, and secure these new tools, SNEHA provided technology support and training to its existing team, thereby strengthening their (and the organization’s) capacity for the future. |
What are the lessons learned from this bright spot?
When the COVID-19 pandemic struck India in March 2020, officials quickly introduced measures such as lockdowns and quarantine to contain the spread of the virus. However, these measures also interfered with the provision of essential health services and made it especially difficult for low-income people in slum communities who rely on a daily wage to obtain necessities in the small, frequent quantities they can afford. SNEHA leveraged its deep roots and decades of relationships with public health workers, communities, and government agencies to provide these essential services using innovative technological tools appropriate for the context of a pandemic lockdown.
“At SNEHA, it is this crisis that turned into a litmus test for the decades of relationship building with public health workers and professionals alike.” – Program Director, Empowerment, Health and Sexuality of Adolescents, SNEHA, Dr. Rama Shyam3
Providing Virtual Counseling and Mental Health Assistance, Especially to Survivors of Domestic Violence
COVID-19 prevention measures that kept people indoors, often in small and crowded homes, elevated the stress level in many households. This, in turn, strained mental health across the board.
SNEHA responded to this crisis by expanding its usual approach and pivoting from in-person interventions (such as services offered at counseling centers) to forming a virtual safety net for domestic violence survivors. Crisis interventions typically included counseling for survivors, coordinating medical aid if required, helping the survivor register a police complaint remotely, immediate conflict diffusion by intervening with the family members through the helpline and home visits by volunteers, exploring support networks for the survivor to seek shelter and mental health counseling. Supportive mental health counseling and mental health interventions mainly for anxiety, depression and post-trauma psychological experiences were carried out through individual counseling and psychological education, role education with the perpetrator, couple and family counseling to minimize the impact of violence and trauma. SNEHA expanded its approach to provide most of these services online and by phone. In addition, SNEHA supported the One Stop Centre at King Edward Memorial (KEM) Hospital, which provided counseling online and by phone to women and children in distress.4
On average, SNEHA counseling centers registered around 400 cases monthly (classification of cases include intimate partner violence, domestic abuse, sexual assaults, child abuse and others), including women and children, and around 4,800 cases annually. Domestic violence survivors typically accessed the counseling centers physically and could access a range of interventions. In March 2020, however, with the first nationwide lockdown, the counseling centers recorded 513 cases (increase of 28 percent over monthly average), with 177 survivors (37 percent) receiving initial assistance, psychological support and education, and referral to the police and counseling services through the helpline.
For survivors who could not visit the counseling centers in person, SNEHA set up crisis helpline and a crisis email address. In the months preceding the pandemic, the counseling centers received on average 1-2 helpline calls and 23 crisis emails each month that required assistance. During the first three months of the lockdown period (from mid-March to May 2020), however, SNEHA counselling centers received a total of 98 crisis emails and 225 calls on the helpline. Contact through the helpline and email went up remarkably due to restricted mobility of women in the household and close, sustained proximity with potentially abusive family members. Survivors requested help as they faced physical, emotional, verbal, and sexual violence in their homes.5
As part of the long-term intervention process, SNEHA counselors conducted follow-up with more than 1,441 survivors by telephone. The counselors mainly checked-in with women to understand their situation and whether they needed assistance. These follow-ups continued for about six months.
Providing Online COVID-19 Training to Health Workers
SNEHA provided essential support services to health workers across seven municipal corporations. The organization offered online training to 714 accredited social health activists (health workers) and 930 members of Mahila Arogya Samitis (women’s health committees) on COVID-19 preventive measures. It also provided 539,650 units of personal protective equipment and other materials such as masks, sanitizers, and oximeters to health workers as of June 2021.6
Monitoring and Evaluating Programs Using Phone Surveys
Typically, SNEHA collects data for research and evaluation using in-person surveys, but during the pandemic it conducted surveys by phone with more than 3,500 people (volunteers, health systems staff, and community leaders). In the process of conducting eight telephone surveys—both to implement its evaluation framework and to boost its understanding of community responses to COVID-19—over 10 months, SNEHA developed a list of six practices for telephone surveys that can be used during pandemic lockdowns and under more ordinary circumstances. The six practices are: (1) build rapport with respondents, (2) obtain informed consent by making sure respondents understand the purpose of the data being collected and what they are expected to do, (3) create a flexible protocol for returning missed calls that accounts for respondents’ schedules and preferences, (4) limit the interview to a maximum of 20 to 30 minutes, (5) ensure the quality of data collected by verifying the respondent’s identity and that they are in a position to answer questions openly and honestly, and (6) strengthen the capacity of surveyors through training and support and an open line of communication to ensure their needs are met.7
How was this promising practice implemented?
Leveraging Community Connections for Outreach and Awareness
SNEHA’s deep roots and relationships in the community where they work enabled them to identify and engage with nearly 8,000 community-based volunteers when the lockdowns began in March 2020. These volunteers connected with people in slum areas both in person and by phone to provide information on proper handwashing, personal hygiene, COVID-19 symptoms, appropriate mask use, social distancing, and other preventive measures. As part of an “Awareness on Wheels” initiative across slums, volunteers spread information in the community through loudspeakers fitted on auto rickshaws. In areas where the rickshaws couldn’t reach, volunteers used public announcement systems to spread information.8
In addition to directly engaging with community-based volunteers, SNEHA reached out to systems staff belonging to municipal corporations, the Integrated Child Development Services scheme, and the police for COVID-19 awareness generation and coordination between August 1 and August 31, 2020.4
Leveraging Technology to Provide Public Health and Social Services
SNEHA’s technology philosophy focused on the following principles:
1. Enabling connections through the use of equipment, internet, and phone
At the beginning of the lockdown in Mumbai, SNEHA created a directory with the phone numbers of volunteers and their neighbors to help coordinate lockdown-response efforts at the ground level. It also created a web-based application to track these contacts and routinely update them. Volunteers using smart phones were also set up with high-speed internet plans and data-pack refills.
To facilitate connections between young people without smartphones in urban communities, SNEHA’s Empowerment, Health, and Sexuality of Adolescents program launched a smartphone library initiative that allowed each participant to borrow a smartphone from a volunteer living in the area. This initiative enabled SNEHA to scale up a critical program whose volunteers sought to enhance self-expression, facilitate strong peer learning networks, and strengthen adolescents’ digital skills. Activities included using smartphones to make videos, creating storyboards using web-based tools, and producing podcasts on topics such as love and attraction.9
2. Web conferencing and video conferencing applications
SNEHA regularly used web and video conferencing applications such as Google Meet, WebEx, and Zoom to connect not only with co-workers but also with community members. These tools were used for daily interactions, trainings, and other capacity-building activities. Using these tools reduced, and sometimes removed, logistical expenses such as the cost of renting a venue for training. Information related to citizen services (public schemes such as distribution of ration and medicines) and COVID-19 awareness messages were routinely disseminated through these applications.2
3. Technology support and security
In addition to enabling connection and leveraging web and video conferencing tools, SNEHA recognized the need for technology support mechanisms and security infrastructure. It therefore provided extensive training on the effective use of communication and conferencing applications and accessing remote services for files and content. It also documented common technology-related problems and compiled a list of frequently asked questions for all volunteers and employees. Emphasis was placed on strengthening the capacity of the existing team rather than hiring and recruiting a new team.
To ensure data security, all team members were made aware of basic cyber-security principles. Antivirus and antispyware software was also installed on every system, a firewall was used for internet connection, and updates were installed regularly to keep up with the latest software.
Supplementary material
SNEHA - Leveraging Technology for a Community-Led COVID-19 Response.pdf
Covid-Vaccination-FAQs-English.pdf
Covid-Vaccination-FAQs-Hindi.pdf
Key-Findings_Community-Needs-Assessment_Final.pdf
Sources
- Rao Y. These good Samaritans help keep up the spirit of Mumbai during Coronavirus outbreak. Hindustan Times. March 26, 2020. Accessed July 29, 2021. https://www.hindustantimes.com/more-lifestyle/these-good-samaritans-help-keep-up-the-spirit-of-mumbai-during-coronavirus-outbreak/story-wp6uXqYvC7mG2zSD9IeGxN.html
- Leveraging technology during COVID-19: The relevance of connectivity for non-profits. Society for Nutrition, Education and Health Action (SNEHA) website. Published May 21, 2020. Accessed July 19, 2021. https://snehamumbai.org/2020/05/21/leveraging-technology-during-covid-19-the-relevance-of-connectivity-for-non-profits/
- Some things have worked… and yet way to go with Covid-19. Society for Nutrition, Education and Health Action (SNEHA) website. Published June 2,2020. Accessed July 29, 2021. https://snehamumbai.org/2020/06/02/some-things-have-worked-and-yet-way-to-go-with-covid-19/
- Social distancing means home closeness: rise in domestic violence during COVID – 19 lockdown. Society for Nutrition, Education and Health Action (SNEHA) website. Published April 13, 2020. Accessed July 19, 2021. https://snehamumbai.org/2020/04/13/social-distancing-means-home-closeness-rise-in-domestic-violence-during-covid-19-lockdown/
- Increase in reporting of domestic violence during COVID-19: insubstantial research evidence in comparison to women’s lived realities. Society for Nutrition, Education and Health Action (SNEHA) website. Published June 19, 2020. Accessed July 29, 2021. https://snehamumbai.org/2020/06/19/dvduringcovid/
- Working through a pandemic: measures taken by SNEHA as response to COVID-19. Society for Nutrition, Education and Health Action (SNEHA) website. Accessed July 9, 2021. https://snehamumbai.org/covid-19/
- Rajan S, Das S, Jayaraman A. Remote data collection: getting it right. India Development Review website. January 20, 2021. Accessed August 12, 2021. https://idronline.org/remote-data-collection-phone-surveys/
- Venkatachalam P, Memon N. Community Engagement to Tackle COVID-19 in the Slums of Mumbai. Mumbai: The Bridgespan Group; 2020. Accessed July 29, 2021. https://www.bridgespan.org/bridgespan/Images/articles/community-engagement-COVID-19-India-slums/community-engagement-to-tackle-COVID-19-in-the-slums-of-Mumbai.pdf
- Smartphone Library – an innovation to bridge the digital divide in the COVID-19 pandemic. Society for Nutrition, Education and Health Action (SNEHA) website. Published June 4, 2021. Accessed July 29, 2021. https://snehamumbai.org/2021/06/04/smartphone-library-an-innovation-to-bridge-the-digital-divide-in-the-covid-19-pandemic/
