What has the Covid-19 pandemic cost India’s vulnerable communities?

The Covid-19 pandemic and resulting lockdowns have disproportionately upended the lives of vulnerable communities in low- and middle-income countries. Beyond surges in infections, pandemic-induced income shocks, government school closures, and healthcare disruptions have compelled disadvantaged households to contend with economic uncertainty, learning losses, food insecurity, and poor mental health.

In a webinar hosted by J-PAL South Asia’s Cash Transfer for Child Health (CaTCH) Initiative, researchers explored the hidden costs of the pandemic borne by underserved communities in Indian, the implications of these disruptions for the design of future social programmes, and emerging evidence to help tackle the adverse impacts of the pandemic.

Disruptions to School Education

Early surveys from an ongoing study in Assam exploring disruptions to student learning and mental well-being found learning losses across students in Grades 2 to 4, corresponding to roughly one year of learning lost. Andrea Guariso (Senior Assistant Professor, University of Milano-Bicocca), one of the researchers on the study, noted that there were no comparable disruptions to students’ mental well-being as of January 2022. This was potentially due to the students’ resilience or because of relief gained from schools reopening at the time of the survey.

Researchers have also uncovered disruptions to early childhood education due to the pandemic and resulting lockdown measures. Surveys examining disruptions to the Integrated Child Development Services (ICDS), the world’s largest early childhood development scheme, found that less than 2 percent of ICDS anganwadi centers in Odisha were operational in November 2020 due to strict lockdown measures. There was also an almost 40 percent fall in the number of ICDS workers providing preschool services, notes Saravana Ravindran (Assistant Professor, National University of Singapore). This lack of personnel also led to a fall in the provision of nutrition services such as the routine monitoring of children’s height and weight.

Access to Non-Covid-19 Health Services

Another fallout of the Covid-19 pandemic has been the upending of routine healthcare services, particularly immunization and treatment for chronic illnesses. Phone surveys with dialysis patients in Rajasthan revealed a 64 percent increase in mortality in May 2020, despite a steady decline in the months preceding the imposition of India’s nationwide lockdown in March 2020. Women and socioeconomically disadvantaged groups experienced larger increases in mortality, said Radhika Jain (Postdoctoral Research Fellow, Stanford University).

Radhika and her team also observed similar disruptions to the provision of routine immunization in Rajasthan. Surveys examining the completion of key first-year vaccinations following the suspension of immunization services found that the government’s catch-up efforts after lockdown measures were lifted in May 2020 remained incomplete at the time of the survey. The researchers found sizeable delays and reductions in immunization coverage, particularly for children who turned a year old during the lockdown (between March and May 2020). These costs were disproportionately borne by vulnerable households.?

Policy Approaches to Alleviate the Mental Stresses of the Pandemic

Gautam Rao (Associate Professor, Harvard University) and Kevin Carney (PhD Candidate, Harvard University) presented preliminary results from a randomized evaluation in Tamil Nadu that tested different approaches to provide mental health support during the pandemic. The study is the first that tests the real-world effectiveness of Psychological First Aid (PFA), the World Health Organization’s framework for providing phone-based psychological support by non-specialist counsellors to meet the demand for immediate psychological relief in disaster settings. The study also evaluated the impact of economic support in the form of a one-time unconditional cash transfer on individuals’ mental health during the pandemic.?

As of January 2022, the researchers have not found any impact of the two measures on individuals’ mental health. However, preliminary results suggest that PFA improved individuals’ ability to work and therefore, resulted in better economic outcomes.

Encouraging the Adoption of Covid-19 Preventive Behaviors

A randomized evaluation, conducted by Sebastian Bauhoff (Assistant Professor, Harvard University) and partners from August to October 2020, tested the effectiveness of text message campaigns in encouraging social distancing and handwashing in rural Bihar. Simple, plain text messages in Hindi offered the researchers a scalable and low-cost means to reach a large number of people quickly.

The study found that the messages had no significant impacts on individuals’ adoption of Covid-19 preventive behaviors. This is potentially because it was conducted at a time when people might have already been aware of these behaviors or overloaded with information.

The Role of Research in Responding to Future Crises

Covid-19 is a unique shock that has disrupted every aspect of life, particularly for socially disadvantaged groups. Understanding the full extent of this shock has required the quick adaptation of research processes, notes Camilla Holmemo (Human Development Practice Leader, India, The World Bank). Data uncovered from rapid phone surveys has highlighted the multifaceted nature of these disruptions and presented a blueprint for policymakers and researchers to respond to them. Strong research and analytical agendas will be key for tackling stubborn development challenges, especially since the long-term costs of a crisis like Covid-19 are still unknown.?