In Conversation With Dr. Swati Mahajan

1. Tell us about project NISHTHA and its work specifically in COVID-19 response

NISHTHA is USAID’s flagship health system strengthening project implemented by Jhpiego, a global health non-profit and Johns Hopkins University affiliate. NISHTHA works closely with the Ministry of Health and Family Welfare at the national level and 12 state governments to transform, redesign and re-engineer primary health care in India for the provision of equitable, comprehensive and client-centered primary health care that contributes to improved health outcomes for India’s marginalized and vulnerable populations. In March 2020, when the entire world was hit by the pandemic, NISHTHA acted swiftly by being the first movers in providing technical support at the national level and state level for a robust and comprehensive. NISHTHA’s COVID-19 portfolio is in immediate and acute response to COVID-19, strengthening oxygen ecosystem, strengthening public health surveillance and improving healthy hygiene behaviours. This included empowering more than 32,000 frontline workers with the right skills and expertise to prevent and slow the spread, providing technical and policy level support to national and state governments for COVID-19 response; developing risk communication materials to create awareness on COVID-19 prevention and address vaccine hesitancy, supporting local communities, especially vulnerable populations, with the tools needed to fight COVID-19 and ensuring continuation of reproductive, maternal, newborn, child and adolescent health, as well as other essential services for all sub-sections of the population including marginalized communities.

Further, when the country was hit again with the devastating second wave, NISHTHA expanded it’s reach and gambit of interventions to 16 states (Assam, Arunachal Pradesh, Chhattisgarh, Delhi, Jharkhand, Karnataka, Madhya Pradesh, Maharashtra, Manipur, Meghalaya, Mizoram, Nagaland, Odisha, Rajasthan, Sikkim and Tripura) and also worked on strengthening the oxygen ecosystem as the country struggled to breathe.

India being a diverse country with diverse geographies, requires contextualized solutions for different regions. In view of this, NISHTHA ensured customized and tailormade solutions specific to different states needs which spanned across various areas which are highlighted below:

· Strengthening health system’s readiness and capacity

· Leveraging technology to strengthen surveillance and decentralize COVID-19 management

· Ensuring continuity of essential health services

· Tapping on the Power of Partnerships to respond to COVID-19

· Empowering communities and reaching the last mile

2. Given the COVID pandemic, there has been an increased need in promoting safe hygiene practices in India. What is NISHTHA doing in this aspect?

Unilever in partnership with USAID- NISHTHA envisages expanding the reach and impact of healthy hygiene behaviors among targeted communities for improved health and well-being of communities. The project tends to leverage and build upon NISHTHA’s strong presence and existing network in Health and Wellness Centers (HWCs) and community platforms like

Panchayats/SHGs/VHSNCs for improving knowledge, attitude, and practices on healthy hygiene behaviors among the targeted communities.

NISHTHA aims to enhance the focus on inculcating positive behaviours towards improved health and hygiene in target communities by leveraging the existing platforms and community level interventions. The project will strategically tailor and deploy key public health and hygiene messages to raise awareness in schools, health promotion, and wellness activities at primary health facilities and demonstrate a community social and behavioural change communication (SBCC) model and inter-sectoral convergence model for promoting healthy hygiene practices. The project will also leverage technology to disseminate and increase the reach within the community. The project will focus on a shared commitment to drive transformational change by solving critical sustainability challenges, including sustained hygiene practices during, and following the COVID-19 pandemic.

3. What is NISHTHA’s perspective on the issue of access among vulnerable groups and its impact on the promotion and adoption of positive health and hygiene behaviour amongst them?

NISHTHA is working towards the creating awareness among various specific vulnerable groups on safe hygiene practices. Barriers to access and inequity continue to exist with regard to Water, Sanitation and Hygiene (WASH) among vulnerable communities. Experience from the field suggests that certain vulnerable and marginalized sections of society have been disproportionately impacted by the pandemic and the generic guidelines on management of COVID-19 are not feasible for them. NISHTHA is working towards creating awareness among various specific vulnerable groups including elderly, persons with disabilities, women and girls on safe hygiene practices.

4. How can we integrate WASH in primary healthcare services and work towards building sustainable hygiene behaviours?

The COVID-19 pandemic highlighted the importance of strengthening WASH services at primary healthcare facilities. Primary health care, along with access to safe and affordable WASH services play a critical role in infection control and preventing community transmission of diseases. Greater attention and investments are needed for building sustainable hygiene behaviour as well as integrating WASH in primary healthcare facilities, as they are the first point of care to safeguard health, prevent infections in households, schools, and health care settings.