State–Society Synergy at COVID-19’s Invisible Front Lines

The Pandemic at the Grassroots 

"It is better to die of COVID-19 than of hunger," said Sunita, a trash collector in Nashik, Maharashtra, during India’s first wave of COVID-19 and national lockdown. Manisha, an Anganwadi (government daycare) worker in Nalanda, Bihar, expressed similar frustration. “No one listens to our demands,” she lamented, highlighting concern over a lack of protective equipment or pay for working overtime. Such voices from local residents and from front-line government workers in India’s villages and small towns are often absent in accounts of the pandemic, which have largely focused on the crises unfolding in major cities. But as the brutal second wave pushed into rural regions with crumbling health and social infrastructure (Chaurasia and Ellis-Petersen 2021), the accounts of citizens and front-line workers offer crucial insight into the invisible front lines of COVID-19. For the past year, we—a team of journalists, academics, and policy analysts—have gathered hundreds of accounts from residents and local government workers across rural India. To bring together the voices of residents and officials, we draw from the grassroots reporting of Video Volunteers’ (VV) national network of citizen journalists complied in their Corona Virus Ground Reports video series,¹ and from phone interviews with local government functionaries carried out by the Accountability Initiative (AI) at the Centre for Policy Research for their Inside Districts series.²

Our analysis is a comprehensive attempt to document the experiences of the pandemic at the rural grassroots and depicts the accounts of residents and local officials’ side by side. The voices that we capture are unique. VV’s “Community Correspondents” (CCs), equipped with smartphones and video cameras, highlight local issues and perspectives that mainstream news coverage (by reporters who visit but are not embedded in local communities) cannot. AI’s documentation of officials’ perspectives focuses on the lowest levels of bureaucracy, with particular attention to (largely female) front-line workers such as nurses, health activists, daycare providers, and teachers, who have been tasked with the lion’s share of local COVID-19 response. These front-line workers, like the CCs, live in or near the same localities in which they work, making them uniquely positioned as linchpins between the community and broader structures of governance. 

In what follows, we draw on these perspectives to document a stubborn disconnect—visible in divergent experiences and in mistrust and miscommunication—between residents and officials at the grassroots. But we also document instances where local actors bridge these gaps, suggesting a powerful—although often elusive—potential for “synergy” between state and societal actors, where each provides inputs that the other cannot. This synergy, we argue, is crucial for a robust pandemic response that reflects and meets local needs.  To build such synergy, locally embedded actors—whether front-line workers or social brokers like the CCs—are required to enable communication, build trust, and enhance both citizen and state capacity.

Local Disconnects: An Ungrounded Local Pandemic Response 

The central and state responses to the pandemic have largely been characterised by a lack of understanding of the ground realities of citizens’ health and welfare needs. This disconnect from local lived experiences was first reflected in the suddenness and severity of the lockdown in March 2020 and accompanying lack of concern for economic and social welfare. Karisma, who runs a tea stall in Sivapuri, Madhya Pradesh, for example, complained, “Before the lockdown all expensive cars would line up here but now, we have nothing to live on!” (VV 2021, 26 May). Citizens also complained of government hypocrisy and heavy-handedness. Rahul of Gwalior, Madhya Pradesh, felt that the state had double standards since citizens were forced to stay indoors while the state government hosted lavish events (VV 2020, 27 March). If citizens did venture outside, they would find the police waiting to beat them with their lathis, according to Manoj, a resident of Varanasi, Uttar Pradesh (VV 2020, 8 April). 

These dynamics have only been accentuated in the second wave, where relief efforts have been further stymied by a lack of understanding of prevailing local health conditions and infrastructure requirements, as well as by misinformation and poor communication. For instance, despite receiving donations of oxygen cylinders, one government hospital in Surendranagar, Madhya Pradesh was accused of mismanaging hospital resources in the absence of clear directives about how to allocate oxygen. Rakesh, a distributor managing oxygen donations, stated, “We provide them with oxygen cylinders but no one is monitoring how they are being used!” (VV 2021, 21 May). In Sambalpur, Odisha, 11 out of 14 positions of doctors were vacant at the height of the second wave. “This hospital can function 24/7 but without surgeons, pathologists, and other technicians there are long lines with people lying in the corridors,” noted Babloo, a janitor in the hospital (VV 2021, 10 June). 

Given these disconnects between local needs and the pandemic response, it is unsurprising that levels of mistrust between citizens and officials are high. In a survey undertaken between April–May 2021 in local communities of 20 districts of Uttar Pradesh and 12 districts of Bihar, VV found that 26% of residents believed that the vaccination campaign was a state-sponsored conspiracy (VV Survey 2021). AI uncovered similar themes of vaccine-related misinformation. Rahul, a panchayat secretary in Bihar, explained that some residents believed that the vaccine was intended for vasectomy (Accountability Initiative 2021, 26 May). Mistrust is also evident in citizens’ hesitancy to report symptoms. Rani, a nurse in Satara, Maharashtra complained, “people are hiding information [about their symptoms]” (Accountability Initiative 2020a, 9 April).  When mistrust is high, citizens are less likely to comply with the directives. Arun, a resident of Raigarh, Chhattisgarh, for example, retorted during a VV interview (2020, 6 August), “What is the point of wearing a mask?” 

Front-line Workers at the Crossroads, and in the Crosshairs

Front-line government workers, such as community health workers, day-care providers, and schoolteachers, have become the de facto local face of the state’s pandemic response. Indeed, many state, district, and block offices have closed to the public, and typical arenas for citizen–state engagement and grievance redressal have become inaccessible during prolonged lockdowns. The state, in this sense, has simultaneously retreated under COVID-19, while it has also—embodied by local front-line workers—pushed deeper into local communities through door-to-door public health outreach and monitoring. 

Front-line workers are notable in several regards. First, they are among the lowest ranked, lowest paid, and least supported in the local bureaucracy. Second, they hold positions that blur the lines between the public and private spheres; they are often residents—and so socially embedded in—the same communities and areas which they serve. Third, they have been indispensable in the government’s response, promoting public health awareness, monitoring symptoms, referring those infected to local clinics and hospitals, delivering rations, and enforcing quarantines. Many front-line workers had to adapt their work to meet local needs in the pandemic—often with no extra support from higher levels of government. In Solan, Himachal Pradesh, for example, citizens began reaching out Accredited Social Health Activists (ASHAs), who are front-line health workers, for needs related to food and other government services during their house calls to monitor for COVID-19 symptoms (Accountability Initiative 2020, 24 July). In Supaul, Bihar, Anganwadi workers assisted pregnant women, even delivering babies, when doctors and nurses were preoccupied with COVID-19 response (Accountability Initiative 2020b, 10 April). 

But these essential local workers often feel cut off from higher levels of government. Many front-line workers have been pushed to their limits by additional pandemic-related duties without adequate training, resources, or regard for their existing workloads (Sinha et al 2021). For example, Prachi, an Anganwadi worker in Jaipur, Rajasthan, conceded that she often had to forgo her regular responsibilities of monitoring child nutrition due to new COVID-19-related tasks (Accountability Initiative 2020, 13 May). Local officials have been ordered to survey citizens, monitor symptoms, and promote health awareness without being provided adequate personal protective equipment (PPE). Saroj, an ASHA worker in Jaipur, Rajasthan, said: “I had to walk 2–3 kms every day for surveys. Nothing was provided by the government for transportation.” These additional responsibilities did not coincide with proportional increases in pay. “It is difficult to meet my monthly household expenses, and I hardly save anything. For COVID-19 work, I received only around ₹3,000–4,000 in total, which is low for the kind of work I have done,” said Lakshmi, an ASHA worker in Kangra, Himachal Pradesh (Accountability Initiative 2021, 12 January). ASHAs have gone on strike in rural communities across India to protest these conditions (Accountability Initiative 2021, 15 January). Nina, an ASHA worker in Madhya Pradesh protested (VV 2021b, 6 July): “We work 24 hours a day. And what do we get in return, ₹ 32?” Raju Desle, the ASHA workers association president for Maharashtra, declared: “The state has failed ASHA workers by not appreciating them for the challenging work they do” (VV 2021b, 16 June). 

Front-line workers, as these examples reveal, are capacity and resource constrained while also serving as the central point of interface between citizens and the state in the pandemic. However, in yet another local disconnect, residents often do not grasp the harsh reality of the conditions under which front-line workers operate. Instead of recognising the tireless efforts of front-line workers, they are often blamed by citizens for the failures of policies designed at higher levels. These dynamics have been starkly apparent around issues of vaccine distribution. Savitri, a nurse in Nalanda, Bihar, for example, told AI (2021, 20 May), “Sometimes people come…, but they have to be turned away… because we do not have enough vaccines. They blame us for all this since we called them to take the vaccine. We have to take the blame and listen to their scolding.” At times, this mistrust and anger towards front-line workers has manifested in violence. Aradhana, an ASHA worker in Puri, Odisha was beaten by a mob of over 500 people when she went to a village to impose quarantine and monitor citizens (VV 2020, 26 September).

Local “Synergy” Despite the Odds

An ungrounded pandemic response disconnected from local realities coupled with overburdened and misunderstood front-line workers are not promising conditions for state–society cooperation. Yet, despite these many challenges, our research uncovered instances of a potential “synergy” (World Bank 2004) between residents and locally embedded government workers. In these instances, we see citizens and officials crossing the “great divide” (Ostrom 1996) between the public and private spheres to take complementary actions. 

Interviews by AI and VV point to the potential for collaboration between citizens and front-line workers. For example, in Udaipur, Rajasthan, where officials and residents alike faced a shortage of PPE, residents began making masks and distributing them to those who needed them—including to local officials. Similarly, to aid the door-to-door campaign of front-line health workers, social media-savvy citizens of a village in Udaipur took messages about public health and safety online to reach an even larger audience (2020b, 9 April). These are examples of what scholars have termed “co-production” (Evans 1997; Ostrom 1996), in which state and societal actors each contribute inputs (for example, technical expertise and resources from the state, coupled with local knowledge and community labour or other voluntary resources) that together enable a more robust response. In these cases, the outcome is more than the sum of its parts; official inputs activate community resources, and vice versa, in ways that allow each set of actors to do more. 

Such complementary state and societal actions rest on key nodal actors who can facilitate and coordinate work across the public–private divide. But simply living in or near a local community is not enough; front-line workers need to be embedded in social networks that help to build trust and facilitate communication with residents. For instance, ASHA workers with long histories in their communities prior to the pandemic are often the first port of call for help in remote communities lacking healthcare infrastructure. VV’s CCs, similarly, draw on long engagements with communities to build trust, while also building linkages to local government. Rohini, a CC in Pune, Maharashtra, for example, coordinated with a local panchayat to set up a 25-bed COVID-19 care facility with oxygen. To do so, she channelled private funds from VV’s COVID-19 relief fundraising to the local government, while also collaborating with doctors from nearby private hospitals (VV 2021, 7 July). Yashodha, another CC in Surendranagar, Gujarat, worked to inform municipal authorities about the lack of PPE for sanitation workers while also organising a fundraising drive to assist them (VV 2021a,  16 June). 

Finding the conditions for these kinds of public–private collaboration is hard. Our research shows, however, unexpected gains—instances where obstacles were overcome to build local cooperation. We highlight three necessary conditions to support local state–society synergy—communication, trust, and investments in local capacity. 

 
From Talking Past to Talking with Each Other

Locally embedded actors can play a crucial role in translating government policies and directives for the average citizen. Residents can also provide crucial information to government officials, making officials more aware of local needs. For instance, Halima, a CC in Dhanbad, Jharkhand, alerted district officials to families who were food insecure following the lockdown (VV 2021a, 6 July). Front-line workers similarly play a key role in conveying local conditions to higher levels of government. In Jaipur, Rajasthan, for example, the district collector was in constant touch with local officials including ASHA workers who facilitated the transfers of COVID-19 patients from villages to district hospitals (Accountability Initiative 2020, 14 July). Communications from these front-line workers enabled the collector’s office to better prepare, giving more accurate estimates of requirements for hospital beds. 

The importance of technology also stands out across efforts to build state–society communication, both from the top-down (using social media platforms to spread information about government directives and programmes), as well as the bottom-up (using social media to highlight local needs, and call attention to inadequacies in government responses). Investing in and strengthening digital communications at the local level has the potential to enable more robust flows of information that will empower citizens and front-line officials alike.

Enabling Trust

Front-line workers can play an important role in addressing local trust deficits, drawing on their dual identities as both state functionaries and residents. But these dual identities alone do not ensure trust. Residents need to see and believe that front-line officials understand their needs and will come to their aid. Sometimes, building trust requires taking on new tasks or ways of doing things, which may fall far beyond workers’ formal job descriptions. In Delwara, Rajasthan, when no one claimed the body of a deceased COVID-19 patient, the local police took it upon themselves to arrange a funeral (VV 2021, 1 June). Thinking outside the box, local school teachers in Bastar, Chhattisgarh installed loudspeakers across the village to allow students to learn from home as classes were synchronously (VV 2021, 6 October). These and other creative efforts help not to meet local needs but to build residents’ trust and confidence in front-line workers. An expression of that trust may be as simple as heeding and spreading public safety advice given by front-line workers. Shikha, a nurse in Nalanda, Bihar reported, for example, “I feel proud when people listen to me and also tell other people what I told them [about public health measures].” “They call me ‘Corona didi (sister),’” she reported happily (Accountability Initiative 2020, 13 July). 

Building Capacity

But even if communication can be improved and trust built, the efforts of front-line officials often face capacity constraints such as inadequate resources, training, and other kinds of support. In some instances, though, local- and higher-level officials have coordinated in such a way that built local capacity. In Himachal Pradesh, for example, Sub-divisional magistrates and block officers created “flying squads”—task forces with dedicated vehicles and personnel that help ASHAs and Anganwadi workers to better monitor and support quarantined citizens (Accountability Initiative 2020, 12 May). This provided much-needed support to overstretched front-line workers and allowed local officials to cover more ground. In another instance, local members of Parliament and members of legislative assembly in Banda, Uttar Pradesh collectively contributed Rs 6,00,000 from their constituency development funds to assist with COVID-19 relief, including investing in PPE, and transportation for front-line workers (VV 2020, 3 April).  
 
While greater top-down support is needed to build local capacity, the reverse is also true: local support can help to build greater state capacity. For example, locally generated, citizen-driven data can help fill information gaps and enable the central and state governments to mount a more informed and coordinated response. Similarly, citizen-produced data can provide real-time estimates needed during a crisis, assist decision-makers and front-line workers in the allocation of resources (Mayberry 2021). Citizen-produced journalism by VV’s correspondents has been effective in drawing attention to this information gap, and to the plight of citizens overlooked at the grassroots; but broader efforts to gather and disseminate local information at scale are still missing. Citizen-driven information platforms are required to bridge this gap. Crisis response can no longer be driven solely by data banks that belong to the state and do not reflect ground realities.

Learning from the Grassroots

As the pandemic rages on, now more than ever, the importance of local state–society synergy cannot be understated. Policies drafted at high levels are implemented by front-line agents who live and work in realities that are worlds apart from their counterparts in district headquarters and in state and national capitals. These front-line workers are embedded in the communities they serve, familiar with their needs, and most suited to address them. Local disconnects and a retreat of higher-level state actors mean that front-line government workers and residents are left, together, at the front lines of the pandemic. 

Our joint research, pulling from hundreds of accounts of local officials and citizen journalists, reveals the potential for synergy between local state and societal actors—even under difficult and unlikely conditions. We—the public, policymakers, donors, and civil society actors—can learn from the grassroots, in finding ways to support and invest in local capacity and collaboration. Our research highlights two essential forms of support. 

First, it is imperative that the state invests in front-line workers, who are the unsung heroes (and most often heroines) of the pandemic. By providing front-line actors with greater resources and agency, the state can build more spaces for effective local cooperation, communication, and co-production. Feedback mechanisms, enabling the flow of information from communities and front-line workers to higher levels of government and back again, cutting through layers of state hierarchy, are also critical. 
 
Second, we must seek ways to enable local agents of the state and residents to overcome their mutual mistrust to support each other’s roles. Locally embedded actors such as front-line workers and VV’s correspondents, alongside other NGO, and civil society actors with deep ties to communities, can support this process, acting as intermediaries between the community and the state in a time of unprecedented crisis. There is, in sum, the need for dual investments, to empower both front-line workers and residents.