Emphasis was placed on the broad range of services made available to these “left behind” groups through interdepartmental and multi-stakeholder collaboration. Health system actors and local self-government members were aware of vulnerable populations prioritized under various schemes but did not describe vulnerable groups beyond this. This involved coordination between health and other departments, which may be formalised, streamlined and optimised in the future. Livelihood support like food kits, community kitchen, and patient transportation were provided by the LSGs to support these groups. During COVID, the government prioritized access to COVID-19 testing and vaccination among marginalized population groups like palliative care patients, the elderly, migrant labourers, as well as Scheduled Caste and Scheduled Tribes communities. In most cases, vulnerable groups were already beneficiaries of various government schemes within and beyond the health sector. In the context of COVID-19, some participants reflected that everyone was vulnerable. Vulnerability was described differentially by geography and economic context for e.g., fisherfolk were identified in coastal areas while migrant labourers were considered as vulnerable in semi-urban areas. The age range of participants was between 35 and 60 years. Recordings were transliterated into English and analysed thematically by a team of researchers using ATLAS.ti 9.1 software. They were also asked if there were any special programmes/schemes to support the access of “vulnerable” groups to general and COVID related health services, as well as other needs. Following written informed consent procedures, each interviewee was asked questions about whom they considered the most “vulnerable” in their areas. Participants included elected local self-government members, medical and public health staff, as well as community leaders. We conducted In-depth interviews with 80 participants from four districts of Kerala from July to October 2021.
Filling this gap was the aim of our study. Less attention has been paid, however, to how inclusive this management was, as well as if and how those “left behind” in testing, care, treatment, and vaccination efforts were identified and catered to. The south Indian state of Kerala received acclaim globally for its efforts in managing COVID-19 pandemic. Among the core principles of the 2030 agenda of Sustainable Development Goals (SDGs) is the call to Leave no One behind (LNOB), a principle that gained resonance as the world contended with the COVID-19 pandemic.
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