Skip to main content

Why decentralized structures exemplified by Kerala manage worst health crises better

By Abhinav Alakshendra, Soumyadip Chattopadhyay, Arjun Kumar*
We are witnessing a humanitarian and economic crisis of unprecedented proportions due to the novel coronavirus pandemic. In India, apart from a fiscal relief package of $23 billion to provide relief to the poor, the Central government has announced a nationwide lockdown which is backed up by additional measures and relief packages of varying nature and scale from the state governments.
Clearly, frailty of India’s health care system, e.g. characterized by 8.5 hospital beds and 8 doctors per 10,000 populations as compared to the 120 to 130 beds per 10,000 populations in Japan and South Korea, has made the management of this outbreak all the more difficult. So far, over 90 doctors, nurses, and paramedic staff have tested positive in India which is having serious regressive impacts on the already stressed supply of healthcare workers.
Covid-19 is creating havoc in the labour market as the recently released the Centre for Monitoring Indian Economy (CMIE) report has indicated an overall unemployment rate of 23.4 percent, with the same for the urban areas being as high as 30.9 percent. Prof Pronob Sen, the former chief statistician of India, has roughly estimated job loss for 50 million workers in just two weeks of lockdown.
The Centre for Policy Research (CPR) reveals that migrant daily wage workers of Delhi lack money to buy food and are facing a hunger crisis. Indeed, the trade-off between containment of the disease and risking the economic consequences is extremely difficult, and India has decided to opt for mitigation procedures.

Coordination and management fiasco

As of now, the policy makers face two clear-cut challenges – (a) to ensure that all citizens are saved from hunger and destitution and (b) to palliate the spread of the pandemic. The 21-day lockdown had caught various wings of the central and state government off guard, worsening the plight of informal workers and virtually making a mockery of the much required ‘social distancing’.
In essence, apart from the allocation of budgets and announcement of fiscal stimulus, effective coordination and management among different levels of government in the form of decentralization is required to respond to the twin challenges.
To manage the looming threats of the Covid-19 crisis, widespread tracing, isolation, testing and treatment strategies are extremely crucial. However, zeroing down on the emerging hotspots and secluding new patients is proving to be a herculean task. Given the population density and lack of awareness, even the simple task of making people understand the need for testing if they are symptomatic is a daunting challenge. Stigmatization of migrant people returning to their native places would only make the matter worse.
Local governments and their elected representatives can better comprehend the needs and priorities of common people and make the governments more responsive in terms of speed, quantity and quality of responses.
These representatives, being the first responders in governance structure, can be a vital node for connecting government health facilities and economic assistances to the people. They can also play a vital role in disseminating information or imparting good habits of social distancing and washing hands and fructifying the battle against Covid-19.
Furthermore, for isolation of infected people, proper quarantine facilities, are needed. The initiatives of the Odisha government in the form of allocation of approximately $6,500 to each panchayat (village council) to get similar infrastructure in place should be replicated at the national level which would cost the Indian exchequer an amount of $1.3 billion.
Setting up of Corona Care Centres, as operationalized in Kerala involving village panchayat, is an important policy intervention, to be scaled up nationally
A speedy mechanism of such funding would help facilitate spending in accordance to the needs and priorities of common people. Setting up of Corona Care Centres, as operationalized in Kerala involving the village panchayat, is another important policy intervention, to be scaled up nationally. The Uttar Pradesh government has already put all village panchayats on alert and has required them to host of preventive measures such as putting soaps at all the hand pumps. 

Serious challenge

Providing food to the poor including migrant and homeless population during this lockdown phase is another serious challenge. The Kerala state government has involved the local government in running community kitchens to supply food to the locked-down families. The local governments are also entrusted with the responsibility of preparing a list of families who cannot afford the meal cost and of delivering food at their doorstep for free.
Importantly, India has enough food to feed it’s entire population, albeit such food might not be reaching them in the crisis times. Here also the local government can be engaged either to provide or deliver the specified quota of wheat/rice and pulses to any citizen who approaches the public distribution system (PDS).
In Indian cities, people are facing difficulty in practicing two basic preventive measures of frequent handwashing and social distancing. Nearly two-thirds of the households do not have access to water within the house and even the available water is insufficient and irregular. In Dharavi, Asia’s most densely packed slum, 80 people share a public toilet on an average.
Multiple agencies including city governments are in charge of providing these basic services in India. and Lack of synchronization of responsibilities among them often contributes to poor service delivery. Infirm financial health of the city governments, especially of the smaller cities in India, further limits their capacity to provide basic services.
Essentially, the cities often get entangled in a vicious circle where paucity of resources causes poor service delivery, leading to poor revenue generation. Urban poor are badly hit as lack of access to basic services exacerbates their existing vulnerabilities, leading to their health and livelihood being compromised in times of public health catastrophes like Covid-19.
Due to lack of genuine autonomy, cities prioritize short-term projects and overlook the strategic approaches that would otherwise prove to be more effective in dealing with health emergencies. City governments should be granted full autonomy to allocate funds to the levels of Market Welfare Associations (MWAs), Resident Welfare Associations (RWAs) and ward committees. They are the closest to the common citizen and can better address their daily needs of cleanliness, hygiene, sanitation and water and, thus, can mitigate the impact of Covid -19.
In some states, local governments are provided with some funds to spend during an emergency situation, e.g. in Jharkhand, Gram Panchayats (GPs) have an emergency fund of $ 130 to help anyone who is at risk of starvation.

Way forward

The bottom line is that the availability, quality and accessibility of health care facilities are necessary but insufficient to ensure an effective pandemic response in India. Now, in fact more than ever, the importance of close as well as robust collaboration between governments at the state and local levels and decentralization of basic responsibilities is being felt.
Not surprisingly, the states with robust decentralized structures, as exemplified by Kerala, are in a better position to manage this worst public health crisis. In the mid-19th century, the city of London was suffering from recurring epidemics of cholera. The metropolitan authority responded to the crisis by constructing a sewer network connecting most of London and carrying out street improvements.
The lesson is far-reaching. As part of a long-term strategy, we should utilize this opportunity to strengthen our local governance systems and empower the institutions as well as their representatives as new frontline warriors in this crisis.
---
*Abhinav Alakshendra is assistant professor and Director, Center for International Design and Planning, University of Florida, USA and senior visiting fellow at Impact and Policy Research Institute (IMPRI), New Delhi. Soumyadip Chattopadhyay is associate professor of economics at Visva Bharati University, Shantiniketan and senior visiting fellow at IMPRI. Arjun Kumar is Director, IMPRI and China-India visiting fellow, Ashoka University

Comments

TRENDING

Delhi Jal Board under fire as CAG finds 55% groundwater unfit for consumption

By A Representative   A Comptroller and Auditor General (CAG) of India audit report tabled in the Delhi Legislative Assembly on 7 January 2026 has revealed alarming lapses in the quality and safety of drinking water supplied by the Delhi Jal Board (DJB), raising serious public health concerns for residents of the capital. 

Advocacy group decries 'hyper-centralization' as States’ share of health funds plummets

By A Representative   In a major pre-budget mobilization, the Jan Swasthya Abhiyan (JSA), India’s leading public health advocacy network, has issued a sharp critique of the Union government’s health spending and demanded a doubling of the health budget for the upcoming 2026-27 fiscal year. 

Stands 'exposed': Cavalier attitude towards rushed construction of Char Dham project

By Bharat Dogra*  The nation heaved a big sigh of relief when the 41 workers trapped in the under-construction Silkyara-Barkot tunnel (Uttarkashi district of Uttarakhand) were finally rescued on November 28 after a 17-day rescue effort. All those involved in the rescue effort deserve a big thanks of the entire country. The government deserves appreciation for providing all-round support.

Pairing not with law but with perpetrators: Pavlovian response to lynchings in India

By Vikash Narain Rai* Lynch-law owes its name to James Lynch, the legendary Warden of Galway, Ireland, who tried, condemned and executed his own son in 1493 for defrauding and killing strangers. But, today, what kind of a person will justify the lynching for any reason whatsoever? Will perhaps resemble the proverbial ‘wrong man to meet at wrong road at night!’

Iswar Chandra Vidyasagar’s views on religion as Tagore’s saw them

By Harasankar Adhikari   Religion has become a visible subject in India’s public discourse, particularly where it intersects with political debate. Recent events, including a mass Gita chanting programme in Kolkata and other incidents involving public expressions of faith, have drawn attention to how religion features in everyday life. These developments have raised questions about the relationship between modern technological progress and traditional religious practice.

Jayanthi Natarajan "never stood by tribals' rights" in MNC Vedanta's move to mine Niyamigiri Hills in Odisha

By A Representative The Odisha Chapter of the Campaign for Survival and Dignity (CSD), which played a vital role in the struggle for the enactment of historic Forest Rights Act, 2006 has blamed former Union environment minister Jaynaynthi Natarjan for failing to play any vital role to defend the tribals' rights in the forest areas during her tenure under the former UPA government. Countering her recent statement that she rejected environmental clearance to Vendanta, the top UK-based NMC, despite tremendous pressure from her colleagues in Cabinet and huge criticism from industry, and the claim that her decision was “upheld by the Supreme Court”, the CSD said this is simply not true, and actually she "disrespected" FRA.

Election bells ringing in Nepal: Can ousted premier Oli return to power?

By Nava Thakuria*  Nepal is preparing for a national election necessitated by the collapse of KP Sharma Oli’s government at the height of a Gen Z rebellion (youth uprising) in September 2025. The polls are scheduled for 5 March. The Himalayan nation last conducted a general election in 2022, with the next polls originally due in 2027.  However, following the dissolution of Nepal’s lower house of Parliament last year by President Ram Chandra Poudel, the electoral process began under the patronage of an interim government installed on 12 September under the leadership of retired Supreme Court judge Sushila Karki. The Hindu-majority nation of over 29 million people will witness more than 3,400 electoral candidates, including 390 women, representing 68 political parties as well as independents, vying for 165 seats in the 275-member House of Representatives.

Uttarakhand tunnel disaster: 'Question mark' on rescue plan, appraisal, construction

By Bhim Singh Rawat*  As many as 40 workers were trapped inside Barkot-Silkyara tunnel in Uttarkashi after a portion of the 4.5 km long, supposedly completed portion of the tunnel, collapsed early morning on Sunday, Nov 12, 2023. The incident has once again raised several questions over negligence in planning, appraisal and construction, absence of emergency rescue plan, violations of labour laws and environmental norms resulting in this avoidable accident.

Zhou Enlai: The enigmatic premier who stabilized chaos—at what cost?

By Harsh Thakor*  Zhou Enlai (1898–1976) served as the first Premier of the People's Republic of China (PRC) from 1949 until his death and as Foreign Minister from 1949 to 1958. He played a central role in the Chinese Communist Party (CCP) for over five decades, contributing to its organization, military efforts, diplomacy, and governance. His tenure spanned key events including the Long March, World War II alliances, the founding of the PRC, the Korean War, and the Cultural Revolution.