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

Vaccine nationalism? Covaxin isn't safe either, perhaps it's worse: Experts

By Rajiv Shah  I was a little awestruck: The news had already spread that Astrazeneca – whose Indian variant Covishield was delivered to nearly 80% of Indian vaccine recipients during the Covid-19 era – has been withdrawn by the manufacturers following the admission by its UK pharma giant that its Covid-19 vector-based vaccine in “rare” instances cause TTS, or “thrombocytopenia thrombosis syndrome”, which lead to the blood to clump and form clots. The vaccine reportedly led to at least 81 deaths in the UK.

'Scientifically flawed': 22 examples of the failure of vaccine passports

By Vratesh Srivastava*   Vaccine passports were introduced in late 2021 in a number of places across the world, with the primary objective of curtailing community spread and inducing "vaccine hesitant" people to get vaccinated, ostensibly to ensure herd immunity. The case for vaccine passports was scientifically flawed and ethically questionable.

'Misleading' ads: Are our celebrities and public figures acting responsibly?

By Deepika* It is imperative for celebrities and public figures to act responsibly while endorsing a consumer product, the Supreme Court said as it recently clamped down on misleading advertisements.

A Hindu alternative to Valentine's Day? 'Shiv-Parvati was first love marriage in Universe'

By Rajiv Shah*   The other day, I was searching on Google a quote on Maha Shivratri which I wanted to send to someone, a confirmed Shiv Bhakt, quite close to me -- with an underlying message to act positively instead of being negative. On top of the search, I chanced upon an article in, imagine!, a Nashik Corporation site which offered me something very unusual. 

Magnetic, stunning, Protima Bedi 'exposed' malice of sexual repression in society

By Harsh Thakor*  Protima Bedi was born to a baniya businessman and a Bengali mother as Protima Gupta in Delhi in 1949. Her father was a small-time trader, who was thrown out of his family for marrying a dark Bengali women. The theme of her early life was to rebel against traditional bondage. It was extraordinary how Protima underwent a metamorphosis from a conventional convent-educated girl into a freak. On October 12th was her 75th birthday; earlier this year, on August 18th it was her 25th death anniversary.

Palm oil industry deceptively using geenwashing to market products

By Athena*  Corporate hypocrisy is a masterclass in manipulation that mostly remains undetected by consumers and citizens. Companies often boast about their environmental and social responsibilities. Yet their actions betray these promises, creating a chasm between their public image and the grim on-the-ground reality. This duplicity and severely erodes public trust and undermines the strong foundations of our society.

'Fake encounter': 12 Adivasis killed being dubbed Maoists, says FACAM

Counterview Desk   The civil rights network* Forum Against Corporatization and Militarization (FACAM), even as condemn what it has called "fake encounter" of 12 Adivasi villagers in Gangaloor, has taken strong exception to they being presented by the authorities as Maoists.

Mired in controversy, India's polio jab programme 'led to suffering, misery'

By Vratesh Srivastava*  Following the 1988 World Health Assembly declaration to eradicate polio by the year 2000, to which India was a signatory, India ran intensive pulse polio immunization campaigns since 1995. After 19 years, in 2014, polio was declared officially eradicated in India. India was formally acknowledged by WHO as being free of polio.

No compensation to family, reluctance to file FIR: Manual scavengers' death

By Arun Khote, Sanjeev Kumar*  Recently, there have been four instances of horrifying deaths of sewer/septic tank workers in Uttar Pradesh. On 2 May, 2024, Shobran Yadav, 56, and his son Sushil Yadav, 28, died from suffocation while cleaning a sewer line in Lucknow’s Wazirganj area. In another incident on 3 May 2024, two workers Nooni Mandal, 36 and Kokan Mandal aka Tapan Mandal, 40 were killed while cleaning the septic tank in a house in Noida, Sector 26. The two workers were residents of Malda district of West Bengal and lived in the slum area of Noida Sector 9. 

India 'not keen' on legally binding global treaty to reduce plastic production

By Rajiv Shah  Even as offering lip-service to the United Nations Environment Agency (UNEA) for the need to curb plastic production, the Government of India appears reluctant in reducing the production of plastic. A senior participant at the UNEP’s fourth session of the Intergovernmental Negotiating Committee (INC-4), which took place in Ottawa in April last week, told a plastics pollution seminar that India, along with China and Russia, did not want any legally binding agreement for curbing plastic pollution.