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COVID-19 | How Kerala’s response to the COVID-19 pandemic is highlighting inadequate responses elsewhere in India by Sreerekha Sathi

The Indian state of Kerala seems to have addressed the COVID-19 pandemic remarkably well, limiting the amount of virus-related infections and deaths through its assertive approach. Kerala’s outlier position in India is well known, and its development model that differs from those of other Indian states might well be the cause of its successes in responding to COVID-19. Central to this development model—and the state’s response—is a well-functioning public healthcare system rooted in the state’s left-wing government. The rest of India and other countries can learn several lessons from Kerala’s government and its people, if they are willing to listen.


By the end of April, India’s coronavirus infections exceeded 40,000 cases, while around 1,300 people have died from the virus. India has been under a severe lockdown since 25 March, which due to the country’s socio-economic dynamics has caused many problems for working-class and unemployed people, especially for the large body of internal migrant labourers and marginalized communities, many without the resources to self-quarantine. Millions of Indians will face starvation due to a sudden loss of income as the lockdown has made it impossible for them to engage in economic activity. More than 90 percent of India’s population of 1.3 billion people work in the informal sector, while two-thirds of the population moreover have to get by on less than US$2 a day.

Kerala, a small state on India’s southern tip, was hit first and hardest. The state reported its first case of coronavirus (COVID-19) on January 29th, and by May counted 500 infections, however had only three virus-related deaths with a recovery rate above 90 percent. It is evident that the state with its population of 33 million people has had significant successes thus far in staving off the virus. Here, for example, there is no shortage of medical masks for health professionals, no lack of hand sanitizers, and people living in the state have not been running around trying to hoard basic necessities as has happened in rich countries like the United States. The story of the state’s success in controlling the pandemic has attracted global attention, particularly because this state in India, one of the poorest countries in the Global South, has managed to do what many others with vastly more resources have not been able to.

So how has Kerala been doing this?

The coronavirus epidemic hit the state as it was in the process of recovering from two majors disasters that occurred in 2018—severe floods and the spread of the deadly Nipah virus. These disasters shaped responses to COVID-19 by creating a readiness to respond to future disasters, so that when the coronavirus emerged, the state and local communities were dedicated toward collectively fighting the COVID-19 pandemic, knowing what was at stake.

When the number of coronavirus cases reached around 100, the state government’s popular health minister declared a campaign called ‘Break the Chain’ to fight the further spread of the virus. The campaign that reached deep into Kerala’s densely populated cities and villages was focused on sharing information about the virus and how to fight it by educating people on maintaining personal hygiene. The state government in a short time installed water taps in all important public transportation hubs and public offices and provided free hand sanitizers. It also informed people about the importance of social distancing and self-quarantining. Students from colleges and universities along with volunteers from different sectors were entrusted with the duty of producing facial masks and hand soap and distributing them through community institutions. This engaged public response is world away from the policies elsewhere in India and many other parts of the world that consigned people to their houses, leaving them to fend for themselves without providing adequate support.

As in other countries, while health professionals remain at the center of the fight against the virus, it is important to point out just how central the community healthcare workers in Kerala have been. The backbone of the fight have been women called Accredited Social Health Activists (ASHAs) and Anganwadi workers (Sreerekha, 2017) who are employed in the state’s social welfare schemes and who were able to reach every nook and cranny of the state’s numerous cities, villages, and towns to trace contacts effectively. Alongside these women workers have been the state police and fire departments as well as other emergency services who have helped the state fulfill services such as distributing essential medicines to non-corona patients.

Most importantly, state-backed community kitchens have been a lifeline for many hungry residents. For the first time in history, by the third week of March, Kerala opened community kitchens in every village and municipality of the state, providing free cooked food so that no-one would go hungry during the lockdown. This contrasts very sharply with the experience of poor people in many other parts of India, where they are left mostly at the mercy of NGO or volunteer help.

How Kerala does it differently

A well-functioning public healthcare system is at the core of the state’s response, the foundation for which goes back to the much popular, well-debated and critiqued Kerala development model (Ravi Raman, 2010). The state is led by the Communist Party of India (Marxist) (CPIM), well known for its experiments with projects related to the grassroots decentralization of government and community-driven developmental planning in the 1990s. The Kerala development model does have its limitations, especially in addressing issues of gender and caste hierarchies and discrimination, and its successes have been achieved even alongside the pressures and compromises with liberal modernity. The state’s successes in fighting the pandemic though have been possible due to relevant steps taken on time and owing to the functional state mechanisms supplemented by the support and commitment of local community networks and an educated population.

With a very high number of expatriates and a big tourism industry the state needed to quickly implement restrictive measures. This has not been an easy path for Kerala, especially considering the fact that its officials are in a constant battle with the right-wing BJP central government. Time and again, the BJP central government has tried ‘to teach Kerala a lesson’ by cutting its funds or even halting the arrival of aid during emergencies. The right-wing party has until now failed to ever win any elections in the state.

Amidst all these dynamics, Kerala presents a useful lesson to the world as a state that even in the face of extreme adversity through sensitive and practical programs and with the support of a politically educated community has been able to take major steps to protect the interests of its residents, particularly marginalized and working class populations. Although the COVID-19 threat remains, Kerala has collectively mobilized to confront it. Kerala’s public healthcare system functions through effective local development measures and community and state networks to make it possible not only to tackle the COVID-19 threat, but also to protect the well-being of its people in so doing.


This article is part of a series about the coronavirus crisis. Find more articles of this series here.


About the author:IMG_4882

Sreerekha Sathi is Assistant Professor of Gender and Political Economy at at the International Institute of Social Studies of the Erasmus University in The Hague. Her research interests span theories of women’s work, feminist critiques of development, feminist research methodologies and social movements in the global south, specifically South Asia.

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In search of a new social contract in the Middle East and North Africa – what role for social policy? by Mahmood Messkoub

Social policy in the Middle East and North Africa (MENA) is in urgent need of reform. Critiques of current social policy models point out their deficiencies in terms of coverage of population, entitlement to services, fragmentation of support for different groups and inadequacy of services provided, and above all a wasteful generalized/untargeted subsidy structure. The answer to these shortcomings not only lies in the redirection of resources from generalized subsidies towards targeted sectors and populations, but also in a broad rethinking and democratic dialogue on a new social contract and social policy models in order to improve coverage, entitlement, and the quality of services.


In 2019, mass popular protests shook several countries in the Middle East and North Africa (MENA) as protesters demanded an end to authoritarian rule and corruption and called for democracy and a decent life. The call for a decent life was not just a protest against the failure of states to alleviate poverty and improve living conditions, but was also seen as an opportunity for a change in the social contract. The protests illuminated a desire to move away from patronage and clientelism that eroded post-independence universalist ideals and social policies.

Some of these protests were triggered by a sudden jump in the price of basic goods (e.g. of bread in Sudan or petrol in Iran) that released the pent-up frustration with repression, corruption, a lack of accountability and deep-seated economic and social problems that have simply been cracked over by the ruling elite. People all over the MENA could easily identify with the Sudanese slogan of ‘freedom, peace and justice’ used in the protests, which would eventually topple the dictatorship of President Omar al-Bashir. Freedom, peace and justice are not only important for their own sake, but are also needed for a national debate on social policies that could meet people’s aspirations for better education, health, social protection, etc.

In MENA, social policies have been developed mainly as an integral part of the broad social and economic development agenda in the post-colonial period. Oil income provided resources to pay for healthcare, education, and extensive subsidies for the provision of food, fuel and energy to consumers. Non-oil producers also benefited from the oil income through labour remittances, foreign aid, and investment by the oil-rich countries. But in the 1980s, a low growth rate and the decline in oil revenues put the finances of the MENA countries to test. The region was ill equipped in terms of a skilled labour force and social insurance policies to compete internationally and diversify its economy. The existing social programmes mostly covered formal sector employees including those in the civil service. Large numbers of informal sector workers, rural residents, and agricultural workers had to rely on poor publicly provided services or fall back on meager family resources and charitable handouts of non-state providers in an informal security regime. The formal and informal social provisioning were based on a male-breadwinner household with negative implications for gender equality in law and in relation to entitlement to welfare and social support that was exacerbated by the low labour force participation rate of women.

In addition, state expenditures on social policy programmes are constrained by expenditures on generalized indirect subsidies, inter alia, to fuel, public utilities, water, and staple food sources.  According to one estimate, fuel subsidies account for nearly 75% of the total subsidy spending in MENA (Silva et al 2013). The higher income groups in general benefit most from these indirect subsidies except staple food, since the latter takes a larger share of consumption expenditure of lower income groups.

The existing social policy model of generalized indirect subsidies has failed to provide a solution to increasing poverty and vulnerability in the region, especially in periods of social and economic crisis. The reform of the subsidy structure should not only take note of differential impact of the indirect subsidies, but also has to be part of a broad social policy agenda.

The current debate on social policy in the region is about the reform and reduction of the indirect subsidy structure and moving away from a universal rights-based approach to social provisioning towards targeting poverty and improving social protection. Whilst cuts in indirect subsidies and strengthening of social protection are needed, it is essential that any targeting and social protection do not undermine the broad rights-based social policy agenda of public provisioning of health and education and rules governing the labour market to support employment that will improve the economic foundation of household economy.

There is also the all-important concern with the role of households and families to support themselves. In the absence of adequate family resources, there is a need for social policy measures that would supplement family resources and support the broad developmental agenda and ensure societal and macro-level inter-generational support. In this context, the most basic objective of any state intervention is to maintain and increase the resource base of households. This is particularly important if we take into account the changing demographics of the region: the lowering of fertility and ageing of the population. The MENA societies and families are ill prepared for an ageing population.

The Arab Spring and its counterparts in Turkey and Iran have been much more than a cry for freedom and democracy. It has also been a cry for social justice and against corruption that has aggravated capitalist inequality. The use of and access to public office for private accumulation, lack of accountability, and poor governance have all contributed to a sense of desperation and alienation of the population, especially the young. The region is in need of a new social contract. Social policy should play an important role in the design and implementation of this social contract.

What MENA needs is a return to the universalist social policy ideals of a developmental state but within a democratic political environment that promotes genuine popular engagement and participation, as well as transparency and accountability, in order to arrive at an inclusive and new social contract. The details and boundaries of this new social contract would be country specific and depend on the national political and economic developments.


This blog is based on the author’s recent publications:
Messkoub, M. (2017). ‘Population ageing and inter-generational relation in the MENA: what role for social policy?’ Population Horizons, 14(2): 61-72.
Jawad, R., Jones, N. and Messkoub, M. (eds) (2019) Social policy in the Middle East and North Africa: the new social protection paradigm and universal coverage. Cheltenham, UK: Edward Elgar publishers.
Messkoub, M. (2020) ‘Social Policy in the MENA’ in Hakimian, H. (2020) Routledge Handbook on Middle East Economy. London: Routledge.
References:
Silva, J., Levin, V. and M. Morgandi (2013) ‘Inclusion and Resilience: The Way Forward for Social Safety Nets in the Middle East and North Africa’. Washington DC: World Bank.

About the author:

Mahmoud Meskoub is senior lecturer at the International Institute of Social Studies (Erasmus University of Rotterdam), teaching and researching in areas of social policy and population studies. As an economist he taught for many years in the UK (at the universities of Leeds and London). His current research interests are in the area of economics of social policy and population ageing, migration and universal approach to social provisioning. His recent publications on MENA are related to social policy, the impact of recent financial crisis on the region, poverty and employment policies. He has acted as a consultant to ESCWA, ILO, UNFPA and the World Bank.


Image Credit: AK Rockefeller on Flickr