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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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Inside Delhi’s Doorstep Public Services Delivery Scheme by Sushant Anand

Informal brokers and middlemen are essential for the delivery of public services in India. In 2018, the government of Delhi launched a programme that seeks to formalise these informal public service providers through an external agency. Examing the programme, Sushant Anand finds that despite its rising popularity, traditional methods are still prevailing. He points out a number of challenges the government has yet to overcome.


My blog published in 2019 discussed brokers and their role in the delivery of public services. The Government of NCT Delhi (GNCTD) in 2018 launched a programme that seeks to formalise these informal public service providers through an external agency. While 40 services were covered in September 2018, this was soon increased to 70 (across 12 departments) by July 2019, and a scale-up to 100 was expected to be reached by the end of 2019. I take a look at the working of the doorstep delivery of public services project.

As part of the project, citizens can call ‘1076’ and book an appointment with a mobile sahayak (facilitator). The mobile sahayak visits the service seekers’ residence at the given time and collects all requisite documents for the service, submits these documents with the concerned department in exchange of Rs 50 as facilitation fees. The sahayak then collects the final certificate from the government department, and delivers it back to the citizen to complete the transaction.

The services in this project include provision of certificates from the revenue department, driving licences and related services from the transport department, and availing access to certain social sector schemes. Most of these services are in high demand, and it can take days for service seekers to apply for and obtain important documents that can be essential to get benefits from government welfare schemes.

As per an annual report card, the GNCTD claims to have been able to service approximately 99.5 per cent of the 2,00,000 requests booked. As many as 13 lakh calls (1.3 mn) were made by the public. The facility currently operates with more than 125 mobile sahayaks, 100 call centre executives, 11 supervisors, 35 dealing assistants and 25 coordinators[1].

The institutionalisation of informal broker practices does incentivise assistance to the general public, however, there still are some teething issues observed through a year of the project’s operations.

  • Technical readiness: The launch of the scheme was accompanied by a series of glitches in the system due to fluctuating demand and the backend team modified the software multiple times. The mobile sahayaks and the call centres were also initially working in silos, and delivery of services reportedly suffered due to lack of coordination.
  • Traditional methods are still more popular: While the scheme was primarily launched to minimise the complexity of Government to Citizen (G2C) services from multiple departments through intermediaries, it was seen that more than 50 per cent of applications were still made directly at the window.
  • Rationalising resources: The scheme also faced issues with respect to planning its human resource base as most sahayaks initially quit their jobs due to low wages, and it was difficult to replace them. Among the requirements was for sahayaks to have their own motorcycle for conveyance, which is difficult to fulfill.
  • Understanding scale: Even as 1.3 million calls were made to the toll-free number, only 200,000 requests were booked and 150,000 were successfully resolved. While the churn rate of successful completion was high, it appears that the scale and demand of services was underestimated, resulting in only 15% cases being booked out of the total calls received.

Source: Hindustan Times, 16 July 2019

All the challenges have important lessons. Donald F. Kettl, a scholar of government and administrative reforms, has suggested that New Public Management (NPM) (such as the doorstep delivery of public services project) aims to “remedy a pathology of traditional bureaucracy that is hierarchically structured and authoritatively driven”. The accommodation of the role that brokers have played in service delivery in this case can be considered as a good example of NPM techniques. The government has attempted to eliminate rent-seeking, and create a leaner, incentive-driven local administration.

Ketll suggests that the six key characteristics of the NPM approach are productivity, marketisation, service orientation, decentralisation, policy oriented and being accountable by design. NPM clearly articulates a result-oriented relationship, specifying performance in a clear manner.  This scheme was understood to be one-of-a-kind offering in India. While I would acknowledge it to be a constructive innovation by the GNCTD, the lack of technical capacity, public readiness and average resource allocation makes it less likely that the project will become a norm.

Any government service, when offered to the public, largely aims to ease public life or welfare, taking into account some degree of compatibility for uptake and reception by its beneficiaries. For a megacity like New Delhi, strong migration patterns, ad hoc living conditions for many, and the comfort associated with informal systems of access to public service delivery can become additional challenges.


This article was originally published by the Accountability Initiative, Centre for Policy Research.


 References
[1]‘Delhi Government delivered on 99.5% of doorstep service requests,’ Hindustan Times, 10 September 2019. Access it here.

sushant.pngAbout the author:

Sushant Anand is a senior officer at the Accountability Initiative. He has a vast spectrum of experience to work in areas including health, education, WASH, resource management and climate change in organisations like FICCI, IPE Global, Ipsos and TERI.
Sushant is a public policy professional by training and completed his MA in Development Studies from the ISS.