Kerala's approach to containing corona

On January 30, the first case of Covid-19 in India was identified in Kerala. After weeks of being the state with the highest number of Covid patients, Kerala has not only flattened the curve, but has done so with an extremely low mortality rate of 0.5 per cent compared with 2.7 per cent for India as a whole.  This has been achieved despite the state having a high population density and high exposure to international travellers. 

The key elements of Kerala’s approach to containing the Covid-19 pandemic were: (1) developing an air-tight health protocol for isolating and tracing contacts of those infected and treating them using the public health care system, (2) assuring necessary food and other household essentials to all, (3) providing income support to those affected by job losses and the slump in the economy, and (4) mobilising all sections of society (government departments, local governments, mass organisations, private organisations and individuals) to effectively implement the Covid-19 mitigation measures. 

Investing in public health 

Kerala has built an effective network of primary health centres (PHCs), spread across rural and urban areas. One of the first initiatives of the current Left Front government was the Aardram (or health) Mission, to further strengthen the PHCs by upgrading them to family health centres with more doctors and nurses at each centre. The public health institutions at each level of the three-tier arrangement, PHCs, taluk and district hospitals, and medical colleges/specialised institutions, were the backbone of the current initiative. 

The health system was alerted in the third week of January when medical students from Wuhan began to return to Kerala. Appropriate arrangements were made to treat all potential cases in public hospitals and in specialised wards so as to control the spread of the disease. In the second wave, the administration began isolating cases, tracing contacts, and implementing strict quarantine measures. With a large number of foreign tourists, emigrants from the Gulf and other countries, the total number of people who were quarantined in Kerala was probably the highest in India: Around 1,70,000 at its peak on April 4. A “Break the Chain” campaign was run using all forms of media to ensure proper washing of hands.  Mobile phone applications and data analytics were used to communicate with people and coordinate the efforts of local governments.

Illustration: Binay Sinha

Provision of basic needs 

Kerala announced a lockdown before the rest of India (on March 23), and soon after, became the first state to announce a relief package amounting to Rs 20,000 crore. An important component of this package was provision of sufficient quantity of free rice through the public distribution system to all households with an Aadhaar card (including those without a ration card). This measure has been successful with news reports pointing to near-universal coverage (about 97 per cent of households). 

In addition, through the ration shop network, the government began to issue a 17-item grocery kit that included dal, oil, sugar, soap, and other items to households on a priority basis, starting with the poorest households in tribal areas. Community kitchens were started by local governments, to serve those who were old, disabled, or under home quarantine. Temporary shelters were opened for homeless people, with food from the community kitchens, and migrant workers were also given provisions. The Anganwadi centres gave take-home rations to all families with children.

In short, by ensuring that no person would go hungry, people’s participation in adherence to the strict lockdown was made sustainable.

Income and production support

Recognising the need for cash support, the state government began immediate transfers to the most vulnerable populations. Advance payments under welfare schemes such as old age, widow, and disability pensions for two months were fast-tracked and completed. For the self-employed and workers, a transfer of Rs 1,000 was initiated. 

For the rural economy, the government took measures to ensure that the rice harvest, which was at its peak in central districts of Kerala, was completed (permits were given to engage harvesters and labour). Arrangements for procurement of milk and processing of milk powder were put in place. 
An important logistical issue for Kerala was to ensure the movement of trucks across state borders, as Kerala depends on neighbouring states for various commodities, including fresh vegetables. In collaboration with the Union government, and other state governments, Kerala was able to ensure transport across borders in a safe manner, and thus control the availability and prices of essential commodities. These measures together ensured minimal income support to all households.

Mobilising people for effective implementation

The large-scale mobilisation of people and government machinery at all levels is perhaps the single most important factor in the success of Kerala’s Covid mitigation efforts. 

 
The state ensured there was both streamlining of information and action and decentralisation of implementation. A daily press briefing by Chief Minister Pinarayi Vijayan was the key source of information and comfort to the entire population. 

Different departments of the government worked together with external organisations. Hand sanitizers and soap were provided at every bus stop by mass organisations. Kudumbashree women’s groups began large-scale production of masks and sanitisers. Private companies and individuals donated to community kitchens run by local governments. The police implemented lockdown measures without any major incident of harassment. More than 250,000 young people registered as volunteers to help in the provisioning of food and other special needs, such as transport of patients to hospitals.

A deepening democracy

Brown University Professor Patrick Heller in a recent piece (The Hindu, April 18, 2020) ascribes Kerala’s success with Covid-19 containment to a deepening of democracy in the state, a feat that he argues emerged out of social mobilisations (peasant struggles in the 1960s, the literacy campaign in the 1980s, the people’s planning movement in the 1990s). All these movements that “strengthened the legal and institutional capacity for public action,” were initiated and nurtured by the Left parties. It is no surprise then that the chief minister of Kerala was able to build a “people-centric response to the challenge of the Covid-19 pandemic” and implement a lockdown “while upholding the rights and dignity of people.”
Swaminathan is a professor and Johnson a research fellow at the Indian Statistical Institute, Bengaluru



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