By Dr Joy Elamon
The world is facing the most severe public health emergency since the outbreak of the Spanish flu in 1918. The new coronavirus disease, Covid-19, has brought the world’s most powerful nations to their knees. In the days of death and mayhem, the world is lapping up stories of resilience and hope. Kerala has been the cynosure of national and global attention throughout the crisis. Several factors such as a robust public healthcare system and an educated populace have helped the state in shaping a prompt response, but it was the Kerala government’s bottom-up approach that made all the difference.
Kerala has faced various disasters during the past few years. These include the severe drought and cyclone Okhi in 2017 to the devastating floods of August 2018, followed by another flood in 2019. The latest in this series, the Covid-19 pandemic, is beyond anything Kerala or the world has witnessed in more than 100 years. Kerala reported India’s first coronavirus infection on January 30 and managed to call into action all the experience gained from previous experiences to organize its disaster response. In the process, Kerala has been learning new lessons and adapting and modifying the course of action on the go to tide over this crisis without leaving anyone behind.
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Throughout all this, Kerala’s strong third tier of government, the local self-governments, assumed the role of the first line of response. During the 2018 floods too, the elected representatives of the local self-government swung into action and organised response measures, saving thousands of lives. Their knowledge of grass-root level realities and the manner in which it was used to take rapid response measures is strong testament to the fact that disaster response has to be bottom up.
This time round, the local self-governments were armed with another important device. In December 2019, the Kerala government in a humble yet brave acknowledgment of Kerala’s vulnerability to such catastrophic incidents mandated that all local self-government institutions prepare local level disaster management plans. Through a people-centric process, local resource groups at the local self-government level were roped in to gather grass-root level data from primary and secondary sources. Different vulnerabilities at the local self-government level were mapped utilising scientific and technical expertise on the basis of past incidence of disasters. Resource mapping was also done extensively to identify the gaps which needed to be fixed through the annual planning process. Under the guidance of the Kerala Institute of Local Administration, the training and capacity building organ under the local self-government department and the Kerala State Disaster Management Authority, local self-governments set out on a massive task early this year. It is that process which is now playing out before everyone’s eyes in the manner of response to the Covid-19 pandemic.
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Leading by example
At the onset, the initiatives were organized by the Department of Health and Family Welfare. At a later stage when the pandemic was declared a disaster, the activities were led by the State Disaster Management Authority. As the state is preparing for a long-term strategy, the actions have to be coordinated at the local level. Currently the local self-governments are carrying out many of the Kerala government’s Covid-19 disaster response measures at the ground level, by working with the health department and the SDMA.
Right from the beginning, the local self-governments have been organising awareness campaigns on personal hygiene and the need for social distancing. The campaign was named ’Break the Chain’. They were especially required to target vulnerable populations such as the SC/ST, coastal communities, slum-dwellers, inhabitants of care-homes, MGNREGS workers, Kudumbashree NHG members and migrant labourers.
The LSGI Samiti has been monitoring and ensuring the smooth execution of the activities within the local self-government area. Existing committees such as the health and sanitation committees at the ward level and the health vigil committees have been revived. Emergency response teams set up under the local level disaster management plans which have received specialized training were also brought into the Covid-19 response efforts. Ward level community groups under the leadership of the respective elected ward members and comprising of health workers, Anganwadi and ASHA workers, Kudumbashree members and SC/ST promoters were also constituted to reach out and gather details on vulnerable groups, especially of aged bed-ridden and other ailing patients to ensure timely support to them in case of an emergency. With the continued identification of cases and the subsequent nation-wide lock-down, the role of local self-governments has also changed and gained further significance over the past week.
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Quarantine measures
Right from when the initial cases started to trickle in, the health department and the Kerala State Disaster Management Authority have been taking active measures to release the route maps of those tested positive for Covid-19. With this, they tracked down persons who had had primary contact with infected people, in order to home quarantine them. The local self-governments at this stage were asked to monitor those who were in quarantine to ensure they did not violate it.
While initially these persons were being quarantined at home, the situation has changed during the last week after travel restrictions have been imposed. Since then, more persons have been mandated to be quarantined. Community quarantine centres have been set up to quarantine those who have come from other countries and states, those who have been mandated to be in quarantine due to primary contact with coronavirus positive cases and those who have violated the home quarantine conditions. The local self-governments are in charge of these centres and have been organising food and other means of support including counseling for those in these centres.
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Planning for future
A massive mapping process is also currently under way wherein local self-governments are taking account of buildings such as abandoned hospitals, hostels and educational institutions in their areas which can be converted into community quarantine centres and first line treatment centres in case the need arises. Under the guidance of the health department they are taking measures to ensure their upgradation as well. This also includes identification of human resources of various nature.
Community kitchens
Most importantly, food and other arrangements are also being arranged by the local self-governments for those under lockdown and unable to procure it. Community kitchens have been started across the state by the local self-governments. The community kitchen facilities, while primarily for the purpose of supplying food for those in quarantine, senior citizens and bed-ridden patients, also ensure that the more vulnerable sections of society do not go hungry during this time. For a very nominal rate, food from the community kitchens are being delivered three times a day right to the door step of people within the local self-government area. The vulnerable sections of the population within the respective areas such as guest workers, destitutes, etc who have been identified by the local self-governments are being given food free of cost during this time.
Volunteer teams
The local self-governments meanwhile are also in the process of pulling in volunteers to bolster their efforts in containing the spread of the coronavirus. Through an online registration process, volunteers are being identified and duties assigned to them according to the tasks at hand. With a primary objective of ensuring that the volunteers themselves do not become carriers of the virus, strict protocols are being enforced especially that of personal hygiene. There is also a plan in place to allot adequate volunteers to each house cluster within wards in order to ensure that information flow regarding government notifications reach all the way to the last person. These volunteers will also be in charge of making sure that the basic needs of the people in those houses, especially vulnerable sections are fulfilled in the coming days of the lock-down.
Migrant workers
The state has been taking great care in the health and wellbeing of migrant workers. Local self-governments had done a massive exercise to map their camps and dwellings and the living conditions. Wherever the condition is not good, camps have been set up and workers are provided food from the camps or from the community kitchen. If they do not like to have Kerala food, they are being provided with grocery kits so that they can prepare the food of their choice. Local self-governments are involved in this too.
Surveillance
Local self-governments have been on a daily basis taking stock of the situation with regard to home isolation and quarantine. Every day they collect details regarding the status of people who are in isolation and quarantine, how many have completed, how many have come in, how many have been tested positive and how many have been cured. In addition to these, on a regular basis, they also look into the status of the vulnerable like the elderly, palliative care patients and the like.
Every day when someone gets the figures and status of various points related to Covid-19 prevention in Kerala, it is to be noted that at the cutting-edge level, the local self-governments provide the data on a day to day basis, which is consolidated at the district and state levels. Emergency response team in the department of local self-governments coordinates these activities.
The tasks ahead
As the lockdown is relaxed, the local self-governments will have to play a key role in the surveillance and monitoring of isolation – home or community based. In the meantime, they are already in the process of getting prepared to establish Firstline treatment centres and more isolation centres, if the need arises. The idea is that within 48 hours of a decision on setting up of these centres, the centres should start functioning. For many LSGs, the preparation of the disaster management plan has become very useful in this regard.
(Dr Joy Elamon is a renowned public health expert based in Kerala. He is director, Kerala Institute of Local Administration, Trissur.)