Analysing Kerala’s Response

The COVID-19 pandemic has been a test of the Indian state’s capacity to deal with the repercussions of a public health crisis. Kerala’s success, as it continues to draw strength from its political culture of participatory governance and its emphasis on social welfare, is elaborated. Some of the decentralised, scientific, and humane policy measures taken to contain the virus are also elucidated.

From a conversation with S M Vijayanand, former chief secretary of Kerala, on 14 April 2020.The School for Democracy has been conducting “Charchas,” a platform created for conversations defined by the participant’s concerns, for the last eight years. In a recent virtual “Charcha,” Vijayanand, was invited to share Kerala’s experience in containing COVID-19. The text of his conversation serves as the source and inspiration for writing this article.

Thomas Isaac, Kerala’s Finance Minister, writing in the Indian ­Express comparing Kerala’s record on COVID-19 with the rest of India, says:

The recovery rate in Kerala is nearly 50% while the all-India average is around 11. While the mortality rate among the infected is 0.5% in Kerala, the all-India average is 3.4%. The transmission rate of a primary carrier is 2.6 while in Kerala it is only 0.4. (Isaac 2020)

People often say that Kerala’s social indicators are so advanced that they hardly bear comparison with the rest of India. However, COVID-19 has provided another opportunity to measure Kerala with the rest of the country and to assess the reasons for its success. As S M Vijayanand, Thomas Isaac and others explain, it is the crafting of participatory governance in consonance with society, resulting in a political culture cutting across party lines that has enabled the people of Kerala to be a part of their ­solutions.

From being the epicentre of the novel coronavirus outbreak to rapidly “flattening the curve,” Kerala has become a model in the management of the ­COVID-19 pandemic. There is general ­curiosity amongst a section of Indians to know more about the much-praised ­Kerala model. The Government of Kerala has, in contrast with the Government of India (GoI), handled COVID-19 efficiently, balancing equally between health security and welfare of the isolated and the often ­terrified migratory labour. The figures indicate that, out of a total 399 cases ­recorded as of 18 April 2020, 257 people (64%) have recovered so far, surpassing the number of active cases. The state has the highest number of recoveries in ­India. Presently, there are 67,190 people in ­observation, and 504 of them in hospitals. The health machinery has tested 18,774 samples so far, of which 17,763 samples were negative (Nidheesh 2020).

Despite the Prime Minister’s grand add­resses to the nation, the GoI has failed to address hunger, health and livelihood issues of the poor during the COVID-19 crisis. The central government’s lacklustre implementation of delivery and absence of genuine concern has acutely had an impact on millions of stranded people—migrant workers and their families, the daily wage worker, the peasant farmer, lakhs of small entrepreneurs, street vendors, the industrial worker, the skilled worker, and even the small manufacturer. Given this dismal scenario, COVID-19 and the continuous lockdown has become one more constraint, applied without imagination or compassion that disproportionately affects the underprivileged.

What made Kerala deal with the complexity of the pandemic was the state’s uniquely participatory governance, nurtured through generations of cross-sectoral dialogues. The individuals and institutions who have fostered this process range from people and people’s organisations like the Kerala Shastra Sahitya Parishad (KSSP) to eminent acade­mics, including economists, sociologists and civil servants, and many organisations of youth, women, and farmers, and unions and cultural organisations. Kerala is unique in how its governance integrates political necessity with socio-economic realities. For instance, the celebrated “Peoples Plan Movement” (1996–97) brought together social and political democratic ideals within the framework of local “self-governance” (Mohanakumar 2003). No matter which party was in power, Kerala chose to keep the welfare state as the framework to guide public policy and ­implementation. This contributed to the rapid increase in participatory development and much better social indicators for the state. The tradition of partnership between people and the government helped counter the COVID-19 crisis and significantly shaped the ability to address insecurity. People’s partnership underscored the government’s response to the crisis.

The Kerala model of COVID-19 relief is actually built on sound principles of governance that have had historical precedence. Successive governments have strengthened welfare, especially public health and education, decentralising gov­ernance and engaging civil society. Regime changes every five years did not affect social welfare policy, as all governments were held accountable by the decentralised system. As a norm, the panchayats and the network of self-help groups (SHGs) (Kudumbashree) kept the other levels of the government in check by making sure that the benefits of government orders reach everyone.

What was most useful in the current dealings with the pandemic was the fami­liarity across the state, with participatory management systems. The daily interface with the administrative system trained the community, drawing attention to details, enabling it to understand its functioning and delivery potential. The local governments were further strengthened through the devolution of financial and administrative power, providing panchayats with operational control of their areas. Kerala’s powerful gram panchayats reach out to a large number of people, who are part of the decision-making process. The allocation to local government this year in Kerala is `20,000 crore. Of this, `7,000 crore are untied funds, facilitating the panchayat to make plans based on people’s articulated needs.

This coordination and communication between various levels of the Kerala government was integral to the relief ­architecture for COVID-19. The coordination across party lines made sure that this was treated as a humanitarian crisis, bringing all energies together. The pandemic was not caught unprepared like in most of the other state administrations. The architecture required to address the new set of issues needed tweaking and alteration, and the Kerala government rose to the challenge.

Contrary to the design of a welfare state that looks at the condition of the most underprivileged as central to its concerns, the GOI was preoccupied ­almost wholly with the containment of COVID-19—the lockdown and quarantine. Its stated concerns implied that this was sufficient and adequate to tackle the spread of the disease. Other issues were discounted. The impact on the lakhs of workers when the lockdown prompted the closure of workplaces all over the country; the displacement of unorga­nised workers, who were left without shelter or food or access to money, took place at an unprecedented scale, and was not prioritised in its stated concerns. This nightmare for the workers, visible on television screens, provoked platitudes and a list of remedies in the now infamous seven bits of advice from the Prime Minister. The worker can neither follow nor be assured of any benefit from this seven-point formula (Dey and Roy 2020). Forcefully cordoned, and with their basic needs ­being ignored, unemployed migrant ­labour began walking home hundreds of kilometres resolutely, often beaten with batons by law enforcement officials ordering them to discontinue their journeys. Many lost all their meagre savings, when the buses they had hired at exorbitant rates to go home were stopped, and the migrants were off-loaded into crow­ded camps. The general ignorance and indifference of the establishment, and of the elite in general, was another dark moment in India’s recent history.

The response in Kerala was diffe­rent—helplines and community kitchens for all those who needed food were ­established. The combination of local government, the network of volunteers, SHG workers and persons in the civil supplies department prevented a situation of panic, curbing a situation of hoarding and overpricing in Kerala. When the novel coronavirus was first detected, the already empowered panchayats were given greater responsibility to deal with this crisis. The decentralised structure of governance enabled them to harness the strengths of the political system and leverage social institutions. In particular, the approximately 60 lakh SHGs initially created to focus on livelihood generation and also look at concerns of women’s empowerment and their participation in development activities were an important part of crisis management. The state’s call for public support to ­address the COVID-19 emergency drew two lakh volunteers. The accredited social health activist (ASHA) and Kudumbashree workers, registered volunteers, and panchayat members ensured that the benefits reached everyone.

COVID-19 Preparedness

Kerala’s preparedness for the pandemic was an offshoot of its historic governance tradition of using a combined ­social and political democratic framework, which included dialogue with its people before putting systems of social welfare in place. Kerala’s experience in dealing with two disasters in quick succession in 2018—the spread of the Nipah virus and the Kerala floods—also educated the government and its people. Many of the processes and methodologies used currently were developed from those experiences. When battling with a fatal ­infectious disease during Nipah, the state health department collaborated with ­experts from the World Health Org­ani­zation (WHO) and the Indian Council of Medical Research (ICMR) and built a scientific public health management system. The shared theoretical understan­ding of the disease guaranteed a transformed, aware community, working with the government at all levels.

The relief response to Kerala floods, which occurred a month and a half after Nipah, displayed a combination of colle­c­tive action, public duty, and care. Though flood relief is the responsibility of the state’s revenue department, panchayat’s and community members were spontaneous in their support for providing relief and first aid. For example, fishermen, who do not generally go inland/midland for fear of damaging their boats, voluntarily went to rescue people.

The processes and lessons learnt from handling the Nipah virus were used to build a response to the COVID-19 spread. In 2018, health professionals developed expertise in virus tracing, testing, and treatment. From an epidemiological point of view, the public health officials ­focused on high-risk people and their contacts, putting into place a system in 2018 to contain infection early. Additionally, the Institute of Advanced Virology was built in Alappuzha, so that testing could occur within the state instead of having to send samples to Pune. This made testing for COVID-19 quicker and more efficient.

The network of healthcare and the ­infrastructure to deliver relief therefore had a tried-and-tested blueprint. By mid-January, the preparations for the eventuality of COVID-19 entering Kerala were in place, resulting in a well-oiled tiered system by the end of the month. This consisted of a middle-level bureaucracy that communicated with both the front-line workers and volunteers in the field and the top layer of the government. Rigid government hierarchies, which were, in any case, less severe than in other states, were softened in response to the crisis. Community mobilisation matured to a larger culture of “care giving” that has permeated Kerala’s history of public delivery systems. This proved invaluable in managing the coronavirus efforts.

The practical implementation and pre-planning of the government was espe­cially visible in its meticulous tracking, testing and quarantine strategies. Kerala introduced strict quarantine procedures around 10 March 2020, long ­before the rest of India had woken up to the impending crisis. Those returning from abroad, including students coming back from Wuhan, were made to isolate themselves at home for 14 to 28 days, ­depending on whether they were high or low risk. Those in quarantine were made to register with the DISHA helpline as well as with primary health centres (PHCs), and were regularly checked on by the authorities. This process was ­followed strictly with no exceptions.

For the country as a whole, but especially for the states, there are lessons to be learnt from Kerala’s investment in an efficient public health system. Its success in public health management is more than evident in the fact that more people are able to access quality medical care and treatment from PHCs and government hospitals. The healthcare given at public hospitals is generally acknowledged to be superior to that in private hospitals.

Culture of Care and Tolerance

The strategies of containment of the COVID-19 pandemic in India will leave a residue of appalling stories of the collateral damage that people are suffering, due to the central government’s skewed plan for containing the disease. The GOI organised planes to transport Indians stranded abroad to come home. Migrant and daily wage workers who have been victims of lockdowns and safety precautions have however been denied the right to even organise their way back home. They have not even demanded subsidised transport. All they have been asking for is the right to travel within the country, following all pre-conditions and precautions. “Social distancing,” better termed “physical distancing,” in crowded camps is impossible. Added to this is the constant fear that they are going to join the ranks of the unemployed and live in daily fear of family members contracting the disease or succumbing to starvation. The constant chant has been “if we have to die, we would rather be home.” It is completely reprehensible that some migrants confront xenophobia, as media propaganda has gone out of its way to link the spread of COVID-19 with an event of one religious sect, and by mischievous implication seeking to stigmatise an entire religion. The narrative in Kerala has brought reassurance that we still have some humanity left.

The Government of Kerala, with its stated and cultivated culture of compa­s­sion and care for migrants, has reass­ured and taken care of those worst affected in this crisis. Given the history of migration of its people looking for work, particularly in Gulf countries, the state has evolved an understanding of the privations of migratory workers. A study in 2018 showed that there were around 21 lakh emigrants from Kerala working outside India (Rajan and Zachariah 2019). The migrants in the Gulf, though better paid in relative terms, recall appalling work and living conditions. Therefore, instead of demonising inter state migrants, local Keralites understand and empathise with their suffering and understand the value of their contribution. They also understand its economics; the exodus is balanced by the influx of labour to fill the vacuum.

The state has stated and developed a framework of care and compassion, both in its policy and implementation. This has now become a part of the admini­strative DNA. The centre has begrudgingly acknowledged the poor in this time of crisis, whereas Kerala has centred them in their planning, and carefully factors their concerns in tackling the public health emergency.

To begin with, far before the centre announced its plan, on 19 March 2020, Kerala announced its `20,000 crore ­relief package that included free public distribution system rations, a kit with essentials for everyone, 2,300 community kitchens, regular Anganwadi ration delivery, cash transfers, and so on. It was followed by principled public action by state, district and local functionaries. The chief minister firmly stated in his address that police excesses and illegitimate punitive measures would not be tolerated, and no person is to be treated with contempt or misbehaviour. He also said that grievances must be heard and sorted out with personal attention at the highest level. When there was dissatisfaction and restlessness, the superintendent of police and collector made visits to the agitating or striking migrant workers to reassure them in person and listen to their grievances. They communicated with a team that immediately attended to and sorted out their distress.

Kerala’s unique combination of religious tolerance and humanity, combined with rational and scientific methods to explain public action, was used once again to contest the communalisation of the virus after the highly politicised ­Tablighi Markaz incident (Bisht and Naqvi 2020). Governments have enormous powers to shape public opinion. While, in Gujarat, there were reports of a hospital allegedly separating Muslim and Hindu patients post the Markaz, the Kerala government swiftly and publicly stemmed bigotry from spreading (Hindu 2020). The chief minister made a strong announcement on a television broadcast and reassured the minorities that the political system would not tole­rate those who aimed to communalise the incident. He also publicly detailed the procedures followed for those who had gone to the Markaz.

One of the most incredible feats of the Kerala administration was its ability to destigmatise the virus in an international atmosphere of near hysteria. The Kerala government showed social and political solidarity during this crisis, when they publicly proclaimed that any patient from neighbouring states could come to Kerala for health reasons with adequate proof of their condition, sending a message that, in the time of an emergency, unity in fighting the infection must ­transcend territorial boundaries, socio-­economic class, religion and other stratifications.

These humane, people-centric methods of maintaining law and order, and implementing benefits delivery with constant reassurance served to reduce anxiety and discrimination during this time of crisis.

The strong social welfare infrastructure and pro-poor focus has shown great results during this crisis. India should learn from Kerala that crises can be dealt with, only if governance is sound, participatory, and strengthens its local bodies. The argument for sustaining the welfare state in India as the basic structure in an economically and socially skewed community and polity is amply demonstrated by the investment in primary public healthcare and education to deal with epidemics and pandemics. There are many lessons to be learnt, but they cannot be absorbed without a strong political will to place people at the centre of the discourse. The lockdown has given space to many authoritarian tendencies. Decisions emanating in New Delhi, have been taken suddenly, and even arbitrarily, and passed down to the people to follow. There has been little attempt to make people true partners in the effort. Kerala, on the other hand has tried to face the challenge by trying to facilitate and launch another peoples movement against the virus. It remains to be seen if the government of India will go back to policy based on welfare, and develop a clear, transparent, and more participatory post-lockdown contingency plan. In times of crisis we need a welfare state more than ever. The welfare state infuses confidence that the government will support its people at times of greatest need. It is in this that helps them gain some measure of self-confidence, as they try to fathom the uncertain future of COVID-19, and its continuing and disruptive effect on the country and its people.

Moving Forward

One critical fallout of COVID-19 is that governments have depended on technological databases for the distribution of basic necessities to vulnerable groups. But the pervasive use of technology for governance is a double-edged sword, and is risky if it is not bolstered by information sharing and creating accountability systems. As technology monopolises and centrally controls data and information, with impunity from scrutiny, it can be used to manipulate and discriminate. This communication is no substitute for face-to-face political and community interaction. The government may use this for further centralisation and controls impacting basic democratic and constitutional rights.

That it is no chimera is underlined by news reports that allege that the Aarogya Setu app will be installed in all smart phones by default. The app allows the collection of personal information of its users and the disclosure of this data to the government for the purposes of “medical and administrative interventions.” The institutionalisation of mass surveillance in the absence of adequate data protection laws is a matter of grave concern in the post-COVID era. The question is whether participatory systems, like the one in Kerala, will be able to resist this invasion of the political space by centrally manipulated technology. Perhaps, a new imagining of global functioning through automated single controls will affect the multiple areas that decentralised democracy has opened up for political participation.

This apprehension is further strengthened by an announcement from the GoI that the PM CARES fund is outside the aegis of mandatory auditing by the Comptroller and Auditor General, leaving the public and state governments in the dark about where the money is being spent. Similar to other state governments, the Kerala government is facing a financial crunch after its distress-alleviation measures during the COVID-19 lockdown. It has repeatedly requested the centre to disburse funds to the states.

What does opaqueness of a centralised fund portend for India’s constitutional republic, a union of states? Can any central government in a democracy abrogate such unilateral powers? If transparency is rejected by the highest elected office in the country, what message does it push down the line? As power and money get rapidly centralised, the federal structure is severely threatened. Dependence on technology often strengthens central controls. The Government in Kerala has placed welfare, which demands participation and transparency, at the centre of its administrative structure. Its resistance to this rapid potential centralisation in governance will be a test case for India to watch and learn.

References

Bisht, A and S Naqvi (2020): “How Tablighi Jamaat Event became India’s Worst Coronavirus Vector,” 7 April, viewed on 19 April 2020,
https://www.aljazeera.com/news/2020/04/tablighi-jamaat-event-india-worst….

Dey, N and A Roy (2020): “Statesmanship Requires Taking People Along; When Basic Security Is Denied, Hope Dies,” 18 April, viewed on 20 April 2020, https://indianexpress.com/article/opinion/columns/india-coronavirus-lock….

Hindu (2020): “Coronavirus: COVID-19 Patients Segregated on Basis of Religion at Ahmedabad Civil Hospital, According to Reports,” 15 April, viewed on 19 April 2020, https://www.thehindu.com/news/national/other-states/covid-19-patients-se….

Isaac, T M Thomas (2020): “What Nation Can Learn from Kerala: Lockdown Is Not Enough: Preparedness, Decentralisation, Are Key,” 17 April, viewed on 21 April 2020, https://indianexpress.com/article/opinion/columns/coronavirus-covid-19-k….

Mohanakumar, S (2003): “Decentralisation in Kerala: People’s Plan,” Economic & Political Weekly, Vol 38, No 30, pp 3214–16.

Nidheesh, M K (2020): “Covid-19: Kerala Confirms Four New Cases, 64% Recover,” 26 April, viewed on 20 April 2020, https://www.livemint.com/news/india/covid-19-kerala-confirms-four-new-ca….

Rajan, S Irudaya and K C Zachariah (2019): “Emigration and Remittances: New Evidences from the Kerala Migration Survey 2018,” Working Papers id: 12989, eSocialSciences.

Aruna Roy ([email protected]) and Saba Kohli Davé ([email protected]) are associated with the Mazdoor Kisan Shakti Sangathan and the School for Democracy, Rajasthan.

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