Work with not against communities, to manage COVID 19


Many couples intending to get married stress test their relationship to determine whether it goes deeper than the kiss-kiss-bye-bye-baby level. Professionals can design a premarital experience – like reality TV shows do – to bring out the best and the worst in you so you can both make a considered choice.

The ongoing novel COVID experience is doing something similar between citizens and the State. So, let’s examine some emerging features.

No room for the shrinking numbers of the poor

First, it is not news that if you are poor and marginalized you are on your own. This has been true even before the British left us to our own devices. The sad thing is that it remains true even seven decades later. The good news is that there are less poor – in absolute and relative terms – than ever before. This means for the top two thirds of our population, freedom from reliance on the benefactor State – often an unreliable partner in time of need.

The growing share of private enterprise insulates those who can pay from the vagaries of public services

Second, private health services now dominate so one doesn’t have to rely solely on the VIP obsessed public hospitals. And don’t forget often it is the neighborhood “Bengali” doctor – uncertified but a skilled practitioner nevertheless, who renders yeoman service (yes they are all invariably men) to those who cannot afford private hospitals or have no access to one, nearby.

The size of the vote pocket-boroughs is shrinking as citizens become free of dependence on government services


Third, the growth of a market-based option for sustenance and health – private supply of diagnostics, health services, medicine on the one hand and enhanced incomes on the other, mean that expectations from government are changing.

Citizens no longer want to spend half a day trying to get their rations from a fair price shop. They would prefer a cash transfer as assistance and buy what they want from the market on their way home from work.

Take the case of the most recent government intervention by the Chief Minister of Uttar Pradesh to make available 1000 buses gratis to ferry returning migrants from the borders of UP to inland destinations.

Yogi ji is to be praised for his sensitivity to the plight of his citizens who were implicitly kicked out by the Delhi lock-down taking their livelihoods away. Giving free rides home to migrants is good politics. But consider, that at every stage in this sordid story, hitherto proud self-supporting members of society are being converted into mendicants – dependent on the government for everything and thereby stripped of their dignity. Yes, that is what benefactors do to you.

Creating pocket boroughs is the oldest political game in democracies. These are communities whose will to be free is eroded over time by a steady drip of public largesse – not enough to help them break out of their dependence but big enough to get by. In aid parlance it is called giving a man fish rather than teaching him to fish.

The virus should scare us into reforming government just as much as an economic crash would


Fourth, COVID 19 is an opportunity. At a crass level it is a political opportunity for one up man ship. At the most benign level it should be changing how governments work. There is plenty of the first evident but little to indicate that the crisis is being used to reform government.

Don’t look at India through a foreign “medical best practice”lens to manage the COVID crisis.

Fifth, COVID 19 is first and foremost a public health emergency and not a medical one. The medical emergency route of management requires systems, finances and facilities way beyond what exists, or which can be arranged before the crisis peters out in the same way it began – on its own.

The public health route of crisis management is to immediately make available additional finances to local governments who work where the rubber meets the road. State level multi-specialty emergency teams consisting of medical experts, community service specialists, revenue/district staff and the police should be created to work in aid of local governments.

Empower local government with funds, equipment and expertise to devise relevant solutions

The aim should be to devise contextually relevant plans per local requirements – work scheduling to limit movement; public outreach about dos and don’ts; distribution of basic protective gear – masks, gloves, soap and disinfectants and most important training for behavior change – physical distance as opposed to huddling, which comes naturally to Indians; no-touch interaction as opposed to our feel and tell instinct and the importance of self-quarantine requirements when required.

None of the above comes naturally in a society where those preferring to be alone are considered odd, anti-social or worse deranged.

Why are we ignoring the role of field level public health and development workers in the crisis?

It is not as if community level contacts do not exist. We have come a long way from being solely reliant on patwaris (revenue workers) or the schoolteacher for reaching out to communities. Nearly 2.5 million anganwadi and ASHA workers are available located within communities. They are trained in community outreach and can be a frontline resource to effect behavior change through the woman of the house. Sixth, decision makers need to become risk takers. COVID 19 cannot be stamped out like a bug as the lock-down is trying to do. We have seen the results. In trying to stamp out a fire we have spread it from cities to all over rural areas via returning migrants.

Don’t flatten the urban infections curve at the expense of peaking the rural infections curve

The urban curve of infections has been flattened but at the expense of peaking many discrete rural curves where migrants are now carrying the virus. Sadly, medical facilities are even worse in rural areas, so it doesn’t take much to create a “peak” of unmanageable rural cases.

Keep the economic engines running – it can be done with basic safety precautions

Ensuring the minimum economic disruptions whilst banking on community participation to adopt safe behavioral practices is a reasonably good weapon to tackle the crisis. Doctors are unlikely to agree. They are trained to offer the “best” medical advice which may not always align with optimum social or economic outcomes.

Hark back to personal experience and the limitations of narrow medical advice become obvious. No doctor would advise pulling the plug on a patient in extended coma. But plugs do get pulled when common sense prevails.

Relax the porous lock-down to let supply chains and labour markets operate freely with safety precautions

There is still time. Relax the lock down under supervised safeguards like minimum protective gear, staggered attendance at the work-place and regulated access to avoid crowding in public transport. This will preserve jobs and economic activity. Equip emergency workers with protective gear and safe work environments so that they are unafraid to work within communities. Relax the rigidities of procurement procedures to speed up deliveries of supplies.

State credibility is best earned during a crisis by taking firm but carefully considered steps with full buy-in from communities. It’s a noisy and troublesome option. But it can be done.

Also available at TOI Blogs March 29, 2020

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