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What nation can learn from Kerala: Lockdown is not enough. Preparedness, decentralisation, are key

Kerala’s health system is a proud legacy of our past. It has had a rebirth under the present Left government with a big push in infrastructure and equipment investment of around Rs 4,000 crore from the Kerala Infrastructure Investment Fund Board.

Written by T M Thomas Isaac | Updated: April 17, 2020 5:34:22 pm
Kerala coronavirus, coronavirus in Kerala, Kerala Covid-19, Kerala coronavirus Covid-19 curve, Kerala healthcare Coronavirus, Coronavirus Kerala news, Kerala covid-19 news The recovery rate in Kerala is nearly 50 per cent while the all-India average is around 11. (File/PTI)

The COVID curve in Kerala is flattening. Every day, for a week now, the number of recoveries has exceeded the number of new infections. The recovery rate in Kerala is nearly 50 per cent while the all-India average is around 11. While the mortality rate among the infected is 0.5 per cent in Kerala, the all-India average is 3.4 per cent. The transmission rate of a primary carrier is 2.6 while in Kerala it is only 0.4.

But we do not want to let down our guard and rest on the laurels. Kerala is preparing for the next challenge, the outcome of which will determine the result of the war against COVID. Lifting of the lockdown is going to result in an influx of returning migrants from foreign countries and other states. Hundreds of thousands would have to be quarantined, tested and, if positive, treated, ensuring there is no secondary spread.

We have already identified accommodation and other facilities for more than two lakh persons. We are also exploring the possibility of big data analytics to plan a strategy and, if necessary, for reverse quarantining. We are fortunate to have access to WHO data covering nearly two-thirds of the state`s population. Integrating this data with information currently being generated, we will be able to map vulnerable sections of the population, simulate scenarios and plan ahead. An exit strategy from the lockdown is being prepared to protect livelihoods and stimulate the economy.

Preparedness — that is the key word to the success of Kerala and the key lesson to be learned from it. The single most important factor that enabled us to be prepared for the COVID is the strength of our public health system. All over the globe, we are witnessing serious market failures in the health sector in the context of the pandemic crisis. Policymakers are learning the hard way of the importance of a public health network.

Kerala’s health system is a proud legacy of our past. It has had a rebirth under the present Left government with a big push in infrastructure and equipment investment of around Rs 4,000 crore from the Kerala Infrastructure Investment Fund Board. Five thousand seven hundred and seventy-five new posts have also been created. The Aardram Health Mission was launched with a focus to transform the PHCs into family health centres. There is also the distinctive flavour of Kerala — mass participation in preventive and palliative healthcare.

The recent experiences of successful containment of the Nipah outbreak and management of the two post-flood health situations have provided a kind of herd immunity to the health workers to crisis situations. Once news of the Wuhan pandemic came, the Kerala health system scrambled to readiness — the control room was set up, mock drills were organised and the first influx was contained. Once migrants from the Gulf and Europe began to return, things began to get out of hand. But now this battle has been successfully concluded. Every day, from isolation hospitals, we witness recovered patients leaving with their caretakers. The biggest applause was reserved for a 93- and 88-year-old couple, with serious health complications, literally snatched from the jaws of death.

The morale of health personnel has been exceptionally high. Special training, protective gear, scientific duty rotation and, most importantly, societal empathy and solidarity, have all contributed. The health minister, KK Shailaja Teacher, does not confine herself to review committees, but reaches out personally to the frontline workers.

A route map of each COVID positive case is prepared and given publicity, alerting everybody who might have been in contact. The protocol of cycles of intense test, trace, isolate and treatment has been the norm. Kerala has the highest test rate in the country. Break the Chain Campaign to promote social distancing has been successful. This is indeed a very important lesson. Lockdown by itself is not going to contain the COVID spread. It would continue to multiply within households and dormitories. Testing has been woefully insufficient in the national response so far.

The lockdown destroys livelihoods and it is the duty of the state to ensure subsistence through income transfers and free rations. The transfer of Rs 500 to Jan Dhan accounts and additional 5 kg grain rations have been woefully inadequate. The payment to construction workers, which is a major component of the Centre`s package, is from the state-level construction workers’ welfare funds.

This is in contrast to Kerala where 55 lakh elderly and disadvantaged have received Rs 8,500 as welfare payments. An equal number of workers have been paid Rs 1,000-3,000 each from the welfare funds. Every family has been provided with a food kit. Interest-free consumption loan of Rs 2,000 crore has been distributed. Besides, nearly 4 lakh meals are distributed every day to the needy from community kitchens set up by local governments. Local governments are also duty bound to monitor the camps of migrant workers, set up new ones and ensure medicine and food to them.

How is all this possible? Make no mistake, not by the state government alone. It is the synergy generated by integrating state government plans and programmes with the local governments, the co-operatives, women neighbourhood groups (Kudumbashree) and civil society organisations that makes Kerala distinct. This August will mark the 25th year of the People’s Plan Campaign that transformed local governments in the state. The floods and the pandemic have given testimony for the potential of democratic decentralisation.

It is a case of multi-level planning with technical committees and groups working at the state level coordinated by the chief minister, Pinarayi Vijayan. His daily evening one-hour briefing is telecast live and has the highest TV rating today. It is very important that the message is transmitted to everyone with clarity and these daily briefings have enabled us to avoid confusion in crisis.

Lack of adequate financial resources has been the biggest impediment faced by the government. The state’s own revenues have dried up. The GST compensation is in four month arrears. Credit is freezing for the SLR bonds. There are no sufficient resources for relief let alone for the stimulus after the exit from the lockdown. The Central government has to step in and ensure adequate fiscal space to the states. Unfortunately, the Centre seems to prefer that state governments cut their expenditure while the country is facing a slump. This is crazy macroeconomics.

This article first appeared in the print on April, 17,2020 as ‘Ahead of the Covid curve’. The writer is Finance Minister, Government of Kerala

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