Abstract
The inter-governmental response to the COVID-19 pandemic in India not only revealed centralized tendencies but also exposed weaknesses in the administrative and planning processes needed for a cohesive but flexible national response. This paper highlights some of the subnational states’ early responses to increasing COVID-19 cases and argues that, while India resorted to centralized measures to deal with the pandemic, a decentralized response may have proved more beneficial. Policy recommendations following this line of thinking conclude the article.
Introduction
India reported its first case of COVID-19 on January 30, 2020 and the nation’s hundredth case on March 14th (Figure 1). By March 23rd, the World Health Organization’s (WHO) emergencies program director declared that the global “trajectory of the virus would be determined by how aggressive and sustained the action of highly populous countries like India was in dealing with the outbreak” (DownToEarth 2020). Two days later the federal government imposed a nationwide lockdown that lasted sixty-eight days. Despite this aggressive action, COVID-19 cases in India crossed the 1 million mark in mid-July and reached 7 million in mid-October. Based on the total number of cases, India became the second worst hit country in the world, trailing only the United States.
Timeline of Coronavirus spread in India. Source: News 18, Aug 23, 2020; The Indian Express, October 17, 2020, and statista, 2020.
India’s response to COVID-19 revealed centralized tendencies of government but also exposed weaknesses in the administrative and planning processes needed to launch a national response, especially a lack of public health infrastructure. This paper highlights some of the states’ early responses to increasing COVID-19 cases and argues that while India resorted to centralized measures to deal with the pandemic, a decentralized response may have proved more beneficial.
Central Response to Pandemic Leaves Crucial Gaps
Government intervention is critical for mitigating the impact of the pandemic (Kumar 2020a, 12) yet some experts criticized India’s COVID-19 management for excessive centralization (Kumar 2020b, 10) and a lack of a clear legal framework to justify pandemic responses (EPW Editorials 2020). The central government declared a national lockdown without taking the states into their confidence, exposing striking disregard for federal principle. With health policy falling in the states’ purview there were questions raised over the constitutional validity of the lockdown.
Centralized advisories issued through the Ministry of Home Affairs also disempowered the states. One example is a circular issued by the federal government in the first week of April 2020 asking state governments not to procure any safety kits—procurement would be managed by the center and supplied to respective states—many states subsequently experienced shortages of medical safety equipment and many doctors and nurses tested positive for COVID-19 ( The New Indian Express 2020). The pandemic also revealed pressing challenges to the healthcare system in India and a need to increase the public health expenditure (currently less than two percent of GDP).
The national lockdown also failed to take into consideration the livelihood concerns of hundreds of thousands of migrant laborers who were left with no job, no food and no transportation to go back to their hometown. A lack of social safety net measures forced migrant workers to walk back to their hometowns, potentially spreading the virus and “exposing once again India’s deep economic divide and the government’s apathy toward the workers who power the country’s growth” (Chatterjee 2020).
Lessons from States
After 68 days of nationally mandated lockdown the damage caused to the economy forced the national government to begin a phased reopening on June 8th. This largely left management of the COVID-19 pandemic to states. Several states responded with a more decentralized and localized approach to manage of the pandemic.
Kerala State
Though Kerala reported India’s first COVID-19 case in late January and initially topped the list of states with higher cases, the number of new cases in the first week of April dropped 30 percent from the previous week (Masih 2020) and its efforts managed to flatten the curve by adopting a strict and well framed pandemic management plan with the help of its local governments and women’s organizations. Quick responses by the local village council members and public health centers were the key to controlling the spread of COVID-19. With the help of community workers, the local government opened community kitchens to feed the people in isolation centers and local health officers ensured provision of medicines on time (Biswas 2020). Additional actions included contact tracing, getting volunteers to monitor home quarantine and aggressive information sharing to citizens. Kerala handled the migrant issue equally well. As a result, the Kerala COVID-19 management model was widely admired, even by the WHO.
Odisha State
Managing the emerging COVID-19 situation was not easy for Odisha state which simultaneously faced natural disasters (cyclones and floods.) However, important crisis management systems were already in place because Odisha suffers nearly 25 percent of India’s natural disasters (Srivastav 2020). Odisha became the first state to declare a lockdown in India. To protect the health of its population the state increased testing capacity and incentivized citizens to undertake tests, allocated resources effectively, engaged the private sector, set up needed infrastructure (including medical camps at the village level), and increased capacity of human resources in the health care sector. The state’s Mission Shakti Self Help Groups (SHGs) stitched masks in bulk to avoid any shortage, while panchayat (village) level kitchens cooked meals for those who were in need. Additionally, Odisha sought to protect residents from a financial crunch by advancing disbursement of welfare resources to the entitled beneficiaries.
These actions resulted in a low case confirmation ratio, a low case fatality rate and a high recovery and discharge ratio (Patnaik, Anshuman, and Asit 2020). Panchayats remained critical players to the state response to COVID-19 pandemic. The state government provided financial support to each panchayat to set up a temporary medical camp and by April 14, 7,276 medical camps with a total of 162,659 beds had been set up across 6,798 panchayats (Patnaik, Anshuman, and Asit 2020).
Rajasthan State
Rajasthan’s Bhilwara Model is one of the earliest examples of efficient management of COVID-19. Bhilwara was the first district in Rajasthan with reported cases of COVID-19 and soon became a COVID-19 hotspot. The state government and district administration immediately took steps in tackling the pandemic. At the initial stage this included contact tracing, setting up institutional quarantine and testing facilities for people showing symptoms of COVID-19 infection and providing mobile vans and telemedicine facilities for other patients. The strict isolation and door-to door screening in Bhilwara district was hailed as a model for rest of the country in preventing the spread of the pandemic ( The Economic Times 2020).
Maharashtra State
Maharashtra tops the lists of states in the number of COVID-19 cases but showed success in Dharavi, Asia’s largest slum and the most densely populated area in the world. In the month of April Dharavi became a COVID-19 hotspot and controlling ever increasing numbers of COVID-19 cases became one of the biggest challenge to state officials. Brihanmumbai Municipal Corporation (BMC) followed four T’s in response—Tracing, Tracking, Testing and Treating (Times of India 2020). Proactive screening and community support helped control the spread of the virus and community toilets, a primary concern for transmission, were sanitized almost hourly by the local authorities (Outlook 2020). As part of Mission Dharavi, “fever camps” were set up by medical workers in different parts of the slum so residents could be screened for symptoms and tested for coronavirus if needed ( Times of India 2020).
Goa State
The response of local governments and community participation were key elements in these success stories yet increasing the powers of local governments also led to constitutional tensions. The case of Goa provides a good example. After a brief period as a designated green zone (from April 17 to the end of May 2020) cases started increasing in Goa in early June and Vasco, a city of 100,000 population in South Goa, rapidly became the epicenter of these cases. There were regular demands from panchayats to declare a lockdown in Vasco and other parts of Goa which witnessed a surge in cases. The state government was unresponsive to these demands so several panchayats declared lockdowns in their areas by passing resolutions. Some questioned the legality of such lockdown laws, arguing that the power to declare a lockdown lies only with central and state governments. This forced some panchayats to reverse their decision or call on citizens to observe a “voluntary lockdown.”
Lessons from State Action
The pandemic makes clear a need for state-level preparedness to control such diseases in the future. The relative success of those actors able to mobilize state and local resources jointly suggests due consideration should be given for decentralized governance and response. Policy recommendations that follow this line of thinking include: The central government should focus on larger issues such as designing better strategies for health management and increasing budgets for health care and research. Empower states in a pandemic situation to act swiftly and in a need-based manner through a clear legal framework. Include state representatives in technical teams preparing pandemic management plans. Rather than instructing local governments by fiat, empower them to handle pandemic situations and strengthen monitoring mechanisms to maintain consistency.
The COVID-19 pandemic forced the Indian state to test its functions, performance and re-examine its priorities. Enabling decentralized initiative can help provide better measures to deal with such pandemics in a densely populated country like India.
Footnotes
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
