(This is Part-III of a three-part series by (retd) IAS officer and public health expert Ms Shailaja Chandra, to mark the first ‘anniversary’ of India’s COVID-induced lockdown. Part I and II can be accessed here and here.)

On 1 April 2020, I wrote for The Quint, and the article’s blurb reads:

“India’s saviour may not be a vaccine, but efficiency of this administration and public health responses to the crisis.”

One year has gone by, and this statement has been proved correct.

The Centre played the role of military generals spearheading the strategies and tactics which were to be used by the combat arms. The armed corps and the infantry were the central and state healthcare systems, and the artillery were the hospitals, drugs — and finally, the vaccines. The corps of engineers were the manufacturers who made India self-sufficient in the production of equipment and consumables.

Central Government’s Role in Handling COVID

By far the biggest strategy was the complete nationwide lockdown which was announced by the PM starting 25 March 2020, and which continued for 68 days. The Epidemic Diseases Act, 1897 and the Disaster Management Act, 2005 were implemented from March 2020, to control the COVID-19 pandemic and prepare for further action.

Indian borders were completely sealed for the first time on 22 March 2020 for any foreign or domestic travel.

Free LPG cylinders were given to BPL families, etc for 3 months. An insurance scheme for health workers fighting COVID-19 included a comprehensive Personal Accident and Life Coverage of Rs 50 lakhs.

Only after four consecutive phases of lockdowns, the Centre announced ‘unlocking’ mechanisms, and services resumed in a phased manner.

How Did the State Govts Manage COVID?

The Disaster Management Act which was invoked to manage the pandemic gave the District Magistrates unquestioned authority to requisition empty buildings, privately owned transport, hotel space and even man power. He could use any of the district resources and institute systems for documentation and reporting and ensure compliance.

No other country has a network where the administrative tentacles can reach every part of the state or district and which can penetrate every house and get down to every family by name, age and sex based upon available documentation. In a crisis situation this single line of district authority does not depend on political actors and what is otherwise viewed as a slow, bumbling and unresponsive administration, functions with incredible efficiency.

Video conferences were held almost daily between the Health Ministry and the states, the cabinet secretary with the chief secretaries. As early as end March last year this was confirmed to me by the health secretaries of the more outlier states like Bihar, Chhattisgarh, Odisha and Jharkhand.

What Kerala & Maharashtra Did Amid COVID Crisis

Some initiatives taken by the states have been done entirely on their own and have proved to be successful. These were gleaned by talking to the Health Secretaries of the states I could contact:

• In Kerala, the community was involved, and to ensure that people strictly complied with the home quarantine requirements, a neighbourhood watch was put in place and a WhatsApp number was created by each district administration which the public used to report violations. For surveillance, the police used drones not only to enforce the lockdown but also to identify the production of spurious liquor and the sale of drugs. The elected representatives were used widely in supporting the surveillance systems and members of the self-help group called Kudumbasree were used. Community kitchens also set up at the local governments to ensure cooked meals were readily available. The fact that the state has the highest number of elderly and also considerable density of population if one looks at the case fatality rate it is among the lowest in the country.
• Maharashtra established dedicated COVID care foods in hotspot areas and a lot of dedicated ambulances. Localised teams carried out door-to-door check-ups of households and the police developed a pyramidical reporting structure which was managed through WhatsApp groups and by designating 7,500 special police officers with some specific powers to help the police to manage micro-clusters and places with high population density and having more than five positive cases.

Community-Based Surveillance, COBOTs for Delivery of Essentials: How Some States Dealt With COVID

• In Odisha, 7 million women by setting up dry ration, vegetable and fruit shops across the state with the help of the district administration. This ensured the financial stability of farmers and the city workers along with food security. Special efforts were made for the high influx of migrant workers such as providing a single unified portal for registration, contact tracing, monitoring health in compliance with quarantine norms and issue of online passes.
• Madhya Pradesh devised a community-based surveillance system which involved citizens as volunteers to red flag and report persons who may have been exposed to the virus. Such initiatives enabled citizens to access accurate information pertaining to collection centres, fever clinics and the other COVID care centres in their vicinity. Citizens would report the oxygen saturation levels when found to be less than 94 percent.
• Jharkhand introduced COBOTs to deliver medicine, food and water to patients without requiring health workers and ancillary staff to come in close proximity. Communication was possible by using a speaker.
• Chhattisgarh gave examples of local initiatives and particularly how the capacity for testing which was non-existent and also by using the testing equipment used for TB cases.

Bihar & Delhi’s Capacity-Building Initiatives Amid COVID

• The funding given by the Bihar government was extraordinary. The chief minister asked for the MLA funds to be placed at the disposal of the health department and over and above that Rs 900 crores were allocated only for testing. Jeevika, a self-help group, was asked to take charge of the food supplied in all the district hospitals.
• In Delhi, bed capacity was ramped up well in advance by on-boarding private hospitals/nursing homes, price capping, linkages with hotels and banquet halls.   The management of the home quarantined patients was outsourced to a private agency having expertise. Patients under home isolation were provided Pulse Oximeters and tele consultation. RT-PCR and Rapid Antigen testing capacity was fortified in all public and private facilities. The first plasma bank in India was set up at the Institute of Liver and Biliary Sciences and the second at Lok Nayak Hospital. An ex gratia compensation of Rs 1 crore was instituted for the nominees of COVID health workers.

Last Mile Connectivity

India has a network of over 1 million Accredited Social Health Activists (ASHAs) and 2.5 million anganwadi workers who help provide medical assistance to women and children in villages and towns. During the pandemic the utilisation of this infrastructure greatly assisted in reaching the priority populations even in remote areas.

The Health Ministry is providing training to over 200,000 Auxiliary Nurse Midwifes (ANMs) who can provide vaccinations at the sub centre level.

65 percent of them will be deployed for the COVID-19 vaccination, while others will ensure the smooth running of the current immunisation programmes.

(Shailaja Chandra (IAS retd) has over 45 years experience of public administration focusing on governance, health management, population stabilisation and women’s empowerment. She was Secretary of the Department of Indian Systems of Medicine & Homeopathy, Ministry of Health &Family Welfare (1999-2002) and following that the Chief Secretary Delhi until 2004. She tweets at @over2shailaja. This is an opinion piece and the views expressed are the author’s own. The Quint neither endorses nor is responsible for them.)

(This is Part-II of a three-part series by (retd) IAS officer and public health expert Ms Shailaja Chandra, to mark the first ‘anniversary’ of India’s COVID-induced lockdown. You can access Part-I here and Part-III here.)

The COVID-19 pandemic that was declared about a year ago, brought with it myriad challenges. Chief among these hurdles being the added pressure on the global healthcare system and equitable access to resources. In India, an already stretched healthcare system found itself overwhelmed as the COVID numbers continued to rise, and what helped the state and central governments meet this challenge was the involvement of the private sector.

However, the private sector too is not without its own issues.

The possible reasons could be that instead of having a blanket price on all COVID treatment, with strict protocols, some hospitals continued their own line of treatment which left scope for variation in protocols for diagnosis, medication (especially the choice of expensive antibiotics).

Indian Govt’s Commendable Response to COVID-19 Crisis

Despite the availability of designated COVID beds in government hospitals, people began crowding the private hospitals, and some managements used the unusual spike in demand to charge exorbitant advance deposits.

The establishment of steering committees with representatives from both the public and private sector helped. The private hospitals appreciated the uniformity in communication and instructions given by the state and central governments as well as the ICMR.

Which other country could electrify a single line of authority to start performing, flowing from the centre to the states to the districts — and down to the entire medical and health formations across megapolises like Delhi and Mumbai, the state capitals and cities, spreading to 730 districts and 5000 blocks?

The Rs 50 lakh insurance for dying in harness was announced by the prime minister early enough, and the Epidemic Diseases Act 1897 was amended through an Ordinance, which gave overriding protection to health workers.

Indeed, these measures stopped troublemakers who had begun to pelt stones at health workers. A 7-year punishment ensured that no one would take chances.

From Foreign Dependence to ‘Atmanirbharta’: India’s COVID Crisis Management

The positive outcome of the lockdown was that it helped slow down and delay the transmission of the coronavirus within and among multitudes of people for a couple of months. It also gave the state governments time to prepare for the upcoming wave of COVID transmission.

The health workers were required to wear special protective gear which was not available for the love of money.

The district magistrates were required to plan and execute the requisitioning of hotels, resorts and dharamshalas for isolating and quarantining patients. The testing capacity was non-existent in some states and highly deficient in others. Initially, states like Chhattisgarh did not have a single RT-PCR laboratory nor sufficient private hospital capacity for treating patients, particularly those needing ICU and ventilator support.

Until early March 2020, India’s production capacity in terms of PPE kits, N95 masks, ventilators and testing kits etc was deficient, and in the initial phases, the country had to import many supplies — even for its healthcare workers — from other nations including China, UK, Malaysia and Korea.

(Shailaja Chandra (IAS retd) has over 45 years experience of public administration focusing on governance, health management, population stabilisation and women’s empowerment. She was Secretary of the Department of Indian Systems of Medicine & Homeopathy, Ministry of Health & Family Welfare (1999-2002) and following that the Chief Secretary Delhi until 2004. She tweets at @over2shailaja. This is an opinion piece and the views expressed are the author’s own. The Quint neither endorses nor is responsible for them.)