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Mainstream, VOL LVIII No 29, New Delhi, July 4, 2020

Is there a Kerala Model of Handling Covid-19? | Joseph Tharamangalam, Jos Chathukulam

Saturday 4 July 2020

by Joseph Tharamangalam & Jos Chathukulam

In the past 3 months we have been daily flooded with news about the unprecedented Covid 19 pandemic by newspapers and the media. Kerala’s people have been proud to see Kerala praised for its successful handling of the pandemic, not just in India, but in several international newspapers and media such as the New York Times and the BBC, just to mention two of the prominent ones. [1] While they praise the effective leadership of Kerala’s Chief Minister and the Health Minister, now nicknamed “the virus warrior”, their main focus is not on any great leader, but on a model of state and governance that has prioritized the development of robust institutions for the provision of health care, education, food and other forms of social security even as it has also engaged effectively with civil and political society, with NGOs and the numerous class and mass organizations that have been the hallmark of Kerala over a century. It is noteworthy that it was half a century ago in the early 1970s that a UN-sponsored study [2] introduced the somewhat controversial concept of a “Kerala model” [3] to refer to this pattern of development. The Nobel laureate Amartya Sen, who played a major role in making the Kerala experience known across the world, also introduced the concept of “public action” as the driving force behind the model. [4] The concept refers to an interventionist state delivering public goods in synergy with a mobilized society that demands the state’s services and holds it to account. It seems that a state that has sustained this model all these years defying critics who predicted its impending collapse, may now be facing the most serious test of all, and emerging successful once again.

In contrast to India and many other Indian states, Kerala has been successful in effectively harnessing and coordinating a variety of social players in all the three crises it has faced over the past two years- a very serious Nipah epidemic in 2018 and two out breaks of unprecedented floods, one in 2018 and one in 2019. The Covid 19 pandemic, highly contagious and wreaking havoc in every country across the world—including the rich ones which claim to be the world’s leaders and models—has been the most threatening of all. And this for a small underdeveloped state burdened also with three Kerala-specific vulnerabilities. An exceptionally large proportion of its young people working outside the country, some of these carriers of the virus, has suddenly returned home. [5] It also has the highest proportion of aging population in India [6], and the highest population density as well. The first two of these are actually positive achievements of the Kerala model of Human Development, but now turned liabilities. Yet, Kerala is now lauded as a model even for Europe and the US. Amartya Sen and Noam Chomsky [7] have also lauded Kerala’s Covid 19 mitigation efforts. [8] Sen said the main reason why Kerala has done a good job is because of the giant strides the state has made in the sectors of health and public education. Sen added that Kerala has over the years proved many people wrong, who predicted the state’s public – welfare-oriented developments would end up as a failed experiment. He remarked that Kerala has some of the highest human development indices in the country. Chomsky noted that only very few places handled the pandemic like Kerala did. He said, “Vietnam was one country that managed to fight the pandemic without registering a single death and it should be remembered that and they share 1,400 kms of border with China. South Korea also handled it well so did countries like New Zealand and Taiwan, but the US failed to handle it and the death toll is one lakh and is rising”. [9]

What, then, is it that makes Kerala different from most countries of the world, including India and other Indian states in the way it has been handling this crisis? Much of the answer to this is now in the domain of public knowledge; for example, that Italy and the UK did too little, too late to take measures to prevent and control the spread of the virus by testing, isolating and treating those infected, and with devastating consequences. The US, the world’s richest and most powerful nation, has also been confronting this crisis with confusing pronouncements and frequently changing policy initiatives by its authoritarian and controversial president even as the virus has spread rapidly turning the country into an epicenter of the pandemic. India took some bold steps in enforcing a lockdown, but with little consultation, planning or provisioning in place to address the consequences of such a lockdown in a country with high levels of poverty and hunger, weak health infrastructure and homeless migrant laborers concentrated in its large urban centers. [10] To see why and how Kerala has been more effective, let us first consider a few of the steps it has taken in a short time, and then also consider the institutional structures and the values and priorities behind these policies, the latter the legacy of the “Kerala model” over a period of time.

First, consider the timely and effective steps Kerala has taken in tracing, testing and isolating affected people. [11] In addition to the usual methods of monitoring and enforcing the rules of isolation it also took early steps in making use of modern technical devices such as surveillance by drones identifying locations of social gatherings, use of “geo-fencing” to stringently enforce quarantine, and deployed location tracking technology to create spatial-temporal maps for re-tracking patients’ movements.

Second, the government organized a popular and strong communication system which includes daily evening press briefings [12] by a government team led by the Chief Minister along with the Health Minister, Revenue Minister and Chief Secretary. The press briefings serve as a valuable source for credible information and provide accurate data about the Covid 19 cases reported in the state. These also play an instrumental role in educating the people in the state regarding the seriousness of the pandemic, concerns to be addressed which includes measures to ensure the adequate supply of food and essential items to the needy, the precautions to be undertaken to safeguard everyone’s health.

Third, the state has implemented effective relief measures to ensure that no one living in the state is deprived of food and essential supplies in the wake of the lockdown. One such initiative is setting up of ‘community kitchens.’ On March 26, the Kerala government issued directives to the local bodies to set up community kitchens with the help of Kudumbashree. [13] Community kitchens were set up in the state to provide food to people including the guest labourers (migrant labourers), senior citizens and people living on the streets as well as those under home quarantine. As per the data provided by the Kerala government dashboard, a total of 86,51,627 individuals were served food from community kitchens so far. [14] The state government also issued guidelines for the operation of community kitchens requiring local bodies to enforce physical distancing, wearing of masks and gloves while preparing food and delivering food packages to people at their shelters. All the 1036 local bodies in Kerala set up community kitchens. However, after the lockdown was eased, those stranded, as well as migrant labourers (guest labourers), are going back to their homes. This has led to a decrease in the demand for food from community kitchen and it has reduced the number of community kitchens operating in the state. At present there are 853 Community Kitchens operating in the state. [15]

In the aftermath of the nationwide lockdown, Kerala took steps to protect 144145 guest labourers and they were housed in 4608 shelters in the state. According to a study conducted by the Gulati Institute of Finance and Taxation in 2013, [16] there were a total of 25 lakh guest labourers in Kerala. Prior to the nationwide lockdown, a considerable number of guest labourers left for their home states. But nearly 4.10 lakh labourers were not able to go back to their home states due to the stringent lockdown. However, after the lockdown restrictions were eased to facilitate the travel of those stranded in various parts of the country, the guest labourers are now sent back to their homes. Kerala Chief Minister Pinarayi Vijayan in a press briefing conducted on June 5 said that a total of 1,67,355 guest labourers have gone back to their home states from Kerala.

The government also rolled out a provision to feed stray dogs and temple monkeys. Such an initiative was launched not just out of compassion for these animals, but also to prevent the danger of these going hungry and posing threats to the local people. A “hub and spoke model” [17] of food distribution was used for sourcing food from existing networks such as hotels run by Kudumbashree and sending food parcels to multiple destinations. Food was distributed to all those in need at free of cost.

Fourth, and especially worth mentioning, is the capacity of Kerala as a state to harness and coordinate the high levels of social capital in the state including governmental and non-governmental organizations and associations. Community Based Disaster Management Plans (CBDM) prepared by a large number of Gram Panchayats in the wake of two earlier floods is a good example for this. As part of preparing CBDM, local bodies collected large–scale ward-based data on shelter management, hospital infrastructure, technical resource persons, and trained health workers. This valuable resource is now being used for the fact-based management of the new crisis. On March 26, 2020, Chief Minister, Pinarayi Vijayan called for the formation of a Youth Volunteer Force (YYF); it received a massive response with some 2 lakhs already registered, half of them women. About 10 percent of the volunteers are kept on standby, well equipped with their mobile phones, ready to meet any emergency. Many of the volunteer women served as cooks in the Kudumbashree-run community kitchens.

In this connection a fact that stands out has been the government’s capacity for reaching out to all social and religious groups and creating consensus on basic issues and policies. By all reports, the government appears to have high levels of support including that of all major religious groups, Hindu, Christian and Muslim. For example, the Catholic Church, a very powerful and resourceful organization in Kerala, and traditionally no friend of the CPM (which heads the current coalition government), has offered its full support to the government’s efforts. The Kerala Catholic Bishop’s Conference (KCBC) has offered the service of some 200 hospitals, 15100 beds, ventilator facilities for 1940 patients, three medical colleges and 20 super specialty hospitals along with over 24000 staff. A total of 2490 doctors including 170 priests and nuns,10300 nurses,5500 paramedical staff are working under church-based hospitals. The church has also offered to hand over 120 ambulances to fight the pandemic. As of now, these hospitals are working with minimum staff as two-thirds of the personnel are being kept as a specially prepared task force ready to deal with anticipated emergencies. Cardinal Alencherry, the head of the Kerala Catholic church, has issued a circular in support of the policies of lockdown and physical distancing, cancelling all church ceremonies during the Easter week. [18]

In sum, we think it is fair to say that while it is too early to celebrate Kerala’s success in controlling the spread of this fast-spreading and fierce virus, the state has taken effective and exemplary measures to contain the pandemic and this despite the exceptional vulnerabilities it faces. Finally, we would venture to make two generalizations based on Kerala’s experience that we think are relevant to all countries. The first is the general point made by a variety of social scientists that contrary to the views of utopian anarchists and modern free-market capitalists who champion the downsizing of the state, evidence from across the world, and now especially from Kerala, shows that all forms social well-being and the provision of public goods and social security, including effective management of epidemics and other similar crises have been associated with strong states governed by laws and constitutional morality with robust institutions that also enjoy relatively high levels of consensus and legitimacy and function in synergy with civil society. [19] To quote the political scientist Atul Kohli, such successful states, from Scandinavia to Kerala, have often been social democracies which create and sustain the kinds of robust democratic institutions discussed above. [20] It is in this context that Amartya Sen’s famous study of famines also becomes relevant. [21] His bold conclusion that modern democracies simply do not have famines is equally relevant here. While the two crises are different because the means to control the new Covid 19 pandemic is not yet available the same way food is available in the world, the basic point about the capacity of an effective state holds true; it is also most likely that the initiative to develop the means, including the needed medical supplies and the vaccine, will also come from such states, other things being equal.

Authors:

Joseph Tharamangalam is Professor Emeritus, Department of Sociology and Anthropology Mount St. Vincent University, Halifax, Canada and currently Ayyankali Chair at MG University, Kottayam, Kerala

Jos Chathukulam is Professor, Ramakrishna Hegde Chair on Decentralization and Development, Institute for Social and Economic Change (ISEC), Bengaluru


[1See Masih Niha (2020) in the Washington Post, Biswas Soutik (2020) in the BBC, Fisher and Taub (2020) in the NY Times, and Spinney Laura (2020) in the Guardian.

[2Poverty, unemployment and development policy: a case study of selected issues with reference to Kerala, UN. Department of Economic and Social Affairs, New York: UN 1975.

[3See, Frank and Chasin, 1994; Ramachandran, 1998: Heller, 2007; Dreze and Sen, 1998, 2002; Tharamangalam,1998, 2006 and 2010, among others.

[4See Dreze, Jean, and Amartya Sen. 1989. Hunger and Public Action. Oxford: Oxford University Press. Dreze and Sen deal with the concept of Public Action in many of their writings, especially Dreze and Sen, 1989, 1998, and Sen, 1999.

[5Kerala had almost flattened the Covid 19 infection in the May first week but the number of Covid 19 cases went up with the return of Non-Resident Keralites (NRKs) and people stranded in various parts of India. It has been reported that one in every hundred Non – Resident Keralite is testing positive for Covid 19. Starting from May 7, under Vande Bharat and Samudra Setu Missions, nearly 5619 persons from Gulf and Maldives returned to Kerala.59,945 Keralites staying in various parts of the country have also returned to Kerala. See Preetu Nair (2020) in Times of India. (As on May 21, 2020). In the press briefing held on Wednesday June 17, 2020, Kerala Chief Minister Pinarayi Vijayan said that a total of 84, 195 Non – Resident Keralites have reached Kerala till June 16. From other states, 1,79,059 Keralites living in various parts of the country have returned to Kerala. For more details see - https://www.keralacm.gov.in/category/media-updates/press-release/

[6According to Economic Review published by State Planning Board, Thiruvanthapuram, Kerala in 2017, the state of Kerala is aging faster than the rest of India.The Economic Review 2019 tabled by Kerala Finance Minister Thomas Isaac in the state assembly in Feb 2020 also states that Kerala is ageing faster than India.

In 1961, Kerala’s 60 plus population was 5.1 percent, which was just below the national level of 5.6 percent. Since 1980, Kerala has overtaken the rest of India and in 2001 the proportion of the old age population rose to 10.5 percent as against all India average of 7.5 percent. By 2011, 12.6 percent of Kerala’s population is past 60 years, compared to the all India average of 8.6 percent. By 2015, population data show that it increased to 13.1 per cent in Kerala against the all India average of 8.3 per cent). Currently, 48 lakh people of Kerala are 60 years and above; 15 per cent of them are past 80 years.
According to the Economic Review, by 2025 about 20 percent of the Kerala population would be elderly. Kerala’s total population as per the 2011 census is around 3.36 crore, of which 12.6 per cent are aged above 60 years. According to a study by Centre for Development Studies titled “ A Survey on Ageing Scenario in Kerala” (2013) by S Irudaya Rajan and U S Mishra states that Kerala’s elderly population is growing at a perpetual rate of 2.3 per cent. The study noted that the growth rate is high among the elderly aged 70 or 80 and above.

[7Noam Chomsky is an American Theoretical Linguist, philosopher, public intellectual and social critic.

[8In the wake of Covid 19, the government of Kerala launched a debate series titled Kerala Dialogue. Noam Chomsky, Amartya Sen featured in the first episode of the series aired on June 26. Soumya Swaminathan, Chief Scientist at World Health Organisation (WHO) was also part of the programme. The programme aims to examine the dynamics of socio-economic welfare and myriad other possibilities that can boost development in post – Covid world.

[9Kerala Dialogue: Rethinking and re-imagining development in a world disrupted by COVID-19 pandemic. (URL Retrieved - https://www.youtube.com/watch?v=YwFGgrHYF4w)

[10See Bhattacharya Indradeep (2020) in the Wire, Krishnan Vidya and Konikkara Aathira (2020) in The Caravan Magazine.

[11Thomas Isaac T M and Sadanandan Rajeev, “COVID-19, Public Health System and Local Governance in Kerala,” Economic and Political Weekly, Vol. 55, Issue No. 21, 23 May 2020

[12Chief Minister Pinarayi Vijayan’s daily press conference began on March 16, at a time when Covid 19 cases started to increase in the state. The daily press conference by the Chief Minister is widely popular among the Keralites within and outside the state. Once the Covid 19 cases were decreasing, on April 17, the CM announced that from then on there won’t be any daily press briefing. CM still holds press conference but not on a daily basis.

[13Kudumbashree is Kerala’s landmark women’s cooperative network and empowerment programme, Kudumbashree is a poverty eradication and women empowerment programme of the State Poverty Eradication Mission (SPEM) of the Government of Kerala.

[14Kerala Government Dashboard – URL retrieved - https://dashboard.kerala.gov.in/ck-view-public.php

[15As per the data released by Government of Kerala Dashboard (GoK Dashboard) as of now 853 community kitchens are functioning in the state. Please Note: The number of community kitchens can increase or decrease based on the Covid 19 situation in the state

[16Narayana D, Venkiteswaran C.S. and Joseph M.P (2013). ’A Study on Domestic Migrant labour in Kerala,’ Gulati Institute of Finance and Taxation(GIFT), Thiruvananthapuram. The GIFT study on migrants has been cited by N. Ajith Kumar in his study titled "Interstate Unskilled Migrants of Kerala, South India: The Push and Pull Factors of Long-Distance Migration within a Country." (2018).

[17A model that contains multiple centres of sourcing and delivering food, but with a “hub” that coordinates the activities and provides a central point of contact to all the clients.

[18See Times of India, Church commits all healthcare units for Covid – 19, March29, 2020.

[19See the article by Kerala’s Chief Minister: Vijayan Pinarayi, “Challenges in the Midst of the Covid-19 Pandemic, Economic & Political Weekly, Vol. 55, Issue No. 24, 13 June 2020. Based on this article Jos Chathukulam has written a critique for Deshabimani, a Malayalam Newspaper. (URL retrieved - https://www.deshabhimani.com/articles/news-articles-25-06-2020/879063). Chathukulam has made an attempt to evaluate the impact of decentralization on health care system in Kerala, See Chathukulam, Jos (2016) “Reflections on Decentralized Health Delivery System in Kerala,” Mainstream, Vol54, No.6, New Delhi.

[20Kohli, A. (2006). Politics of Economic Growth in India, 1980-2005: Part II: The 1990s and Beyond. Economic and Political Weekly, 41(14), 1361-1370. Retrieved June 15, 2020, from www.jstor.org/stable/4418059

[21Sen A. Poverty and Famines: An Essay on Entitlement and Deprivation. Oxford: Clarendon Press; 1981

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