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

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:

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