Kerala

The Role of Panchayats in Implementing COVID-19 Policies in Kerala State

by Case Study

About the author:

Parth is an industrious and ambitious student, with a strong sense of compassion and curiosity that always has him looking for innovative ways to impact those around him. Studying in the 10th grade at Hill Spring International School, Parth currently looks to enhance his understanding of public policy as he gears up to pursue an undergraduate program along the same lines.  Having spent his life in a metropolitan city, Parth looks to foster a deeper understanding of rural culture, and the impact of policy at the grassroots.

Abstract

The COVID-19 pandemic presented significant challenges globally, with India facing a severe crisis during the 2021 second wave. Kerala, despite its high population density and economic vulnerabilities, notably emerged as a successful model in pandemic management. The state’s proactive measures included early containment, extensive testing, and efficient contact tracing, underpinned by a robust health infrastructure enhanced by initiatives like the People’s Plan Campaign and the Aardram Mission. Kerala utilized digital technology for effective communication and surveillance, expanded telemedicine to reduce hospital strain, and ensured community support through initiatives like community kitchens. The research paper highlights Kerala’s challenges, such as economic impacts on tourism and managing expatriate returns and concludes with policy recommendations for broader pandemic preparedness. These recommendations advocate for Kerala’s approach, emphasizing decentralized governance, digital innovation, and community engagement as key to effective health crisis management.

Introduction

COVID-19, the disease caused by the novel coronavirus SARS-CoV-2, had a profound impact on India. The nation faced daunting challenges, including the massive second wave in 2021 that strained its healthcare infrastructure to the breaking point, leading to shortages of medical supplies, hospital beds, and oxygen (Bari, 2023). The government and public health authorities responded with nationwide lockdowns, extensive vaccination drives, and public health campaigns to mitigate the spread of the virus.

Kerala’s handling of COVID-19 was notable for its early and aggressive response. The state implemented strict containment measures, widespread testing, and an efficient contact tracing system. Kerala’s health infrastructure, bolstered by community participation, panchayat-level as well as urban public awareness campaigns, played a key role in managing the pandemic’s impact effectively, setting a model for others (Besley et al, 2007).

Policies that Kerala Implemented

As Kerala has one of the highest population densities in India, social distancing measures more challenging to implement effectively, especially in urban areas. Despite having one of the best healthcare infrastructures in India, the pandemic strained Kerala’s healthcare system (Pilla, 2021). The state faced challenges in increasing ICU beds, ventilators, and medical personnel to deal with the surge in cases. Furthermore, a significant portion of Kerala’s population works abroad, especially in the Gulf countries. Managing the return of these expatriates, who were among the hardest hit by the pandemic, posed a logistical and healthcare challenge. The state had to ensure quarantine facilities and testing for a large number of returnees (Aksoy, Eichengreen and Saka, 2020). The pandemic severely impacted Kerala’s economy, particularly the tourism sector, which is a significant source of income for the state. Lockdowns and travel restrictions led to massive losses in this sector. Additionally, the state had to support those who lost their jobs or were economically affected due to the pandemic.

The pandemic also disrupted the education sector, with schools and colleges closed for extended periods. Kerala had to rapidly adapt to online education, which was challenging due to issues like unequal access to the internet and digital devices among students. Kerala is also home to a large number of migrant workers from other Indian states. Ensuring their health, safety, and well-being during lockdowns and restrictions was a significant concern (Bhuyan, 2021). The pandemic and the ensuing lockdowns led to increased reports of mental health issues among the population due to isolation, economic hardships, and health anxieties. Addressing these concerns required expanding mental health services and public awareness campaigns.

A landmark initiative in Kerala is the People’s Plan Campaign, launched in the mid-1990s, which empowered Panchayats with greater financial resources and autonomy (Udayakumar and Taylor, 2021). This initiative aimed at decentralizing power to the Panchayats, allowing them to play a significant role in planning and implementing development projects tailored to local needs. It emphasized participatory planning, where community members directly contribute to decision-making processes regarding important issues like health (Kazmin, 2020).

With the Panchayats being a significant player when it came to the people’s, the state’s prior experiences with disease outbreaks and natural disasters, such as the Nipah virus outbreak and floods, became instrumental in shaping its preparedness and response strategies to COVID-19 (Sohel et al, 2022). Community Health Workers (CHWs), volunteers, Kudumbashree (Kerala’s government-run women’s self-help group program), and newly formed Rapid Response Teams (RRTs) at the ward level were crucial in containment efforts (Pandey, 2020). These teams were formally constituted by the state to supervise and monitor pandemic mitigation efforts, trained by LSGs and staff at Primary Health Care facilities (PHCFs) under the broader supervision of elected LSG members​.

Moreover, the state’s health system reforms, particularly the transformation of Primary Health Centres (PHCs) into Family Health Centres (FHCs) with extended hours and improved service delivery, were significant. Key to these reforms was the “The Kerala Aardram Mission,” launched in 2016 by the Government of Kerala (Pilla, 2021). This mission’s objective was to transform the state’s public health sector to ensure quality health care services are accessible, affordable, and equitable to all residents.

Once Covid-19 hit Kerala, the authorities enabled early release of technical guidelines on contact tracing, quarantine, isolation, hospitalization, infection prevention and control, and extensive capacity-building for all cadres of health and other interlinked departments. Digital technology played a pivotal role in Kerala’s pandemic response, leveraging the state’s high rates of computer and internet access. Digital tools were used for communication, surveillance, clinical management, and non-clinical support, enhancing routine health services delivery (Udayakumar and Taylor, 2021). The state provided widespread information through various digital platforms, including a COVID-19-specific dashboard and mobile applications, to keep the public informed and engaged. Kerala’s key strategies also included surveillance activities, ensuring good quality quarantine, intelligent testing strategies, uninterrupted treatment services, community participation, proactive care for the elderly and people with comorbidities, and education and social mobilization for behavioral change.

Kerala’s contact tracing was meticulous, with health workers mapping the travel history of infected individuals to identify potential exposure sites (Chattopadhyay and Duflo, 2004). The state used apps like ‘GoK Direct’ and Covid-19 Jagratha portal to help citizens self-report symptoms and receive timely guidance. To reduce hospital visits, Kerala expanded telemedicine, allowing patients to consult doctors online. This minimized the risk of virus transmission and eased the load on healthcare facilities. Operated by local bodies with volunteer support, Kerala launched community kitchens. These provided free meals to the needy, demonstrating an integrated approach to health and well-being.

Recommendations

Kerala can be used as an excellent example of a system of governance that was designed to work well at the grassroots level. Especially, when it comes to critical and time sensitive issues like the spread of the pandemic. The following are some of the policy recommendations that can be implemented across India for better pandemic preparedness:

  1. Kerala’s contact tracing process was thorough and swift, involving an extensive network of public health officials, community health workers, and volunteers. The state effectively utilized digital platforms and mobile applications to streamline the tracing process, ensuring prompt identification and isolation of contacts (Mullick and Patnaik, 2022). This meticulous approach, combined with a strong public health infrastructure and community participation, made Kerala’s contact tracing more efficient and comprehensive than many other parts of India. At the national level, having a more stringent contact tracing process like Kerala’s would help India control future outbreaks especially through secondary or tertiary contacts.
  2. The panchayats in Kerala played a pivotal role in the state’s COVID-19 response by localizing government initiatives. They were instrumental in enforcing quarantine measures, facilitating widespread testing, and managing community kitchens to ensure food security for the vulnerable (Chattopadhyay and Duflo, 2004). Additionally, they coordinated with health officials for contact tracing and mobilized local volunteers for awareness campaigns, showcasing an effective model of decentralized governance and community engagement in public health crises. This process followed by Kerala could be key for India’s preparation for future outbreaks. With more than 68% of Indians residing in villages, empowering the panchayats is significant to pandemic readiness.
  3. Kerala implemented stringent travel restrictions during the COVID-19 pandemic, including state border controls, mandatory RT-PCR tests for incoming travelers, quarantine for those testing positive, and a pass system for inter-district travel. A strict program like Kerala’s “Covid Jagratha” form would be needed to stem the flow of people whose health status would otherwise not be recorded (Biswas, 2021).
  4. Kerala’s panchayats played a critical role in extending the state’s testing strategy to the grassroots level. They organized mobile testing units and camps in collaboration with local health departments to ensure accessibility to testing facilities, especially in remote areas. Empowering volunteers beyond healthcare workers will ensure that necessary testing can take place. This would also allow detection of diseases before it becomes fatal for infected patients.
  5. Kerala’s panchayats efficiently mobilized local resources to ensure the widespread distribution and administration of COVID-19 vaccines. They identified and set up vaccination centers in accessible locations, coordinated with health workers for smooth operations, and launched information campaigns to address vaccine hesitancy. Their grassroots approach was crucial in covering diverse populations, including the elderly and those in remote areas, contributing significantly to Kerala’s high vaccination rates.

Conclusion

In summary, Kerala’s adept management of the COVID-19 pandemic exemplifies the effectiveness of proactive planning, community engagement, and decentralized governance in tackling public health crises (Sohel et al, 2022). Facing challenges such as high population density and economic dependency on sectors like tourism, Kerala utilized a robust public health infrastructure and participatory governance, highlighted by the People’s Plan Campaign, to effectively mitigate the pandemic’s impact. Strategies like effective contact tracing, the utilization of panchayats for a localized response, stringent travel controls, widespread testing, and an inclusive vaccination campaign were pivotal.

This model, characterized by its emphasis on equity, accessibility, and community participation, not only curtailed the virus’s spread but also prioritized the welfare of vulnerable populations. Kerala’s approach demonstrates the critical need for preparedness through investments in public health, technology, and community mechanisms before emergencies arise (Anuj and Shashwata Sahu, 2022). As the world faces ongoing and future public health challenges, Kerala’s strategies offer a blueprint for developing resilient healthcare systems capable of equitable and humane responses to pandemics. Adopting these lessons can enhance global health security by emphasizing grassroots governance and the significant role of community involvement.

References