HOW KERALA DOES IT EACH TIME EVERYTIME?
In early March, Kerala and Maharashtra were the leading states in terms of the positive COVID19 cases. The number of infected patients started to increase in Kerala until the end of March, as a section of international migrants started to return to the state. But the vigilance of the state government in targeting social contacts and tracing them started to show results by April. This task continued for an extended period. The sustained efforts started to yield results and by mid-April the state, which was second in total number of infected cases in mid-March, slipped to the 10th position and was well on its way to have a carefully drafted exit policy from the lockdown. This remarkable achievement of Kerala has attracted international attention much like the famous ‘Kerala Model’ of development.
What is Kerala model? How did this Indian state achieve such a mark? Containing an epidemic like Nipah with ease, dealing with the floods with such solidarity among their civilians, government and the forces? What makes them stand out?
Kerala’s welfare-oriented growth model has attracted attention, with economists like Amartya Sen, Jagdish Bhagwati and Arvind Panagariya weighing in on it in the past. As they say Rome was not built in a day, Kerala has its fair share of story to tell.
- Long history of division and struggle against rigid caste system of the 1900s. The nineteenth century Indian reformer Swami Vivekananda had once called the region “a madhouse of caste”.
- Early-1900s expansion of the education system into the countryside which paved the way for the mass mobilization and active citizenry (this early emphasis on vernacular schools however was actually implemented with much the opposite intention).
- Though advocating for education, the elites believed it would lead to a less barbarous, easier to control populace. Ironically, the very education reforms structured to make the populace easier to govern would help inform the radical movements which later swept Kerala.
- Various modes of dissent against structural violence, organized activism like temple entry marches.
- Instituted reading and writing circles, which had a strong Marxist component and ensured that the right to literacy in Kerala was transformed from a purely government-sponsored policy to a popular mass movement (grassroots movements, such as the 1990 Total Literacy Program, helped Kerala to achieve 100% literacy by 1991, while the overall literacy of India was just 52%. This led to a more active and engaged citizenry which was better able to protect its own interests throughout various forms of government).
- Implementation of significant land reforms.
Kerala Model of Development:
Kerala’s model has essentially emphasized on the development of health and education and thus laying a strong foundation for sustained long-run development.
- Developed government-funded primary health care and education. Today, every village has a health center, as well as doctors, nurses and paramedics.
- Private participation in tertiary health care and education without losing the focus on the primary priorities.
- Successive governments in Kerala emphasized on universal literacy much ahead of the rest of the country. Its literacy rate and life expectancy are the highest in India. In a situation like this, that’s paid off too – for example, the Chief Minister Pinarayi Vijayan hosts a concise daily briefing with the most recent information and even posts figures on Twitter. People understand why they need to stay at home
- What becomes important in the context of ‘flattening the curve’ of spread of COVID 19, is this priority accorded to public health. Public health and hygiene issues have never taken a back seat even when the focus started drifting towards privatization and efficiency in the health sector. Kerala’s sanitation drive began much before Swachh Bharat became fashionable. Close to 95% of its households have toilets, as per 2011 census, while close to half of India doesn’t have them. In 2016, Kerala also claimed it had turned “Open Defecation Free" (ODF), the third Indian state to do so after Sikkim and Himachal Pradesh.
- Apart from a well-laid health system throughout the state, the general level of awareness is high, especially among women due to high female literacy. On account of awareness, the reported morbidity in Kerala is always significantly higher than in the rest of the country and it is often argued out that morbidity among infants is high not necessarily as an indicator of ill health, but it is indicative of mother’s awareness.
- In case of COVID 19, with this combination of high level of awareness and a well-functioning health sector, Kerala has been able to contain the possible rapid spread swiftly. The human development achievements contributed, as the state is endowed with an army of skillful population and a large pool of medics and paramedics, who are integral to a well-functioning health sector. Kerala has thus created its own comparative advantage and is thus uniquely placed to deal with calamities much more adroitly.
What can the rest of the world learn from Kerala’s experience?
Unarguably it is difficult to replicate the ‘Kerala Model’, as the rest have poorly invested in health and education, more so than the other states in India. However, the ‘Kerala Model’ offers some important insights:
- Efficiently dealing with such a pandemic would require larger investments in social sector to create capacity and make the population aware of the gravity of the situation so that they are equipped to tackle it at their individual level. Make an opportunity out of the lockdown to create capacity by instituting prudent policies for the health sector.
- There exists a dire necessity for having more public goods. The approach of WHO, ‘test, trace, isolate, treat’, which Kerala followed diligently, banks on the availability of public goods in the system. A well-functioning public distribution system, which provides the much needed ‘safety net’ to vulnerable sections of the population, bears testimony to this.
- Social mobilization/community participation: Kerala could successfully quarantine the infected and deal with the issues of in-migrant workers simultaneously due to community participation. Much like the previous episodes of crisis, Kerala launched a campaign mode to mobilize people for a variety of activities ranging from ‘break the chain’ campaign to setting up community kitchens.
- The leadership was swift to realize the secondary effects of the lock down such as increased poverty and deprivation and counter it upfront due to the unstinted support of the community. Social mobilization of this scale can only be possible with high levels of social development. Kerala’s experience underscores the need for sustained development policies and not short-term one-off interventions.
Steps Taken so far by Kerala
- By the 24 January Kerala had already put in protocols recommended by the WHO: test, trace, isolate and support.
- People flying into Kerala underwent screenings at the airport as far back as the end of January.
- A state response team coordinating responses from various government bodies at a regional and state level was set up.
- The state government used an army of manual contact tracers to trace infection routes using a combination of GPS data from phones and CCTV footage from other public places. Those infection routes were then posted online along with a number to call if you had been in contact.
- Vigilante healthcare team that instructs possible hosts to self-isolate.
- Quarantining for 28 days
- Aggressive testing – anyone who had been in contact with an individual with symptoms was tested.
- Mental health helpline was set up in March, with people in quarantine or self-isolation encouraged to call – and sometimes, called by counsellors who want to check up.
- The government also set up a WhatsApp helpline for victims of domestic abuse. Both of these helplines operate 24 hours a day.
- The state government has also used technology effectively: a digital dashboard has detailed information about confirmed cases, deaths and infections, broken down by region.
- People's livelihoods were obstructed .The most adversely affected ones would be the daily wage laborer. Almost all of the guest workers in Kerala are wage laborer. Their needs were met. Kerala arranged relief camps for migrant workers, with adequate healthcare support and supplies for personal hygiene. When travel was allowed by the central government, Kerala arranged for their travel back to their home states.
- Sufficient institutional quarantine facilities have been prepared as well. To date, almost 200,000 bath-attached rooms have been readied.
- Food were arranged through the community kitchens.
- Ample use of SDRF (State Disaster Response Fund) was made for making the necessary arrangements.
Kerala is now up to implementing two focused schemes in the aftermath of this pandemic.
1.) Subhiksha Keralam, which is a program aimed at ensuring the food security of Kerala. In just one year it will have an expenditure of Rs 3,860 Crore ($509m).
- The program will attract more people to farming especially the returned migrants. The procedure will include assessment of lands for possible conversion to agricultural land, promoting rooftop farming, providing seeds, technical assistance to farmers etc.
2.) Vyavasaya Bhadratha, through which an assistance of Rs 3,434 Crore ($452m) will be granted to MSMEs (Medium, Small and Micro Enterprises). This program will ease land premium payment policy, factories rentals, provide immediate capital assistance, special loan for asset creation for MSMEs and interest subvention on additional term loan for MSMEs. Apart from this Entrepreneur Support Scheme will be liberalised too.
- Providing assistance through NORKA [Non-resident Keralites scheme]. All COVID-19 positive patients, who are members of the Pravasi Welfare Fund [fund for expatriates], will be provided Rs 10,000 ($132) as emergency aid. Rs 5,000 ($66) will be granted to all those who have returned with a valid passport and work visa.
- Through NDPREM (NORKA Department Project for Return Migrants), assistance is being given to set up MSMEs and even to take up agriculture. Seed capital funding of up to Rs 3 million [$39,594] is available under this project .