News Destination For The Global Indian Community
News Destination For The Global Indian Community
Difficulties Faced By Delhi Administration In Dealing With Corona Pandemic
by Dr. Shehla Ahmad / 28 September 2020From the time the start of the pandemic in February till now, Delhi has consistently maintained it's 3rd -4th position in terms of the number of patients of this disease, as compared to other states, all of which are bigger than Delhi. While the total number of cases here till 21st September' 2020 were more or less 2.5lacs, the average number of daily deaths in the week preceding 21-9-2020 has been around 35/day. If Monday's 32 deaths are added to the previous figures we see a total 5147 deaths till 25-9-2020 in Delhi alone.
On Monday the total number of new cases for Delhi was 2548.
All these figures can be seen as markers for the challenges that corona has put before Delhi. To assess the contribution of Delhi in India's fight against corona the first & foremost point which we have to keep in mind is that Delhi is the only state where people from other parts of the country think it to be their right to come for treatment and investigations.
Though this situation has been present since before the advent of corona, the pandemic has made things much more complicated and difficult for Delhi administrators. During the lockdown period when the entire nation was under strict orders not to step out even on to the road outside their houses, Delhi saw innumerable corona cases being brought here from other states for treatment & investigations. This prompted the state government to try and restrict outside corona patients to central government hospitals and reserve Delhi government's and Delhi's private hospitals for citizens of Delhi only. But this stand of the state government was immediately and vehemently opposed by the governor Mr Anil Baijal, who was representing the central government. The resultant differences of the two sides made headlines of all dailies in greater part of June'2020. Following these related news items, a reader could have drawn two conclusions; one that the governor was acting in his capacity of Chairman National Disaster Management Committee and was thus protecting the constitution's that particular item which gives every citizen of India full right to seek treatment &/or investigations for his or her ailments from anywhere they deem it necessary. As for the chief minister's order for reserving Delhi hospitals' covid beds for its own residents-he issued it after taking public opinion and received a 90% support to his proposal for which there were more than 2lacs answers. Not just that he even formed a joint committee of five highly placed senior doctors for consulting on the effects of such a step and they unanimously approved it.
That time in June, interstate transport was prohibited and had this order been fully implemented it would have given Delhi advantage of restricting entry into its premises, but once again impartiality in applying rules was overlooked, with the result that though patients from other states were frequently and unhesitatingly being brought here for corona management, for Delhi vehicles needing to cross its borders into adjoining states even for procuring life saving oxygen & medicines there were unending hurdles.
Delhi administration's efforts to reserve Delhi hospital beds for Delhi residents was not universal. They were only trying implementation of this rule for corona patients, and had made it clear that the rule was not meant for patients of any other disease, Before the lockdown period, at any given time 60-65% of Delhi hospitals' beds were occupied by patients from outside the state.
In the early days of the pandemic the total number of corona beds in Delhi's private & state run government hospitals was '1000' and exactly the same number i.e. '1000' was the availability of these corona beds in central government managed hospitals which are AIIMS, Ram Manohar Lohia & Lady Hardinge Medical College Hospital. In such a situation the obvious conclusion should have been "no room for disputes" but what we get in this politics studded country is a drag into an unconceivable, mind boggling, unexpected bag of controversies for even the smallest of issues.
While analysing the performance of Delhi government in handling corona cases one should keep in mind another very important point, that is that Delhi being the Capital of India, most international travellers coming to this country, have their first stopover on Delhi airport, and since corona has been gifted to us by foreign nations, especially China and the Middle Eastern countries, we in Delhi had an early influx and exposure to the disease. However some southern states like Kerela & Mumbai too had a sizeable number of direct to & fro of international flights, which is why Maharashtra, because of Mumbai is still above Delhi in terms of corona cases.
Of 100 confirmed corona cases two will loose their lives, a study of Delhi numbers tells us, which is much more than the national average of 1.6/100.
As a warning to its people, the Delhi government has issued an information bulletin saying that of the total 3081 state administered ICU beds in the city 67.4% are already occupied and that in a short period of 24hrs between last Saturday & Sunday 7000 corona patients had to be hospitalized here! One aspect of this news which should scare us is that since the big private hospitals, having full facilities for managing corona cases are getting full, Delhi citizens who prefer going to private hospitals are now rushing towards middle sized and small setups which are not fully equipped to manage these cases. This increases the risk of spread of the disease many fold, here in Delhi. Here again we find a situation where residents of Delhi have had to compromise with their safety and rights. To understand the background of this situation one has to realize that people living in smaller towns of other states have prior information about these big hospitals of Delhi and bring over their corona patients for direct admission to these hospitals. This is a glaring example of impingement of our rights as Delhi residents.
The end result of this situation is that 30% of corona cases admitted in Delhi hospitals at any given time are from other states. So the Delhi government's health department, in order to reduce this imbalance, decided on 21-9-2020 to add '1500' new beds to its corona reserved beds in the next ten days.
However there is another side to this situation which is not as encouraging and that is that the total number of tests being done here for corona has fallen from '58000' per day in the week preceding 21-9-2020 to a mere '33733' in the next 24hrs. Another shocking news related to the disease is that in a short period of less than three weeks the number of patients in home isolation have increased from '8119' to '18910' and that these home isolation patients are not taking their containment orders seriously, therefore the chief minister of Delhi has issued strict orders that any home isolation patient found to be flouting the rules, should be forcibly shifted to the hospital and will remain there till he gets corona negative.
THE MESSAGE THUS COMES OUT CLEAR THAT IF THE CITY'S ADMINISTRATORS SHOW LAXITY IN PERFORMING THEIR DUTIES, THE SITUATION IS BOUND TO GET OUT OF EVERYBODY'S CONTROL.
Author Bio: A medical graduate from the King George Medical College of Lucknow and a post graduate in health administration. Has been interested in Urdu poetry writing and reading from an early age. The Corona pandemic has been a stimulus for her to take up the socio-medical impact of the pandemic and write on the subject both in Urdu & English. Lives a peaceful semi retired life in a South Delhi journalist colony with a clinic of her own to practice clinical medicine.
Time to fight tobacco use with telemedicine
by Romita Shah | Vivan Sharan / 24 September 2020Unlike many other medical conditions, treating tobacco addiction and diagnosing its sequelae, like oral cancers, can often be done remotely
The Coronavirus pandemic has prompted billions to seek shelter in their homes as countries across the world have gone into lockdowns at different times and in many phases. Although doing so has checked the spread of the virus to a certain extent, it has not slowed the progression of other diseases. Therefore, the need to find innovative ways to stem and treat such diseases grows daily and for many countries, telemedicine has provided a cheap and practical way to meet this need.
It is a quintessential example of the Fourth Industrial Revolution in action and is an area in which India has already demonstrated its ability to lead. Few interventions are as conducive to piloting ambitious telemedicine in India than tobacco cessation and there are three reasons for this.
First, as the Foundation for a Smoke-Free World’s India Report shows, tobacco use is widely prevalent in the country and its results are devastating. There are nearly 270 million adult users of tobacco in India. Experts estimate that tobacco use is responsible for nearly 10 per cent of all deaths in the country and the resulting economic burden amounts to more than one per cent of the Gross Domestic Product (GDP). This figure rises when we consider the economic toll of tobacco-related disability and other indirect costs. Ultimately, the burden of tobacco use constrains healthcare, particularly for the poor.
Second, many of those most affected by tobacco use live in places with few specialists to provide cessation services. The shortage of healthcare providers is acute in these regions where brick-and-mortar clinics are few and far in between. India already suffers from a shortage of healthcare providers, with only one doctor for every 1,400 people and only one hospital bed for every 2,000 people (well below the World Health Organisation’s recommended norms).
Third, unlike many other medical conditions, treating tobacco addiction and diagnosing its sequelae, such as oral cancers, can often be done remotely. Tobacco cessation is predicated on counselling for behaviour, which can be effectively delivered via telemedicine platforms. India has more cases of oral cancer than anywhere else in the world due to the popularity of smokeless tobacco products in the country.
The scale of tobacco use and its resulting harms, its disproportionate toll on those in rural areas and the ability to effectively treat it and diagnose many of its sequelae make it a natural contender for telemedicine. However, some structural changes are required to successfully integrate telemedicine in the healthcare sector’s arsenal. Specifically, the three “Ds” — doctors, diagnostics and data — require redoubled focus in this context. The Ministry of Health and Family Welfare’s recently-notified Telemedicine Practice Guidelines provide a scope for registered medical professionals (RMPs) to familiarise themselves with telemedicine. The guidelines include instructions for RMPs to maintain digital records of patients, including evaluation and management reports.
Doctors may still require guidance to select appropriate software and technology that can help streamline these tasks. Though specialised digital applications to facilitate cessation are available, doctor awareness is the key to unfetter their use-case. Additionally, issues of medical ethics and liabilities need to be addressed, to build patient trust.
The second critical area is investments in diagnostics. Recent experiments with tele-diagnostic services in Maharashtra have enabled the use of photos to detect early cases of oral cancer and identify at-risk patients. This ensures that RMPs can make clinical evaluations to identify early onset of diseases to reduce the time between diagnosis and treatment.
The country requires similar interventions that leverage the combination of widespread smartphone access and state-of-the art diagnostics. But scale requires private sector investments, based on a profitable business model.
Diagnostics capabilities can likely be bolstered through hub-and-spoke telemedicine models to ensure access to larger markets at reduced rates of service distribution. Moreover, the use of Artificial Intelligence (AI) and Machine Learning (ML) to augment diagnostic capabilities of physicians can also reduce healthcare costs. Studies estimated that the use of this model to treat stroke patients can reduce costs by 10 per cent.
India’s fragmented healthcare ecosystem has multiple public, private, and individual healthcare providers. Therefore, it is often a challenge for healthcare professionals to maintain robust medical records. Even when they do, such records are not easily portable, and patients rarely get timely access. Digitisation of health records can help doctors administer appropriate treatment and create a knowledge bank that will help officials understand trends in public health, such as the burden of tobacco use.
It is important that such solutions are designed as open data ecosystems, subject to user audits and not as vulnerable single points of failure. Studies indicate that high, out-of-pocket expenditure on healthcare pushes around 32-39 million citizens below the poverty line every year.
Telemedicine services offer an opportunity to leapfrog traditional constraints to quality healthcare. The three “Ds” offer the means to unlock such potential and reduce the healthcare burden that is a consequence of widespread tobacco use.
(Shah is research manager at the Foundation for a Smoke-Free World and Sharan is, partner, Koan Advisory Group. The views expressed are personal.)
Green buildings only hope in post-pandemic era
by Archana Jyoti / 23 September 2020It is high time governments act by adopting mandatory energy-saving codes for new buildings and refurbishing existing ones
Sneha Singh shifted to an apartment in a highrise building with her husband and children in the national Capital two years ago. She has two air-conditioners, a TV, a refrigerator and other electrical appliances in her home. But she has stopped using air-conditioners now and has minimised the use of other electrical appliances because of the economic impact of the Covid-induced lockdown.
“With the mercury shooting up in April and May, it was extremely difficult for my kids to study or sleep. They were restless and unable to focus on their work,” she says. But what she does not understand is that the problem lies with the design and construction of the flat, which was not built keeping the health of its occupants in mind. With the virulent virus forcing Sneha to spend most of the time indoors, she and many other families like hers are now realising the importance of the quality of the environment inside the house.
Experts are of the opinion that green building technologies can help the world prepare for a future in which pandemics will be more common. In fact, the Singapore Green Building Council (SGBC) president Dr Ho Nyok Yong made it loud and clear at a webinar in May this year when he said, “Think of green buildings as giant N95 face masks, protecting you from harmful toxins the moment you step inside.”
Echoing his observation, a study in Singapore said that people who stay in “green” buildings are less likely to suffer from fatigue, headache and even skin irritation, showing that their benefits stretch beyond saving energy.
In contrast, the health impacts of living in energy-inefficient buildings have been studied extensively in some countries like the UK and New Zealand. They have shown that the list of consequences of non-energy efficient houses is long: Increased chances of respiratory infections, cardiovascular disease, gastro infections, asthma, allergy symptoms, poor mental health, arthritis, rheumatism and a higher number of falls — a major safety risk for the elderly. Closer home, in 2018, IIT Bombay and Doctors For You, an NGO, conducted a study in Mumbai’s poorest ward, M-East, that established a co-relation between mortality due to tuberculosis (TB) and housing conditions. It found that eight to 10 per cent of the residents in the denser, less light-filled and more poorly ventilated complexes had TB, compared to one per cent of residents in a better ventilated project. Even within a building, the risk of TB declined on higher, well-ventilated floors.
Veteran architect Ashok B Lall explains, “Most of the time buyers are not aware that housing conditions have an influence on physical health. People must understand that houses are more than the physical structures providing shelter. For example, a warm and dry house can improve general health outcomes and specifically reduce respiratory issues. Children living in crowded homes are more likely to be stressed, anxious and depressed, have poorer physical health, and inattentiveness at school.”
Lall is a supporter of green building design focussing on reductions in energy and water usage, creation of healthy indoor environment and minimisation of environmental disturbances.
Realising the significant co-benefits of improving housing conditions, in 2018, the World Health Organisation (WHO) came out with guidelines on health and buildings. “Improved housing conditions can save lives, reduce disease, increase the quality of life, reduce poverty and help mitigate climate change,” said the WHO, also noting that these can contribute towards the attainment of Sustainable Development Goals (SDGs) related to health (Goal 3) and sustainable cities (Goal 11). As per the guidelines, installing efficient and safe thermal insulation can improve indoor temperatures that support health, while also lowering energy costs and reducing carbon emissions.
Thermal quality refers to whether the indoor temperature is comfortable and healthy. While most evidence relates to the impact of cold environment, overheating can also damage health through dehydration. In cold climates, better and improved energy efficiency can lower rates of excess winter mortality while in hot climates it helps reduce the risk of dehydration and negative health impacts, says Sameer Maithel, Director of research and advisory firm Greentech Knowledge Solutions and Head, Building Energy Efficiency Project (BEEP) Project Management and Technical Unit in India. BEEP is a bilateral cooperation project between the Union Power Ministry and the Federal Department of Foreign Affairs (FDFA) of the Swiss Confederation. Maithel says that the health quotients in energy-efficient buildings are: Thermal comforts, natural ventilation, daylight availability, which serves as a disinfectant as well as the source of Vitamin D, safe drinking water, sanitation and waste management.
Talking about the design principles of building green and sustainable homes in India, Lall says, “If we can devote 60 per cent of the terrace area of a four-storey building to install solar panels, it will meet the energy demand of all its residents.” The height of the building has a direct co-relation with its carbon emissions and is inversely proportional to affordability, he adds.
Refining the ventilation system is another key to minimising disease transmissions while saving electricity.
Unfortunately, in India most buildings are not equipped to establish and maintain healthy indoor air quality and need to be upgraded. The number of buildings conforming to green labels covers only about one per cent of the urban buildings in India. Isn’t there a risk that raising standards will push up costs further? “But in the bargain you cut down medical bills as well as enhance productivity,” argues SP Garnaik, executive director of Energy Efficiency Services Limited (EESL), a joint venture under the Power Ministry.
On its part, with an aim to make workplaces healthier and greener in the Covid-19 scenario, EESL and the US Agency for International Development’s (USAID) MAITREE programme, launched the “Healthy and Energy-Efficient Buildings” initiative to ensure efficiency along with health components at workplaces.
“We hope that this pilot will spur urban planners, architects and property managers to rethink the design, operation and maintenance of the buildings so as to safeguard the health and well-being of the occupants at offices and homes as well,” he says.
It is high time governments act by adopting mandatory energy-saving codes for new buildings and for the refurbishment of existing ones, assert experts. “This is all the more urgent in the light of soaring construction rates. Most buildings lack mandatory building energy codes. By strengthening these codes every three-five years, zero-emission and net zero energy codes could rapidly become the norm,” says Maithel.
(The writer is Special Correspondent with The Pioneer. The article has been published as part of CMS-BEEP Media Fellowship Programme.)
Going rural
by Opinion Express / 22 September 2020Forcing post-graduate medical students to spend three months in rural areas will be beneficial for the doctors too
In an answer to Parliament in 2019, Ashwini Choubey, Minister of State for Health, had stated that assuming an availability of 80 per cent, there was only one doctor per 1,445 people in India. Of course, if one added up alternative systems of medication, the number would be closer to the World Health Organisation’s mandated one doctor per thousand population but over the past few months, we have seen many alternative medical practices wither away in the face of the pandemic. What these statistics do not reveal is just how skewed India’s medical system is towards large metropolitan areas. It is only when you see thousands of patients from across India crowding the entrances at All India Institute of Medical Sciences (AIIMS) in Delhi that you realise just how bad things must be for families to transport critically ill patients hundreds of kilometers for proper care. The fact is that cities like Delhi and Mumbai, while suffering immensely from the pandemic, have enough beds and facilities. There was a joke, not one of any laughing matter though, that there were more intensive care beds and ventilators in Delhi’s Saket area alone than in some other Indian states.
Part of the reason for the deficiency of healthcare in upcountry India is that young specialist doctors want to work, for rather obvious reasons, in big city hospitals. And it is unfair, given the poor facilities in even smaller towns, let alone rural areas, to expect young doctors to work there for extended periods of time. However, if young medical specialists did spend time in rural areas, they would possibly understand the gravity of the medical scenario a lot better than they currently do and suggest innovations in existing infrastructure. Operating in cities, they are often insulated from the realities of India just as much as “expert commentators” on news television channels. The Government’s mandate that post-graduate medical students spend three months in rural areas is understandable and while some of them might be disappointed, this is a practice that should ideally be spread across disciplines. If we talk about “two Indias,” then the only way to redress that is to ensure that young people from urban India see the problems of rural India and understand why they behave — with their votes and their money — the way that they do. Being a warrior on social media isn’t quite the same thing.
(Courtesy: The Pioneer)
No people’s vaccine
by Opinion Express / 21 September 2020Vaccine nationalism is rearing its ugly head again even as the Coronavirus pandemic rages on. The implications of manipulating access to essential drugs, particularly HIV-AIDS ones in developing countries, due to bulk purchasing power of richer nations and honouring of pharmaceutical patents, are already known. That crisis worsened. Sadly, the trend continues as the race to develop a vaccine for COVID-19 intensifies with five leading candidates currently in phase three clinical trials. Who gets hold of the vaccine and when determines which country stops the caseload from going up exponentially, saves lives, escapes the second and third wave predicted by experts and gets on the path of economic recovery faster. However, with the pharmaceutical industry being largely cartelised, it won’t come as a surprise if developing countries are at the far end of the line. Remember the 2009 H1N1 flu pandemic? Australia, which was the first country to come up with a vaccine at that time, blocked exports while some of the wealthiest countries entered into pre-purchase agreements with several pharmaceutical companies. The US alone obtained the right to buy 6,00,000 doses. It was only when the H1N1 pandemic began to recede that developed countries offered to donate vaccine doses to poorer economies. However, the damage at that time was not as severe as it will be this time round because the Coronavirus is far more infectious and deadlier than the H1N1 and has almost strangled the have-not nations. If a recent report released by Oxfam is to be believed, wealthy nations, accounting for just 13 per cent of the global population, have cornered a whopping 51 per cent of the promised vaccine doses. It is just what poorer nations and the World Health Organisation (WHO) had feared, that while they would be prime picks for vaccine trials, they would get to use doses the last. The inevitable result would be a deepening of the pandemic. Right now, many world leaders, like US President Donald Trump, who is facing a re-election in November, will not listen to the feeble voice of the poor or the WHO. A vaccine is his ticket to the White House, he needs it for his voters. This “vaccine nationalism” has also emerged at a time when global majors are trying to establish their political prowess while using their scientific superiority to validate the claim. Thus, whoever has the first access to the vaccine will end up on the top of the global pyramid of power, apart from reaping the enormous monetary benefits that come out of it.
One of the developers of the COVID vaccine is Moderna, which has received $2.48 billion in committed taxpayers’ money. It intends to profit from its vaccine and has sold supplies to rich nations at prices that range from $12-16 per dose in the US to around $35 per dose for other countries, leaving poorer nations out of the procurement loop entirely. However, according to reports, the company’s production capacity is barely enough for 475 million people or six per cent of the world’s population. Even if all five vaccine candidates succeed, which is rather unlikely, it is only by 2022 that two-thirds of the world’s population will have access to them. Also, even if one country does get vaccinated, how will its policy on travelling restrictions change? Will the restriction be limited to those who are yet to get access to the vaccine or will they have vaccines for those entering their land? Remember it’s a global pandemic and just like the WHO warned, creating vaccinated pockets will not be beneficial for long if one is aiming for a stable economy. This is why various organisations are calling for a “people’s vaccine”, free of the monopolistic control of the pharmaceutical companies over its sale and urging nations to share the needed information with others so that it is available to every single human being at affordable rates and can be distributed on a need-based rather than a paid-for basis.
If all the five vaccines work, Oxfam says that would amount to a combined production capacity at 5.94 billion doses, enough for 2.97 billion people, keeping in mind that the vaccines will most likely require two doses. The supply deals already agreed upon are for 5.303 billion doses, out of which 2.728 billion (51 per cent) have already been procured by developed countries including the UK, US, Australia, Hong Kong and Macau, Japan, Switzerland and Israel, as well as the European Union. The remaining 2.575 billion doses have either been bought by or promised to emerging countries, including India, Bangladesh, China, Brazil, Indonesia and Mexico among others. This also includes the 300 million doses of the AstraZeneca vaccine pledged to the Covax Advanced Market Commitment (AMC), the vaccine pooling mechanism, promised to developing countries. It is essential for global powers to understand the gravity of the situation and on ethical grounds work in favour of public health and the global economy.
Fight hunger with an inter-sectoral strategy
by Sunil Rajpal / 19 September 2020The ‘POSHAN Abhiyaan’ seems to have made some headway with an ambitious target of achieving a malnutrition-free India by 2022
It is disconcerting that every second child in India suffers some form of nutritional failure in India. Over the years, Government data have borne witness to how many people, especially women and children, do not get three square meals in a day. Worryingly, the potential disruptions caused by the lockdown may make the varied forms of malnutrition a lasting reality. However, the launch of the Government’s flagship programme ‘POSHAN Abhiyaan’, seems to have made some headway, with an ambitious target of achieving a malnutrition-free India by 2022.
It also aims to reduce stunting in children aged between zero and five years from 38.4 per cent to 25 per cent during the same period, along with reducing the level of anaemia and low birth weight in children.
With inter-sectoral convergence being the key strategy, the programme makes a shift from the existing approach of making planning and implementation the responsibility of one Ministry. Instead, it rightly notes the various critical components of success and makes ‘POSHAN Abhiyaan’ a multi-ministerial initiative. While the Ministry of Women and Child Development acts as the nodal office, the Ministry of Drinking Water and Sanitation is responsible for the Swachh Bharat Mission (SBM) that ensures cleanliness and hygiene and the Ministry of Education is responsible for the Mid-Day Meal Scheme (MDMS).
Two other Ministries, that of Health and Family Welfare and the one responsible for Rural Development, are looking after health programmes such as Mission Indradhanush for immunisation coverage and rural income schemes, such as MNREGA, respectively. The LPG distribution scheme by the Ministry of Petroleum and Natural Gas enabled safe and hygienic cooking in underprivileged households.
But will India accept malnutrition as everyone’s problem? The copious fund allocation for the ‘POSHAN Abhiyaan’ and its increase in the past three years have shown the Government’s sincerity in taking the mission to its intended conclusion. From Rs 950 crore in 2017-18, the current allocation for the ‘POSHAN Abhiyaan’ reached a sum of Rs 3,400 crore for the financial year 2019-20. However, the potential challenge can be bringing social and behavioural change towards malnutrition at the community level. Ensuring equitable nutrition to build a healthier nation will require the following.
Eating local and seasonal food: This comprises a part of the trend known as “sustainable eating” and has been proven to be an economical solution to the food crisis globally. This saves time and the cost of transportation while promoting the use of fewer preservatives. Such food items are also suitable to fulfil the nutritional needs of the people in a way that is commensurate with the local environment.
The concept of introducing kitchen gardens in schools to fulfil some part of the requirements under the MDMS is an innovative step. In the coming days, introducing more steps, such as promotion of local, nutritious millet and crop diversification to promote traditional millet will be the right steps to complement this ongoing effort. Recent studies have observed that investing $1 in nutrition-related interventions will have economic gains of about $19 to $22.
Addressing intrinsic social and cultural biases: In his paper ‘POSHAN Abhiyaan: Making Nutrition a Jan Andolan’, NITI Aayog member Vinod K Paul and co-authors observe that despite the Prohibition of Child Marriage Act, 2006 mandating the legal age of marriage at 18 for girls, 30 per cent of them are married before that age and eight per cent are already pregnant by the time they are 15-19 years of age. Facing intra-household deprivations due to their sex and abject poverty, these young girls often forego necessary nutrition, care, and rest even during their pregnancy, thus delivering low birth weight babies. For these babies, the cycle of malnutrition has already begun, they note.
This long-standing social bias deepens with socio-economic nuances. For example, in tribal households, the overall amount of food is anyway low and the men, by tradition, get the larger share of it, considering the physical labour they must undertake. A male child may get less to eat than his father, but is likely to get more than his mother, grandmother or sister. There is a need to free nutrition from the perceived requirement of the receiver. Disseminating a scientifically-validated diet chart according to age and sex to the Panchayat level can help in spreading awareness and help households modify their practices.
Clear and visible measures for better accountability: Owing to the possible institutional leakages, Government initiatives should be monitored by some metric for accountability. For this, an enhanced information and process system is crucial. Monitoring, surveillance, and evaluation remain critical to all Government initiatives not only to firm up the people’s trust but for better outcomes as well. Understanding ground-level realities will not only enrich policymakers’ understanding, it may help in building a positive perspective among beneficiaries about public interventions. Public consultations, surveys among beneficiaries and social audits are some of the most effective ways to do this.
Building a case against hidden hunger: Few realise that malnutrition is not exclusively a rural phenomenon. Many people, especially children, in the cities, too, suffer from malnutrition, albeit of a different kind. Since a good part of their diet is filled with refined and finished items, not to mention the large amounts of salt, sugar and trans-fat they consume, the children lack micronutrients such as iron and zinc. Traditional crops and millet, marked as nutri-cereals that should have been part of our diet, are fast becoming a favourite of the educated and wealthier part of the society. However, as companies producing fast-moving consumer goods look to the rural market to revive from the economic effect of the pandemic, it is important to ensure that rural consumers do not acquire the habits of cities. The onus is on the Government to ensure that the learnings from the cities reach the villages before it is too late.
(The writer is Associate Professor, Health Economist, IIHMR University, Jaipur)
Spare a thought for our kids
by Sumitra Mishra / 18 September 2020Let our children, including those at the margins of territory, identity, services, social and economic interventions, find themselves future-ready
Infants and children — naked, hungry, crying, sleeping in overcrowded trucks, on the shoulders of their tired parents and caretakers. These were some of the heart-breaking pictures that emerged as everyday lives were disrupted following the Covid lockdown put in place in March across India. The multiple fault lines of our societal order were more visible than ever as migrant workers and their families were seen out on the roads across major cities, while the rest of us took to working from home. This was not “a long walk to freedom”. It was a walk back home through a terrain that was as indifferent as it was strange. It was reverse migration, a story of lost livelihoods and ever-increasing struggles. For some, it was a walk to their deaths.
As we battle the Coronavirus and its varied impacts on our lives, it is important that we do not lose sight of these fault lines. It has especially hit the families of workers in the unorganised sector, who do not have adequate social protection, support and additionally find it hard to provide adequate care to their children.
One of the casualties of the lockdown was the slew of programmes tackling malnutrition. As per the National Family Health Survey-4 (2015-16), 21 per cent children below the age of five in India were undernourished, 91.4 per cent of the children aged six to 23 months did not receive an adequate diet, one in three (38 per cent) of children under five years of age was stunted, one in five (21 per cent) of the children was wasted, 36 per cent were underweight. The lockdown resulted in a more dire situation where the resulting socio-economic impacts, the closing down of anganwadi centres and the resource crunch minimised the likelihood of availability of food to counter malnutrition.
These intersecting impacts of poverty, gender discrimination, caste and class differences, violence, issues of availability and accessibility of services to the young child and lack of professionalisation of childcare workers are brought to the fore in the State of the Young Child in India (SOYC) report, that Mobile Creches, an organisation working for early childhood development (ECD), released recently. While the report was finalised before the pandemic hit the world, it nevertheless offers important insights into the status of India’s children under six years of age — who form over 13 per cent of the country’s population — in addition to a critical examination of legislative frameworks designed to address their needs. The report also goes beyond a homogenising understanding of the child, as it emphasises various disadvantaged categories within this age group and the dire situation they are in. It calls for specific interventions for each vulnerable category, otherwise it results in a risk of lifelong consequences of deprivation.
The results emerging from the indexing can be used to draw out good practices from top performers like Kerala and Goa and turning more attention towards the poor-performing regions and States like Jharkhand, Uttar Pradesh, Bihar and Madhya Pradesh. With recommendations stemming from exhaustive analysis, it can also enable in envisioning a post-pandemic world where the issues of marginalisation and neglect receive due attention and policy intervention.
The Integrated Child Development Services scheme (ICDS), the world’s largest programme catering to children, requires recalibration for it suffers from design and capacity deficits, does not adequately address the components of care and early education and is still a long way from reaching the most marginalised in an effective and equitable manner.
The youngest child is often the most invisible and exceptionally vulnerable. This calls for tapping development opportunities in this young age that can set a healthy foundation for life. Investment in ECD not only has the potential to enhance individual capacity and economic growth, it also provides an opening for women empowerment by recognising the overlapping rights of women and children and bringing in State interventions and increased budgetary allocations.
The SOYC report recognises the biological role in care-giving yet questions the gendered stereotypes that result in an undue burden on the mother. In the unorganised sector especially, women are bogged down by a triple burden — the responsibility of childcare, work outside the home that mostly entails unequal access to the market, longer working hours, unhealthy working environment and lesser wages, and the household work as well. Often, young children are seen lying or roaming around these unsafe work sites since these women are deprived of maternity or childcare benefits. This weak support system compromises their ability to provide quality care to the infant/child. Therefore, it is important that where families are unable to provide due childcare, compounded by their multiple issues, the State steps in as an enabler. As the sole scheme to cater to the needs of children of women engaged in the informal sector, the Government-sponsored National Créche Scheme has actually seen a reduction in the number of creches, with only 7,930 of them functional across the country in 2019, which translates into one creche per 21,000 children. The scheme needs to be re-imagined and strengthened with serious revision of the budget, and this can also be supplemented by a phased conversion of anganwadis into anganwadi-cum-creches.
The pandemic-induced lockdown witnessed a rare visibility of anganwadi and ASHA(Accredited Social Health Activist) workers as they emerged to be the first line of defence in dealing with the contagion. However, as the SOYC report notes, they are otherwise marginalised — not seen as a professional cadre, treated as part-time workers, paid well below the minimum wages in most States. There is a pressing need for their critical role in the childcare ecosystem to be recognised, acknowledged, professionalised and for their remuneration to be in line with their responsibilities. The professionalisation of this service will also mean adequate training of these workers and can strengthen the Early Childhood Care and Education (ECCE) component, which remains a weak focus of the ICDS.
All children in the ages of three to six should have a right to quality ECCE, irrespective of whether they are located at anganwadi centres, pre-primary sections of Government, private schools or any other pre-school centres.
For the country, prioritising ECD can translate into fulfilment of Sustainable Development Goals and its international commitment towards child rights. While data paucity on multiple dimensions of child well-being hampered the indexing process and a more accurate insight in certain areas, the budgetary analysis through national-level data and allocations to States brings forth issues of inadequate allocation, under-utilisation, lack of management capacity to cater to the needs of children.
The per child expenditure in the country for 2018-19 was an abysmally low figure of Rs 1,723. This must be enhanced to Rs 1.25 trillion annually to cover funding gaps and ensure holistic interventions. This approach has the potential to bring in returns that would exceed budgetary spends on any alternative welfare programme.
Coronavirus has significantly altered the way we thought of our lives, our work and our very support systems. It has taught us lessons, tragic ones at that.
Yet, it is in this moment that we must recognise the deprivations, neglect and exclusion that mar equitable access of various vulnerable groups, including children, to essential services. Let our children, including those at the margins of territory, identity, services, social and economic interventions, find themselves capable for the future.
(The writer is Executive Director at Mobile Creches and an early childhood development activist)
US showing ominous signs
by Gwynne Dyer / 16 September 2020It would be a very big deal if the US started distributing a vaccine that has not been properly tested. Yet the signs are that this is just what is going to happen
Nine of the world’s biggest pharmaceutical companies have just promised not to apply for regulatory approval for any new Covid-19 vaccine before it has gone through all three phases of clinical study. Why would they do such a thing? You’d be surprised if brain surgeons got together and promised not to operate while drunk, or if the bus drivers’ union publicly pledged that its members will not drive recklessly. They don’t do that because operating sober and driving carefully are just part of the job. So is ensuring that new vaccines are safe and effective. Yet nine major players in the international pharmaceutics market — AstraZeneca (UK-Sweden), BioNTech (Germany), GlaxoSmithKline (UK), Johnson & Johnson (US), Merck (Germany), Moderna (US), Novavax (US), Pfizer (US) and Sanofi (France) — all felt obliged to reassure the public that they won’t cheat. What’s up? Obviously, it’s the perception that other players in the same market may indeed be cutting corners. We’re not talking here about Russia and China, both of which have begun inoculating some key workers with vaccines that are still listed by the World Health Organisation (WHO) as being in clinical trials. No surprise here: Everybody knows that those regimes break the rules whenever they feel like it.
Usually the Donald Trump Administration’s actions are viewed with weary resignation by the rest of the world, but it would still be a very big deal if the US started distributing a vaccine that had not been properly tested. Yet the signs are that this is just what is going to happen. Last month at the Republican national convention, the US President told the delegates and the country: “We are developing life-saving therapies and will produce a vaccine before the end of the year, or maybe even sooner.” On September 4, the US Government’s Center for Disease Control and Prevention (CDC) told American health officials that “limited Covid-19 vaccine doses may be available by early November 2020.”
More specifically, the CDC urged State authorities to consider “waiving requirements” and grant permits to McKesson Corporation so they can start distributing a vaccine by November 1. You don’t need a weatherman to know which way the wind blows. The presidential election is on November 3, two days later: That’s long enough for the glad news to get around and floating voters to be swayed in favour of Trump, but too short for any defects in the rushed vaccine to come to light. Donald Trump is going to liberate Americans from the curse of Covid in a little less than two months. If the vaccine’s miraculous properties subsequently fade, even if it turns out to kill large numbers of people, that won’t matter. The votes will have been counted and Trump will be back in office for another four years. That, at least, is the scenario that is currently envisaged by the people around Trump.
It is a plausible one, especially if the race has tightened by then. Just 1,00,000 votes in three States, mostly from people who had previously voted Democratic, put Trump in the White House in 2016. A miracle vaccine could certainly swing that many votes again.
The nine pharmaceutical majors, who felt the need to issue a “historic pledge” to uphold scientific and ethical standards, were doubtless driven by this scenario. Even if there really has been an American breakthrough, they would still have to cope with the public’s suspicion that Trump is cheating — and the mistrust that will also attach to any other early vaccines. It is possible that the vaccine or vaccines that Trump is about to unleash on the American public really do work and are safe. It would be a historic first in the development of vaccines — having a Covid vaccine ready for general use by next June or July would normally be seen as a remarkable achievement — but miracles do happen. The problem is that they don’t happen often, and if the full testing regime is not followed, you don’t know if this is one of those times.
It’s only because the AstraZeneca/Oxford University vaccine was going through the full third phase of tests, involving tens of thousands of individuals and many months of testing, that they spotted a bad reaction requiring hospitalisation and paused the tests. Now they have resumed them again. The American miracle vaccine will only start third-stage tests at the same time that it is made generally available. Pauses like AstraZeneca/Oxford University’s happen often in the development of a vaccine. And the pause was temporary because one person in the UK had a side effect but later it was deemed safe to continue with the testing. But even a very low-frequency bad reaction can be a mass killer when tens of millions of people are being vaccinated, and these are not desperately sick people willing to risk anything for a cure. They are people in good health, and you mustn’t kill them.
(Gwynne Dyer’s new book is ‘Growing Pains: The Future of Democracy and Work.’)
Voices of sanity in the wilderness
by Jagannath Kompella / 15 September 2020Due to the efforts of AIH, UNICEF and intrepid SHG workers, an entire village in Dantewada is free of its fears of immunisation
If interaction paves the way to heart-touching subjects, the person feels contentment and automatically ventilates with inner thoughts and feelings.” This quote of Elton Mayo, the father of human relations, got justification when the team of Alliance for Immunisation Health (AIH) interacted with Laxmi Kunjam, a Self-Help Group (SHG) member, who shared her diligent efforts for ensuring the immunisation of every child in her village at Koriras in Dantewada district, a project village affected by Maoists. The village posed a challenge to the Rural Health Organiser (RHO) because many new mothers were reluctant to get their infants immunised despite counselling. The reluctance was due to the prevailing myths and misconceptions that a child gets fever and develops other health issues after immunisation. However, this situation is changing slowly but surely as Kunjam, who was oriented and mobilised by the district coordinator during AIH interventions, has been actively engaged in tracking the children, sensitising the people on COVID-19, supporting the RHO during Village Health and Nutrition Day (VHND) sessions and coordinating with other SHG groups in the village on various activities.
Kunjam was encouraged by her husband, a school teacher, to get involved in the village developmental efforts. After getting orientation on Routine Immunisation (RI), hand-washing and COVID-19 from Babita, the district coordinator of AIH, Kunjam was motivated and started associating with the RHO in every VHND session and helped the ASHAs (Accredited Social Health Activists) in bringing the children to the session for immunisation. She was linked with the Panchayati Raj Institution (PRI) and RHO by Babita and allowed to participate in the training programmes. The AIH interventions, that are being handled by Babita, aim at ensuring immunisation and hand-washing at 24 hard-to-reach villages of Dantewada and Bijapur districts, by engaging local institutions such as women SHGs and panchayat-level institutions. One of the attempts of AIH includes the community engagement process where it links the PRI members, SHGs, stakeholders such as traditional leaders, teachers, ASHAs, AWWs (Anganwadi Workers), ANMs (Auxiliary nurse midwife), elected representatives and so on. Women SHGs serve as the main platform at villages for initiating activities and they are reaping constructive results due to their close proximity with the communities.
It is in this drive that Kunjam, as a group member, was trained by the AIH team, extensively on all the sections of immunisation, COVID-19 and hand-washing. She has been associated with the project since the beginning and started working for children in order to save them from diseases. The immunisation programme is fulfilling her objectives as it is the best preventive measure for a child.
The routine immunisation process was thoroughly internalised by Kunjam and she started following every instruction given by Babita seriously. Kunjam motivated her fellow group members and started working on extra miles. Her group visits every household of the village, who has a child to be immunised and informs the family on the programme. Once, she met a mother and found that the infant was not immunised because the woman feared that the baby would fall sick after getting the shots and drops. However, the child was immunised after Kunjam convinced the mother and the family that it was needed for his foundational health.
The system of tracking children, introduced by the AIH team, is being updated with the help of the Rural Health Officer and ASHA workers with necessary pre-alert, counselling, sensitisation and peripheral support. When Kunjam started updating the register and the tracking system, she realised that many children were vulnerable because of their mother’s misplaced fears. She felt that counselling them and clarifying their doubts was the need of the hour and she began an outreach programme.
Initially, she faced resistance from the villagers, who thought that she was getting monetary incentives for getting the children immunised. To convince them otherwise, Kunjam had to take the help of other SHG members, PRI members and the Mahila Panch to make home-visits and counsel women on the importance of routine immunisation. She visited every house with children below the age of 23 months and clarified their doubts. Today, due to Kunjam’s efforts, the entire village is free of its myths and fears about immunisation and new mothers have become conscious about the advantages of getting the children their shots. The Health Department has noticed this and Kunjam’s efforts are being cited by it as an example of how a group with progressive thoughts can cause positive change.
(The writer is State Coordinator of AIH in Chhattisgarh and his work is supported by UNICEF, India.)
Managing Covid the Indian way
by Vinayshil Gautam / 14 September 2020The desi variant of regulation has many unique characteristics, namely observing the format even if the content sounds silly
The last six months have seen exponential growth in the use of internet-enabled platforms for communication purposes. More webinars have been, perhaps, held per week than were seminars held per month, in each of the preceding years, with any month being taken as an example. This is understandable because after the initial severity of the lockdown began wearing off and the overenthusiasm of regulations without back-ups created its own long-term damages, gradually a greater sense of realism became a part of the scene. Dealing with a pandemic where — at the best — mitigation was the only strategy (and inexorable personal disaster a real possibility), there was little option but to allow life to begin limping towards the so-called “new normal.” If in the process infection multiplied and unmanageable risks erupted, it was a price which could not be avoided.
The eateries started opening up and public transport was back on the wheels. Those who could not do without air travel went back to flying. The standards were more of a lip-service, than being implemented seriously. Reports had it that two twin airports, called “sister airports” and managed by identical agencies, manpower and serviced by identical airlines, at least on September 10, offered two diametrically opposite scenes. Long queues at Jammu airport, more organised systems at the Srinagar airport. At the Jammu airport, people were reconciled to standing shoulder to shoulder. If in the process they contracted or passed on the virus, how could it be helped? The system wanted to know personal details, including the mobile number. How could one know whether this was a genuine mobile number?
The Indian variant of regulation has many unique characteristics, namely the form must be observed even if the content sounds silly. This is truly an understandable approach because the circumstances demanded that procedures be shown to be observed. Once in a while somebody talks of increasing medical literacy in the extension mode and somebody else notches up a point by talking of public healthcare systems. Once in a while, somebody even talks of some modifications in the medical education curriculum. Truly speaking, nothing much seems to have been seriously attempted. At the time of writing this column, guidelines were being issued for re-opening of higher educational institutions: “Staggering of classroom activities to be done with separate time slots to allow for adequate physical distancing and disinfection of classroom premises…and so on.” It has been directed that a distance of six feet would be observed between desks. It is mandated that academic scheduling should have an intermix of regular classroom teaching and online teaching and assessments. What has been missing is a back-up calculation to assess how many square metres of space does an average educational institution have? The smugness of powers that be is touching. It is duly leavened by people willing to sing praises to it in the hope of some compensating privileges coming their way. The guideline document is a delight to read: “Institutions conducting skill or entrepreneurship training, higher educational institutions conducting doctoral courses and postgraduate studies shall specifically ensure online and distance learning….’’ The document even goes on to suggest the “utilisation of any outdoor space by relocating equipment outside like in veranda, courtyard, shed and so on.” This kind of wisdom eludes comment.
The truth of the situation is, in the absence of any standards of prevention, in a verifiable sense, one cannot sense what the future would look like. The efforts seem to measure up only to a format. It is little wonder then that on September 9, India had the highest number of cases in a single day of any country on this planet. The official response was swift, pointing to “the low percentages of fatalities.” This debate should not even have begun. In reality, no real teaching has begun in many places. There is much drumming up of the “hybrid approach” but the contents of the curriculum have not even been touched.
Education as a domain is not a fallow field where anyone can walk all over with command and confidence. It is management of an expert system and the identification of genuine experts in sufficient numbers to plan, develop and execute is an important pre-requisite. The powers that be claim that the education policy had comments from over two lakh individuals. This is fabulous. Who were the core group of people — with what expertise — to screen their reactions? Nevertheless a good aspirational document has emerged. What is now required is its conversion to an operational level. A rebirth is possible provided the envisioning is clear and process issues clarified.
(The writer is an internationally-acclaimed management consultant)
The second coming
by MUSBA HASHMI / 13 September 2020With over 4.66 million cases and 77,472 deaths, India has overtaken Brazil to become the second worst Corona-hit country. This is not all, there are around 95,000 cases reported daily. Is India witnessing a second wave of the virus? MUSBA HASHMI speaks with doctors to tell you more
Just when we thought that India is getting a respite from the Coronavirus and the Capital is on its path to recovery, the second wave of the virus is about to grip the nation. So much so that the country started to recording not less than 80,000 cases per day and went on to overtake Brazil to become the second worst-hit country by the virus.
Having said that, what seems like a silver lining in the clouds is the recovery rate which has soared to 77.77 per cent.
Dr Ajay Kaul, Chairman & HOD — CTVS, BLK Super Speciality Hospital, tells you that with over a billion population, lack of hygiene and overcrowding there is a good chance of having a second wave of COVID-19 and that India is prepared to handle that.
“This pandemic has prepared us very well for the second wave or any other outbreak of a major pandemic in future. The rise of technologies like telemedicine and teleconsultation, proved to be beneficial during this time because it has minimised the doctor-patient contact. This technology has been there for years, but was not being used frequently. Also the use of 3D-printing to make various equipments like ventilator, mask, PPE kits and other disposable items at a very short notice and custom made according to the needs of the medical staff, has equipped us to lead the fight. Not only this, but with the help of various apps which can be installed on mobile phones, we were able to trace the infected people. An example of a country that made the best use of technology for curb the disease is China,” Kaul says.
He adds that in order to slow down the falling economy many shops, metros and shopping malls are opened up and a lot of people are already flocking to these places. This along with the lack of discipline and preventive measures is definitely going to bring a second wave of COVID-19. But, fortunately this time we are better prepared to handle the problem. In hospitals too, we are well prepared to segregate the patient right from the emergency unit to the ward, the whole hospital is geared up to manage an infective patient without contaminating the other routine patients.
We should learn from the countries which has reduced the infection rate and are back going to normal, he says. “The countries like Germany, Italy, Spain, UK, France and other European countries where despite of an early rise in the number of cases, implementing strict measures are able to reduce the number of infected patients. This is an example that it is not to impossible to curb or at least slow down the spread of the virus,” he tells you.
There are reports that claim that winters can prove to be worse in terms of the virus spread. However, Kaul says it can be the other way round. “Since, very little is known about this virus, we still don’t know what is the effect of weather and climate on this virus. Normally, viruses multiply rapidly in cold atmosphere and a decline is seen in summers, but this was not true about coronavirus where even during the peak summer months in India the virus continue to spread very fast and in fact during the months of June and July it was a peak time. So contrary to the normal belief that in winters there may be an increase in the number of patients, it may be the other way around. But, we shouldn’t forget that in the months of October and November there is a sharp increase in the number of patients with other viral illness. So, we have to be very careful and should perform hand hygiene frequently. Social distancing and face masks are the preliminary shields in fighting the virus,” he says.
He adds that the number of cases may see a decline from October onwards, when the case load rate gets lesser than the recovery rate, there after COVID-19 patients would start to see a decline.
Dr Shiba Kalyan Biswal, Consultant, Pulmonary and Sleep Medicine, Narayana Hospital, Gurugram, says that one can’t speculate about whether the country will see a second wave or not.
“While witnessing an alarming rise in the number of infected cases it is understood to be sceptical about the situation. Considering population, congestion, infrastructure and lack of proper use of mask and social distancing norms in a section of society in the country are adding to the problem of rising cases, but it cannot be considered as a second wave, and it cannot be speculated whether our country will see one or not,” he tells you.
The reason behind the increased number of cases, he says, is lockdown being lifted with guidelines and restricted movement is almost free. “People are now coming out of their confined places for economic reasons. And once you step out of your house risk is there. Lesser education, poor awareness and lesser understanding about the precautions related to COVID infection are adding to the problem. The situation is such that it is hard to identify whether the person standing next to you is infected or not, because there are asymptomatic cases as well. Hence, the person may be feeling totally fine, but still can be the carrier of the virus. To curb this, the crowd in public places needs to be managed,” Biswal says.
Our healthcare workers, doctors and frontline warriors are fighting this battle day in and out. Hence, we are more prepared to fight the virus, he says. “A number of steps have been taken by the Central and State Governments. We have private and Government COVID care centers. Every required step is being taken as per the need. Now that we all are aware about the infrastructure and lack of availability of proper medication in certain areas of the country, we need to work on that as well. As far as the treatment is concerned, even developed countries are working hard to prepare a vaccine and medical trials are being done. This virus and its mutation is making the situation more complicated,” Biswal says.
As for the cases of reinfection that India has seen in the past few days, Biswal says that it can prove to be a setback.
“Without any doubt it may prove to be a setback because this means a COVID-19 survivor is equally at the risk of getting infected again. Developing antibodies may help to fight the infection but it is not a guarantee that one cannot be infected again. Back in time we had witnessed the same with dengue. In some areas, people were repeatedly getting infected with the same disease again. Hence, precaution is the key for everybody. Follow a healthy lifestyle, work on your overall wellbeing and consult a doctor if needed,” he asserts.
Dr Shuchin Bajaj, Founder-Director, Ujala Cygnus Healthcare Services tells you that the high number of cases that are recorded every day can be a result of the second wave. “It looks like the second wave of COVID-19 has already started. And with more States opening up for business purposes, we can say that this wave will be severe and more widespread. Because usually the second wave of any disease is more severe with higher fatality rates. Take for example the Spanish flu, the second wave of which was started in winter season was deadly. For COVID-19, it may not be deadly because we have better healthcare infrastructure and facilities and certainly have more knowledge about this virus. But having said that, the number of cases are expected to rise in the second wave for sure,” Bajaj explains.
To protect ourselves in the second wave, he says, people need to be more vigilant than ever. “Proper sanitisation is must. Follow the rule of SMS — Sanitisation, Mask and Social Distancing. As the virus is relatively new, we don’t know the post infection complications. Hence, it is all the more important to follow proper hygiene practices. We have seen some young patients who got cured but months later they came back to us with breathing problems. The only solution is to take as much precautions as possible,” he says.
He adds that with winter approaching we have to be more careful. “The Spanish flu’s second wave was seen in the winter months. The viruses are known to thrive in cold conditions and the infection rate is high in cold weather,” Bajaj says.
‘Following a centralised crisis management approach is key’
At a time when the world is fighting to curb the raging virus, Praja Foundation released its report on the Importance of Local Governance in Crisis Management in Mumbai on September 8, 2020. The report is based on Praja's COVID-19 response study of 29 cities across all 28 States and NCT of Delhi in the initial phases of lockdown during the months of May and June, 2020.
Nitai Mehta, Founder and Managing Trustee, Praja Foundation, says that the country followed a strongly centralised approach during the initial phase of the lockdown.
“Cities across the country have become hotspots of the COVID-19 virus. City level crisis management is of paramount importance in the wake of such crises. However, it was observed that the COVID crisis management in the country followed a strongly centralised approach during the initial and extremely vital period of the lockdowns before June 2020,” Mehta tells you.
Under such circumstances, it is important to understand how city Governments across the country were handling the COVID crisis in the cities. Hence, Praja reached out to stakeholders i.e., elected representatives, administrators of City Governments and CSOs in 29 cities across 28 states and NCT of Delhi.
“To start with, Praja's COVID response study highlights that eight cities (Vijayawada, Itanagar, Guwahati, Bhopal, Shillong, Kohima, Bhubaneswar, Coimbatore) out of the 29, do not have an active functioning City Government council as municipal elections are yet to be held,” Mehta says.
The report also covers key data points on the involvement of City Governments and Councillors in the COVID crisis management interventions, City Governments that undertook ward level actions, and on distribution of control over delivery of public health service in the cities.
“The decentralised and efficient delivery of public health services have always been very important, especially in this pandemic. In line with this, The Twelfth Schedule in the 74th Constitutional Amendment Act has provisions on the need for State Government to devolve Public Health function to the City Government. However, it was noted that out of the 29 cities covered in the study, the control of delivery of public health services lies with multiple agencies in 20 cities, and only in four cities, the City Government has control over the delivery of public health service whereas rest of the five cities have public health service delivery under the complete control of the State Governments,” he tells you.
The report also covers the case studies of Agartala, Aizawl, Guwahati and Kochi, which have set examples of localised management of COVID crisis through decentralised citizen engagement in the city.
In Agartala, The Agartala Municipal Corporation (AMC) utilised the ward committees led by the Mayor and respective councillors across the city for discharging quick relief measures as a result of the COVID crisis. Localised monitoring and enforcement of COVID-19 norms were issued at each ward. The AMC also used shelter home kitchens for supply of cooked food to the migrant workers.
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