COVID-19: Efforts at National, State and City Levels

India saw its first positive cases of coronavirus between 30th Jan to 2nd Feb, from Kerala. Since then, the country has seen a steady rise in the number of confirmed cases in the month of March. At the time of writing, there were already 600+ cases in India spread across 27 states. 

 There is a multi-level effort from national and state level governments to deal with the current crises - the 21 day national lockdown being the most recent one. Here we summarise some of the recent efforts being made by these various levels.

 National and State Level Responses

• Acts and Laws that enable a response

  • Epidemic disease act: By invoking Section 2 of the Epidemic Diseases Act, advisories and directions of Union Ministry of Health and Family Welfare became enforceable across the country. Section which was invoked on 12 March, empowered state governments/UTs to take special measures and formulate regulations to contain any outbreak. It gave the centre and state, powers to prescribe temporary regulations to be observed by the public or by any person or class of persons to prevent the outbreak of this contagious disease. The recent state-wise lock-downs (and the ones following Prime Minister’s declaration of national lockdown on 24th March) of all activities other than essential services were also implemented through the provisions of this Act and state-specific regulations.

  • Disaster Management act: On 11 March the disaster management act was invoked by the centre in the wake of COVID-19 health emergency. This act gave powers to release central and state funds reserved for disaster management as well as direct power to the state governments to carry out disaster management with the central government playing a supporting role. This act has helped mobilize resources across ministries and departments. Each state through this act is also obligated to have its own separate institutional framework for disaster management at the state-level. This state level framework however in some states currently is not structured. Some of the states are also categorising COVID-19 as a disaster to utilise the funds from the state disaster funds

  • Essential Commodities Act : As per the Act, masks and hand sanitizers have been declared as essential commodities up to June 30, 2020. As per the Act’s provisions, states can ask manufacturers of these items to increase the production to avoid any hurdles in their supply

  • The International Health Regulations (IHR 2005): The International Health Regulations (2005) are a legally binding instrument of international law that aims to

    • assist countries to work together to save lives and livelihoods endangered by the international spread of diseases and other health risks and

    • avoid unnecessary interference with international trade and travel. To this effect training workshops are being organized with World health Organisation’s (WHO) expertise to strengthen core capacities for disease preparedness and surveillance

    • For intervention at state level, MoHFW requested WHO for support, upon which four WHO teams have been deployed to support response in Delhi, Uttar Pradesh, Telangana and Rajasthan which will be followed by nine teams to other states shortly.

    • In addition to this the field offices of UNICEF have been coordinating with state governments to plan their support in case COVID-19 situation escalates. Toolkits for Health Service Providers for Designated and General Health facilities have been prepared and will be rolled out.

• 8 states have health related acts and regulation: States such as Tamil Nadu, Puducherry, Goa, Daman and Diu, Kerala, Gujarat, Assam, Karnataka have their own health acts or regulations. While most of these states offer regulatory Acts and bills, Assam and Gujarat are right based

• New regulation passed in states: With the rise in positive cases across the country both Haryana and Karnataka have issued regulations under the ‘Haryana Epidemic Disease, COVID Regulations, 2020’ and ‘Karnataka Epidemic Disease, COVID-19 Regulation, 2020’ respectively. These regulations give each state further authority to direct and impose restrictions in public health interest

• Awareness creation: Efforts to raise awareness and impart information and community guidance by the Ministry of Health and Family Welfare (MoHFW) can be seen on the official MoHFW portal where one can find a daily state-wise list of confirmed cases across India and all relevant information and help services as well as various other advisories for citizens, travellers, hospitals, and other awareness material.

Response of the city Governments

In India, the responses of the city governments so far have been commensurate with the powers that they hold; a large part of the decision making has been done at national and state levels.

• Some of the city governments like Mumbai and Thane were able to identify municipal hospitals to set up isolation wards.

• City governments like Nagpur which have seen positive cases, are doing door to door containment drives

• Kohima is creating ward level vigilant teams to monitor and implement all directives and advisories issued by the government

• Amritsar has taken various steps to ensure cleanliness and hygiene in the city by mobilising its sanitation workers

• Berhampur has started online delivery of groceries as well as medicines

Many others are concentrating on sanitation and awareness drives, something in which they have built capacity as well as expertise, as a result of the Swachh Bharat Mission.  At a minimum, city governments are trying to raise awareness amongst the people regarding safety etiquette and providing support to state or district-level initiatives. 

This role being played currently by the local governments is also in line with a pan-India study on urban local governance conducted by Nagrika. In the study we found that city governments were at the forefront of solid waste management, cleanliness and hygiene along with raising awareness on these issues. A public health related activity that most municipalities undertook was fogging and spraying of disinfectants to prevent vector-borne diseases. However municipal bodies in very few states had health care facilities under their control. These health facilities included, but were not limited to, Urban Primary Health Centres, Urban Community Health Centres, Ayurvedic hospitals, homeopathic clinics and first referral units.

City Governments: Disaggregated Knowledge and Disaggregated Decision-making

 As COVID-19 surges ahead and hopefully is subdued in the coming months, it will have brought to light the immense potential of countless actors who are working tirelessly to put up the fight against it. While citizens are realising their role more than ever before, the role of city governments will come into focus as well. The pandemic has largely been an urban pandemic. The current narrative around COVID’s expansion has established our nation states as the main actor and countries as the main battleground. However, the cities have been the epicentres of the action.

Even in the states which have a low urban population, cases have emerged in the cities. For the purposes of administrative operations as well as reporting, cases have been reported and actions recommended at district levels. However large the aggregation of a geographic unit, greater is the loss of the detail. One can understand this fact while zooming in on a google map.

Disaggregated Density

To illustrate, in Maharashtra, the state with maximum number of COVID-19 cases, approximately 10 districts have been reported to have been impacted. Mumbai city district, which is the island city of South Bombay, has maximum number of cases. In Mumbai City district’s case, both city and district have the same boundaries. However a look at the next two most affected districts for Pune and Nagpur show the stark differences between populations and densities of the district and the city. As one can see, the density of Pune city is almost 15 times that of the district. For Nagpur as well, density of the city is 19 times that of district.

Comparison of Population, Area and Density for Pune District and City

Data source: Wikipedia

Comparison of Population, Area and Density for Nagpur District and City

Data source: Wikipedia

It is an intuitive as well as researched fact that decision making is better if made on disaggregated data. Geographic granularity of data can help in knowing essential details – basic facts such as ‘where’ people live. This is critical especially during the times of disasters when local disaggregated data can help in making quick decisions for providing relief.

Density as a planning metrics has come into new light in the context of this pandemic. Some cities internationally have reported that their density control measures to reduce the impact of COVID-19 have been working. What it means is that the cities have been able to identify pockets within the city which are dense such as parks, public spaces, residential zones among others which are denser and hence pose a greater risk of creating community-based transmission. In absence of disaggregated density values, at zonal or neighbourhood levels, it would not be possible to make such decisions and hence these decisions will have to be taken at an aggregate level or without any extra or special provisions for areas which may need extra attention.

Decision Making Capacities

Another enabler for decision-making at local level is the capacity of decision-making itself, to deal with public health issues including emergencies. A National Disaster Management Guidelines of Biological Disaster by the National Disaster Management Authority (NDMA) noted a wide inter and intra-state differential in terms of public health assets, functioning of the public health departments, teaching and training institutions as well as public health research. This differential gets magnified when seen at a city level.

In unprecedented scenarios such as now, it will require the entire public health apparatus of the country to be mobilised at its full capacity. To mobilise, the actual transmission of advisories and orders from national to state to city level may not take time given the fast means of communication. It is the comprehension of these orders, the assessment of the local contexts of the implementing agencies and actual implementation that takes time. And this is caused due to the differing capacities of the local authorities, including capacity to analyse data and information to make decisions. 

Hence even when state governments may transfer powers to local authorities to take up roles during crises, the accompanying capacities of these authorities to already assess and act based on their local contexts are limited. To address this challenge it is important to bring the public health capacity at a common minimum at city level including their analytical capacities such that they are able process the information and convert it into actionable knowledge. Such capacity will provide a local supporting framework which would be ready to respond when an emergency strikes. For example in the current scenario, some of the experts are suggesting that national containment is no longer an option in India but state and local mitigation and containment is still a possibility

City governments are in the best position to do disaggregated data collection. To deal with scenarios as we face now, as well as in normal circumstances, it will be important to enhance capacities of city governments to collect and analysis such information, make decisions and act based on such analysis.