Analysing India’s systemic reponse to COVID-19

Credit: Moska Najib / for NBC News

This article reflects my thoughts and observations from India’s systemic response to a virus.

Ever since the COVID-19 which spinned out from epicentre Wuhan, it has covered all the attention of almost every individual and institution worldwide. India, however has given a very strong response to the pandemic with all its individual, political and institutional weight strongly responding to the outbreak and deploying human, financial, social and physical resources to fight and control the outbreak.

It is interesting how a nanometer small virus can disrupt the institutional system of a human body, as well as of a country. Our immune system is fighting the virus and so are our institutions. So, how do we understand a systemic response to a nanometer sized virus?

India started responding by issuing a travel advisory, thermal screening passengers from China and then to other countries, suspending VISAs, home isolation protocols, compulsory quarantine and suspending all international flights. Along with this, it parallely started waging a war against COVID-19 by a slew of measures.

To this, we have to think in a framework where large scale systems and institutions respond to a pandemic such as the Bureaucracy, Legislative, Judiciary, Media, Civil Society, Corporates, Families and Individuals. There are hundreds of interventions being done by all of them in response to the Coronavirus outbreak.

A systems thinking framework for Disaster Management

Let us understand how each of these interventions are trying to stabilise the system back.

1. Control and War Room Management: Control and War Rooms are used for a very specific purpose and a lot of Municipalities and State Governments have setup control rooms which track and monitor activities, direct people to relevant resources, counsel and help people if they have any doubts. India kickstarted its response and quickly provided a list of state-wise phone numbers for COVID-19. People would call them if they had doubts on their symptoms, needed to get to the nearest call centres, etc. Various cities have setup their Control Rooms to monitor people who have returned from abroad, take complaints from people, monitor the number of cases and deaths, etc.
2. District administration: District administration is the final leg of the top-down policy implementation and I have seen all the representatives such as District Magistrate, Mayor, Municipal Commissioners, CEO of ZP, Sarpanch, etc. are pro-active. Officers are doing micro-planning, surprise visits, review meetings, taking initiatives, speaking to and re-assuring people. The administration is on its toes as it monitors cases, coordinates with their respective State Governments and tries to implement the lockdown in a very smooth way. Several cities have take innovative measures to deliver essential services to people, practicing social distancing and monitoring the lockdown efficiently.
3. Philanthropic Funds & Collaboratives: The social sector is coming together during this time. Several organisations like Bridgespan, Dasra, Sattva, etc. are forming collaboratives, collating information, getting dedicated funds, collating information on civil society organisations and the needs on the ground. Philanthropists and bi-lateral organisations have started to commit funds to support innovations and non-profits who are fighting this.
4. Work from home innovations: This was perhaps a result of the systemic disruption. But due to the result, the sub-system of infrastructure, products, platforms and services helped the transtition from office to work from home. People are using conferencing platforms, messaging platforms to collaborate with their teams. Fitness and meditation apps have gained traction.
5. Donations & Volunteering: It is heartening to see all crowdfunding websites, payment providers and volunteering platforms becoming a single window for connecting donors and organisations working on ground. Government has called for volunteers using Self4Society, called doctors to volunteer using NITI Aayog’s platform. Citizens are starting individual campaigns to further provide relief, distribute ration and basic supplies for the vulnerable groups. Citizens are also volunteering with non-profits, religious organisations and their district disaster management authorities to spread awareness, distribute supplies and check on quarantined citizens. Government organisations like IAS, IPS, CRPF, etc. are donating their salaries to the relief funds.
6. National Relief Funds: With the prime minister himself launching the PM-CARES Fund, State CMs putting out details on State CM Relief Funds; citizens, elected representatives and corporates have started donating money to the fund.
7. Corporate Social Responsibility: With the Coronavirus now included as an activity under CSR and with the financial year coming to an end, corporates are giving funds to non-profits and government funds. Other than CSR, corporate foundations and the founders are pledging money.
8. Procurement: India has ramped up the production of ventilators, testing kits, PPE, masks and sanitizers. With a lot of suppliers, the Governemnt E-Marketplace and Invest India’s Business Immunity Platform have come to the rescue and have done phenomenal work by becoming one stop chanels connecting the suppliers and the government. India has banned the export of most of the above mentioned things too and has ordered from other countries as well.
9. Physical Infrastructure: Frugal innovation is driving the increase in state capacity dramatically. With the states, now on a mission to build dedicated facilities, testing centres and quarantine centres, they are converting stadiums, government buildings and railway coaches as health infrastructure.
10. Behavioural Nudges and IEC materials: How do we get billions of people practice hand-washing and social distancing? How do we get a billion people to observe a voluntary lockdown? The Janata Curfew did a phenomenal job of setting the tone, appreciating the frontline workers, doctors, policemen, etc for their job through clapping and banging utensils. Similarly, creative advertisements, announcements through songs and memes are playing a huge role to make people wash hands frequently, to not touch their face and to practice social distancing.
11. Food Security: This is perhaps the most important response and is on the top of the priority. India will provide extra 5 kg grains, 1 kg pulses for free under PDS for next 3 months. Apart from this, Urban Local Bodies are delivering food and medicines to people’s home, arranging special locations and timings for people to get the essential supplies. Startups like Zomato and Big Basket are playing a very crucial role through their network of service delivery.
12. Data Systems: Surveys like NHFS and systems like NRHM’s HMIS have provided the demographic, economic and health data of India’s citizens and has helped districts plan their health infrastructure and interventions. This data is also used to build risk profiles of India’s districts and do more targeted interventions to quickly improve state capacity. Several public and private organisations have built their dashboards, have geo-tagged relief centres, testing centres and patients. India recently has developed an app called Aarogya Setu which alerts people when a COVID-19 patient is nearby and also helps in checking symptoms, getting health messages, etc.
13. Police: The police is making sure the lockdown is implemented properly, is making people aware about the dangers and symptoms, is naming and shaming people and also controlling the movement of essential supplies. Several city police departments are using drones for mapping people’s movements, have built applications to issue passes to service providers and are constantly active on social media to assess any threats and provide support to people. Indian Police is also using drones to ensure people are not gathering at a place
14. Monetary Policy: RBI has reduced the policy repo rate by 75 basis points to 4.4% and the reverse repo rate by 90 basis points to make it relatively unattractive for banks to passively deposit funds with the RBI and instead use these funds for on-lending to productive sectors of the economy. It has also released Rs 1.37 lakh crore of primary liquidity into the system.
15. Media: India’s citizen engagement platform MyGov has played a phenomenal role in engaging citizens and governments. It has started a dedicated page with all the relevant details, helpline numbers, dashboard, etc. Public broadcaster PIB is making sure all the messages of the government are reaching to the masses. It is also doing a fact-check on the fake messages people receive on WhatsApp. On the other hand, journalists are the feedback loop of our systemic response system. They’re checking the situation on-ground, speaking to people, bringing out stories, finding loopholes and delivering important news to all citizens.
16. Civic collaboration: Platforms like MyGov, Omidyar Network, Social Alpha have started organising innovation challenges and are urging people to innovate and create solutions to help fight the epidemic. Technology companies are giving grants, providing access to data and resources for people to collaborate and work. People from design, data science, manufacturing, software are collaborating and creating masks, ventilators, applications for contact tracing, etc. Government is crowdsourcing ideas through its citizen engagement platform MyGov and it is heartening to see citizens forming local groups to solve local issues.
17. Academia: The academia community is collaborating very swiftly with journals and studies getting out, building disease modelling and projections, studying other countries’ responses and is being a second feedback loop and a learning machine for the system.
18. Religious organisations: Religious organisations, temple trusts and spiritual organisations are donating money, mobilising people, distributing essential supplies and have been working on-ground day and night to provide relief.
19. Legislative Acts: The constitutional framework has made provisions for laws during an epidemic through the Epidemic Diseases Act and the Disaster Management Act. The DMA has the National Disaster Management Authority, State Disaster Management Authority and District Disaster Management Authority. They’re preparing guidelines, policies, plans and are coordinating and implementing them along with the public administration. India has also declared COVID-19 as a ‘notified disaster’ which allows the States to spend a larger chunk of funds from the State Disaster Response Fund (SDRF) to fight the pandemic. Morever, the government has also formed empowered groups under the Disaster Management Act Coordinating with private sector, NGOs and international agencies, Economic Welfare & Relief, Info, communication and awareness, tech and data, grievances, medical emergency, health infrastructure, supply chain, etc.
20. Welfare: India has announced a Rs 1.7 lakh crore relief package under the Pradhan Mantri Garib Kalyan Yojana which provides insurance cover to health workers, free 5 kg of wheat or rice and 1 kg of preferred pulses to 800 million poor people, Rs 500 per month to 200 million women Jan Dhan account holders, increase in MNREGA wages to Rs 202 a day, Rs 1,000 to 30 million poor senior citizens, poor widows and poor disabled as ex-gratia payment, frontloading Rs 2,000 to 87 million farmers under the Pradhan Mantri Kisan Yojana for the next three months.

After analysing India’s response, here are some of my reflections:

• No single platform to match donors and NGOs: At this time, when the donors are having a difficult time to search NGOs which are fighting COVID-19 and the NGOs which are searching for potential funders, there is a need to build a centralised portal which is frequently updated and has all the donors from individuals, CSRs and philanthropists on board. DARPAN portal does a good job of compiling the information of all NGOs but at the time of a crisis like this, something like this comes in handy. India needs an NGO database, it needs a donor database as well and marrying the two.
• Government needs a ticketing system: MLAs are tweeting whether there are any NGOs who are working in the district, volunteers want to connect with their local MLA so that he/she can help the migrant workers arrange food and transportation, a local supplier wants to obtain permission for his truck delivering essential supplies. Where will everyone go? Whom will they approach in the first place? At this time, control rooms and a dedicated system for raising tickets and grievances can play a pivotal role. Imagine the government has a track of each and every request it is getting and has dedicated staff sorting out information, raising tickets and further escalating it to officers and elected representatives.
• Siloed information and too many initiatives, portals/helpline numbers lead to confusion: I have seen countless helpline numbers, new circulars everyday and new announcements and dashboards on 10 different portals. India needs a one stop portal comprising of all the details in one place whether it is the location of testing centres, relief centres or helpline numbers for districts and states. We need authorized information at a single place through a single window to avoid duplication and information asymmetry. Building the window is very important. Citizens should know that they need to land on this portal and through that, they can get access to information, resources, connections, circulars, FAQs and other platforms. Time for India to bring service design into public service delivery and go big on Govtech!
• Re-inventing the wheel: While it is a good thing that people are trying to make their own designs, start their own initiatives but a lot of the times we end up duplicating the work in silos. We need a robust open source system which spots problems and innovations across public and private sctor and makes it open so that replications can be done instead of again creating it.
• Journalists and citizens should be watchdogs and everyone should critique the government: During this pandemic, everyone has to become the watch-dog. Each and every citizen has to wear the hat of a watch-dog, a sharp criticiser of government and at the same time appreciate the good steps being taken. Everyone should criticise because it works. Government was criticised on the licenses of test kits for one company, after that it allowed the Pune based company. It was criticised for not considering manufacturing of sanitary pads as an essential activities, it allowed that after the criticism. Similarly, after the outrage on media, government has made provisions for the migrants. Keep criticising and reporting! I wish there was a platform where anonymous reporting would be allowed and the data would go the nearest control centre.
• Bottom up movements are driving change: Whether it is the Janata Curfew or the Corona Sainik, Suraksha Mitras or community radios of Uttarakhand, citizen driven movements are driving change at the grassroots. Platforms like TikTok which are used heavily by the rural youth are playing a crucial role in making people aware through innovative messaging.
• Accountability is needed: Whether it is the Rs. 1.7 lakh crore welfare package or the donations to PM-CARES, PMNRF and CMRDF, citizens need to know where the money came from and where did the government spent the money. Government should provide a breakup of 1.7 lakh crore relief package and later elaborate on how much of it was actually spent.
• India needs to invest in its state Capacity and frontline workers: India’s second line of defense: the ASHA, ANM, Anganwadi workers are paid very less, are overloaded with work and have no protection. Using data from National Health Profile–2019, we observed that there are 7,13,986 total government hospital beds available in India. This amounts to 0.55 beds per 1000 population. Assuming that 50% of these ICU beds have ventilators, we arrive at an estimate of 17,850 to 25,556 ventilators in the country [1].
• Easily accesible, geo-tagged and information in local language is a challenge: Imagine you want to know which hospitals are open in your city during the lockdown or where are the nearest relief or quarantine centres? Who are the manufacturers of essential commodities or what is the proximity to nearby coronavirus cases? Finding all this information is a pain. Specially when the Government orders are in PDF, one cannot geo-tag it and the ones who are tagging it do not have the reach and authenticity. The NDMA dashboard does give some information but it can be made very comprehensive.
• India needs it’s very own public sector observatory: India’s public sector has driven innovation to tackle this crisis. From Railways which are converting the coaches into hospital isolation beds to the Ministry of Consumer Affairs dealing with the supply and demand of essential commodities through the PDS, Ministry of Electronics and IT developing digital platforms and apps for contact tracing. India does not have an observatory of such interesting public sector innovations which can be documented, studied, evaluated and scaled up.
• India needs a faster implementation of National Open Digital Ecosystem: India has made a significant progress by creating Digital platforms such as the DIKSHA platform for teachers, eRaktKosh for blood-banks, e-NAM for Agriculture and several stacks to further enable service delivery. The Ministry of Electronics and IT recently came up with a strategy paper on National Open Digital Ecosystem (NODE) and I think it would be phenomenal and will enable innovation and efficient service delivery across multiple sectors. Health, needs a NODE too. With the National Digital Health Mission being rolled out, we need seamless integration between care providers, patients, pharmacies, medical device manufacturers and regulatory bodies. The National Health Stack will enable collection of comprehensive healthcare data across the country

I hope this gives a lens to think about systemic responses to a pandemic like Coronavirus. Would love to hear your thoughts, reflections and compiled resources to be shared with everyone!

Stay safe, be grateful and help in whatever way you can!

Footnotes:

[1] COVID-19 | Is India’s health infrastructure equipped to handle an epidemic? published by Brookings India