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Subject: Social Justice

  • Global Nutrition Report, 2020

    The Global Nutrition Report 2020 has stated that India is among 88 countries that are likely to miss global nutrition targets by 2025.

    UPSC may puzzle you by asking a prelim question like-

    With reference to the Global Nutrition Report, which of the following is/are a Global Nutrition Targets?

    Visit this link for more graphics related to India: https://globalnutritionreport.org/resources/nutrition-profiles/asia/southern-asia/india/

    About the Global Nutrition Report

    • The GNR is a report card on the world’s nutrition—globally, regionally, and country by country—and on efforts to improve it.
    • It is an independently produced annual stock-take of the state of the world’s nutrition. It is a multi-stakeholder initiative, consisting of a Stakeholder Group, Independent Expert Group and Report Secretariat.
    • It was conceived following the first Nutrition for Growth Initiative Summit (N4G) in 2013 and was first published in 2014.
    • The report tracks global nutrition targets on maternal, infant and young child nutrition and on diet-related Non-Communicable Diseases adopted by member states of the WHO as well as governments’ delivery against their commitments.

    India would miss the targets

    • According to the Global Nutrition Report 2020, India will miss targets for all four nutritional indicators for which there is data available, i.e.

    1) Stunting among under-5 children,

    2) Anaemia among women of reproductive age,

    3) Childhood overweight and

    4) Exclusive breastfeeding

    What are Global nutrition targets?

    • In 2012, the World Health Assembly identified six nutrition targets for maternal, infant and young child nutrition to be met by 2025. They are:

    1) Reducing stunting by 40% in children under 5 years age

    2) Reducing anaemia by 50% among women in the age group of 19-49 years

    3) Ensuring a 30% reduction in low-birth-weight

    4) Ensuring no increase in childhood overweight,

    5) Increasing the rate of exclusive breastfeeding in the first six months up to at least 50% and

    6) Reducing and maintaining childhood wasting to less than 5%.

    Data on Underweight children

    • Between 2000 and 2016, rates of underweight have decreased from 66.0% to 58.1% for boys and 54.2% to 50.1% in girls.
    • However, this is still high compared to the average of 35.6% for boys and 31.8% for girls in Asia.
    • In addition, 37.9% of children fewer than 5 years are stunted and 20.8% are wasted, compared to the Asia average of 22.7% and 9.4% respectively.
    • One in two women of reproductive age is anaemic, while at the same time the rate of overweight and obesity continues to rise, affecting almost a fifth of the adults, at 21.6% of women and 17.8% of men.

    Data about India

    • Stunting and wasting among children

      • Data: 37.9% of children under 5 years are stunted and 20.8% are wasted, compared to the Asia average of 22.7% and 9.4% respectively. 
    •  Inequity:
        • India is identified as among the three worst countries, along with Nigeria and Indonesia, for steep within-country disparities in stunting, where the levels varied four-fold across communities.
        • For example, Stunting level in Uttar Pradesh is over 40% and their rate among individuals in the lowest income group is more than double those in the highest income group at 22.0% and 50.7%, respectively.
        • In addition, stunting prevalence is 10.1% higher in rural areas compared to urban areas.
    • Overweight and Obesity
      • Data: Rate of overweight and obesity continues to rise, affecting almost a fifth of the adults, at 21.6% of women and 17.8% of men.
      • Inequity: There are nearly double as many obese adult females than there are males (5.1% compared to 2.7%).
    • Anaemia
      • One in two women of reproductive age is anaemic.

    Inequities in Malnutrition

    • The report emphasises on the link between malnutrition and different forms of inequity, such as those based on geographic location, age, gender, ethnicity, education and wealth malnutrition in all its forms.
    • Inequity is a cause of malnutrition — both under-nutrition and overweight, obesity and other diet-related chronic diseases.
    • Inequities in food and health systems exacerbate inequalities in nutrition outcomes that in turn can lead to more inequity, perpetuating a vicious cycle, says the report.

  • What is the Sample Registration System (SRS)?

    The Registrar General of India released its Sample Registration System (SRS) bulletin based on data collected for 2018.

    Since we are talking about birth rates and death rates, how about revising Demographic Transition Model. Can you recall 4 distinctive stages of Indian Demographic history?

    Sample Registration System (SRS)

    • The SRS is a demographic survey for providing reliable annual estimates of infant mortality rate, birth rate, death rate and other fertility and mortality indicators at the national and sub-national levels.
    • Initiated on a pilot basis by the Registrar General of India in a few states in 1964-65, it became fully operational during 1969-70.
    • The field investigation consists of a continuous enumeration of births and deaths in selected sample units by resident part-time enumerators, generally Anganwadi workers and teachers; and an independent retrospective survey every six months by SRS supervisors.
    • The data obtained by these two independent functionaries are matched.

    Highlights of the data

    Birth and death rates

    • According to the data released the national birth rate in 2018 stood at 20, and death and infant mortality rates stood at 6.2 and 32, respectively.
    • The rates are calculated per one thousand of the population.
    • Madhya Pradesh has the worst infant mortality rate in the country while Nagaland has the best.
    • Chhattisgarh has the highest death rate, while Delhi has the lowest.
    • Bihar continues to remain at the top of the list in the birth rate while Andaman and Nicobar are at the bottom.

    Infant mortality

    • The data shows that against the national infant mortality rate (IMR) of 32, Madhya Pradesh has an IMR of 48 and Nagaland 4.
    • Bihar has the highest birth rate at 26.2 and Andaman and Nicobar Islands has a birth rate of 11.2.
    • Chhattisgarh has the highest death rate at 8 and Delhi, an almost entirely urban state, has a rate of 3.3, indicating better healthcare facilities.
    • As far as IMR is concerned, the present figure of 32 is about one-fourth as compared to 1971 (129).
    • In the last 10 years, IMR has witnessed a decline of about 35 per cent in rural areas and about 32 per cent in urban areas. T

    Birth rate

    • The birth rate is a crude measure of fertility of a population and a crucial determinant of population growth.
    • India’s birth rate has declined drastically over the last four decades from 36.9 in 1971 to 20.0 in 2018.
    • The rural-urban differential has also narrowed. However, the birth rate has continued to be higher in rural areas compared to urban areas in the last four decades.
    • There has been about an 11 per cent decline in the birth rate in the last decade, from 22.5 in 2009 to 20.0 in 2018. The corresponding decline in rural areas is 24.1 to 21.6, and in urban areas, it is 18.3 to 16.7.

  • Strategy for calibrated opening of economy

    The article discusses the performance of India so far and the strategy for reopening of the economy. Dividing the districts based on the number of cases and adopting a suitable approach for opening the economy there while keeping the spread of the virus in control is suggested in the article.

    India performing better

    • While the OECD countries are reeling under the COVID-19 impact, India is clearly ahead of the curve.
    • This is not merely in terms of the confirmed cases in the country but is also strongly reflected in very low mortality numbers (8.5 deaths per lakh population) compared to other nations (4,040 in the UK and 1,930 in the US).
    • While the first cases were reported in most hotspot countries and India around the same time (last week of January), today, the outbreak is far more manageable in India than in most other countries.
    • It was pragmatic for a resource-poor country to be pre-emptive and declare a national lockdown when the total number of cases were still low at 500.
    • The subsequent growth of the pandemic clearly shows a perceptible decline in the number of cases due to the lockdown.
    • Though stringent, this was much-needed and a timely policy intervention by the government.
    • It is important, however, to appreciate the high and growing opportunity costs that are involved during a lockdown.
    • We must brace ourselves for long-term pandemic management (18 to 24 months) with significant economic impact on our lives.

    Policy interventions by government and two major concerns

    • The immediate costs of the lockdown are borne by the most economically vulnerable people in society.
    • This perhaps was the rationale behind the first round of economic policy interventions announced by the finance minister within a few days of the lockdown.
    • They targeted front-loading of cash transfers through PM-Kisan, support to construction workers, self-help groups, food distribution through the public distribution system, among others.
    • Two major concerns: Beyond welfare concerns, there are significant growth concerns that are mounting with every day of economic inactivity in the country.
    • Companies are struggling to honour payroll and maintain their workforce against cancelling orders and declining demand for their goods and services.
    • These in turn will lead to greater delays and defaults in loan repayments, thereby further weakening the fragile banking sector and struggling credit markets.

    The RBI’s intervention and increasing damage to the economy

    • The Reserve Bank of India stepped in for some timely monetary interventions.
    • However, the longstanding climate of risk aversion within the banking sector will mean that transmission of these monetary interventions is unlikely to be timely or adequate.
    • All eyes are set expectantly in one direction.
    • Historically, when economies are faced with major calamities, governments step in to stabilise the environment and boost confidence within the business community.
    • We have seen this response from all major economies disrupted by COVID-19 over the last several weeks.
    • India will not be an exception to this as the government fine-tunes its strategy to support and kickstart our immobilised economy.
    • The opportunity cost of time, however, is ballooning with each passing day.
    • Just like the spread of the virus, we are up against the full force and power of compounding.
    • Mindful policy interventions, when timed well, can cut growing losses and the misfortune of many.

    How the states are performing against Covid-19?

    • While we have succeeded in slowing the growth of the virus at the national level, the true gains and pains are at the state and local level.
    • As the data reveals, currently we have three states that have made remarkable gains and “flattened the curve” of COVID cases.
    • These are Kerala, Haryana and Tamil Nadu where recoveries are growing and active cases are rapidly declining.
    • States like Karnataka and Telangana are improving their recovery rates consistently, despite fluctuations.
    • Every state and local administration has to keep eternal vigil and double down on containment and testing.
    • They have to aggressively improve their contact tracing efforts with the help of their police who are trained in debriefing, call record mapping and have more manpower than public health departments of local administrations.

    The article contains the policy and governance aspects which are important from Mains Paper-2, and economic issues such as the size of the package and opportunity cost of time involved are important from the Mains Paper-3 perspective. Take note of these issues.

    What should be the strategy?

    • Given the scale and variation in infection control across the country, our national strategy needs to be informed and calibrated.
    • Currently, there are more than 300 districts in the country which have reported zero COVID-19 cases.
    • This can be confirmed quickly with some random testing and the lockdown can be lifted effective immediately.
    • Then there are about 225 districts which have reported less than 10 cases each.
    • With adequate ring-fencing at the level of the block where these cases are reported, these districts too can afford to lift their lockdowns.
    • There are, however, approximately 30 districts across the country which have reported large numbers of confirmed cases and are identified as “hotspots”.
    • The lockdown in these places needs to continue with some relaxations for basic trade and essential services.
    • Not surprisingly, these “hotspots” are also important economic centres of the country.
    • The capacity of the local administration to develop and enforce appropriate strategies of containment, contact tracing and testing, should determine their decisions to ring-fence and isolate blocks while allowing other parts of the district/city to resume economic activity.

    Way forward

    • Given the uncertainty of the virus, we seem prepared for large hospitalisation and care if the need arises.
    • The efforts now must be to further contain the growth of the infection.
    • Acting against the power of compounding: If the current rate persists, we will reach over lakh cases within three weeks. That is the power of compounding we are against.
    • Public health support team: Beyond knowledge sharing across states and adopting successful containment strategies from each other, there is a role for the central government in providing “NSG-like” public health support teams to states that need them.
    • Economic package: On the economy front similarly, the central government’s timely economic package should flatten the curve of exponentially rising opportunity costs across the sectors.

    Conclusion

    Given the relative scale and virulence of the COVID-19 virus in India, the odds seem stacked in favour of a calibrated opening of the economy.

     

  • [pib] Year of Awareness on Science & Health (YASH) Program

    National Council for Science & Technology Communication (NCSTC) has launched a programme on health and risk communication ‘Year of Awareness on Science & Health (YASH)’ with focus on COVID-19.

    There are various initiatives named with Hindi acronyms. YASH is newer among them. It is very unlikely to frame a prelim question on it. Still, we should know it for the sake of general awareness.

    YASH Program

    • YASH is a comprehensive and effective science and health communication effort for promoting grass-root level appreciation and response to health.
    • The current pandemic scenario has posed concerns and challenges all around, where scientific awareness and health preparedness play a significant role to help combat the situation.
    • This requires translation and usage of authentic scientific information to convey the risks involved and facilitates communities to overcome the situation.
    • The programme will encompass the development of science, health, and risk communication software, publications, audio-visual, digital platforms, folk performances, trained communicators, especially in regional languages to cater to various cross-sections of the society in the country.
    • It would help to save and shaping the lives of people at large, as well as build confidence, inculcate a scientific temper and promote health consciousness among them.

    Activities under YASH

    • The programme is aimed at minimizing risks at all levels with the help of public communication and outreach activities.
    • It would promote public understanding of common minimum science for community care and health safety measures like personal sanitation and hygiene, physical distancing, maintaining desired collective behaviour and so on.
    • It also includes information dissemination mechanisms to reduce the fear of risks and build confidence with necessary understanding for adopting sustainable healthy lifestyles and nurturing scientific culture among masses and societies.

  • Spanish Plan for Phased Easing of Lockdown

    • Spain’s Prime Minister has presented a four-phase lockdown exit strategy for the country.
    • It’s imperative for India to learn from global examples for easing lockdown without doing away with health concerns.

    With the nearing end of nationwide lockdown, various exit strategies are being discussed for a smooth restart.

    Spain’s exit strategy

    • The opening up of the lockdown will begin with phase 0 throughout Spain, except for a few islands that will already be in phase 1 by then.
    • A week later, provinces will enter phase 1, which will last for two weeks and the remaining phases will also last for two weeks each.
    • In total, the de-escalation will take at least six weeks to be complete.

    Phase 0: The preparation phase

    • De-escalations in this phase include opening up of takeaway facilities at restaurants and opening up of some other establishments such as hair salons.
    • From May 2, individuals will be able to go out for a walk or to exercise alone or with people they stay with. In this phase, professional athletes will be able to access individual training sessions.
    • Children aged 14 years or younger have been allowed to go out for walks from April 26.

    Phase 1: The initial phase

    • Begins on May 11. Small businesses will be allowed to open under strict security measures.
    • For instance, gyms can open for people who want to train individually and by appointment.
    • Further, hotels and tourist accommodations will be allowed to open, excluding the common areas and with certain restrictions in place.
    • Places of worship will also be allowed to open, limiting their capacity to one-third. Owners of terrace bars can open their establishments but with 30 per cent capacity.
    • In this phase, some degree of social contact with a limited number of people may also be allowed, subject to what the conditions are then.

    Phase 2: The intermediate phase

    • Begins on May 25.Will include the resumption of hunting and sport fishing, and the opening of cinemas and auditorium theatres at one-third of their capacity.
    • Visits to monuments and cultural facilities, such as exhibition halls and conference rooms, will resume with one-third occupancy.
    • Cultural shows will be allowed with less than 50 people in closed spaces. In the outdoors, shows and events can be held with less than 400 people provided they are seated.
    • All places of worship will have to limit their capacity to 50 per cent.

    Phase 3: The advanced phase

    • Begins on June 8 and provided the situation is under control, general mobility will be made more flexible.
    • Wearing masks will be recommended when people venture outside, especially on public transport. In commercial settings, capacities will be restricted to 50 per cent.
    • Beaches may also open in this phase. The movement of people into other provinces or islands is restricted until the de-escalation process is complete.

  • Stress test of leadership in pandemic

    The article discusses the three stages involved in successfully dealing with the pandemic. In the next part, it goes on to explain the factors that determine the success or failure of the governments. In the last week, we read about the success story of Kerala and underlying reasons. This article is also written on similar lines.

    Stages in the pandemic response

    • Disease outbreaks, even global pandemics, are scarcely new. The playbook for dealing with them, therefore, is well understood and has been honed by practices and lessons gleaned from hard-fought battles.
    • A first stage is an early clear-eyed recognition of the incoming threat, and, in the case of COVID-19 at least, requires the unpalatable decision to lock down society.
    • Ideally, this is done with full consideration of how to support the most vulnerable members of society, especially in a country such as India, where so many survive hand-to-mouth.
    • This is a phase aimed at buying time, of flattening the epidemic curve, so that public health facilities are not overwhelmed.
    • And, for using this time, paid for by collective sacrifice, to secure the personal protective equipment (PPE) and medical supplies necessary to save lives.
    • The second phase of the pandemic response is slowly to ease the burden on the economy by permitting a measured return of business activity so that livelihoods and supply chains can be restored.
    • This stage can only be safely executed if accompanied by a war-footing expansion of testing capacity so that new infections can be identified and isolated at once, allowing contact tracing to be implemented by masses trained to do this crucial and painstaking work in communities across the country.
    • The final stage, which for COVID-19 seems a lifetime away, is a mass vaccination programme and then the full rebuilding of economic and social life.
    • None of this is easy, but, like an examination in a dreaded subject, one’s only hope is early and persistent preparation and, at crunch time, remembering the lessons learned.

    The above-mentioned stages are sort of a template that seems to have gained acceptance for dealing with the pandemic. A question based on it, like “What are the various stages involved in government’s response to deal with a pandemic?”

    Following three factors make the difference between successful and failed response

    1. Leadership problems in global politics

    • The defensive finger-pointing, opportunistic politicking and xenophobic posturing are shown by some leaders amid pandemic.
    • This is not a crisis that can be tackled without robust and multidimensional international cooperation between nations.
    • We are watching in real-time the benefits of intellectual collaboration that does not stop at national borders.
    • From the epidemiologists to the medical community identifying more effective treatments, to the research scientists racing to find a vaccine, we are benefiting from collaboration.
    • But the nationalistic turn in global politics over the past two decades has reduced investment in and undermined the legitimacy of the very institutions that facilitate international partnership at the very time they are needed most.
    • Prime Minister Narendra Modi did well to convene the leaders of the South Asian Association for Regional Cooperation (SAARC) nations in mid-March to discuss the possibility of a regional response.
    • But that video-conference call also highlighted that there have been no summit-level meetings of SAARC since 2014.
    • Similarly, United States President Donald Trump demanded that the U.S. end funding of the World Health Organization (WHO).
    • This not only endangers American lives by cutting off his own administration’s access to vital international data.
    • But also directly affects India which receives significant funding and expertise from WHO with ~10% of its overall WHO financing in 2019 coming directly from the U.S.

    2. The whole-of-the-government strategy

    • Pandemic response requires a whole-of-government strategy, for which political will and legitimate leadership are vital to convene and maintain.
    • Germany and Kerala provide two powerful though different examples of this in action.
    • In Germany, in spite of a high level of federalism that gives its States (Länder) a lot of power, Chancellor Angela Merkel’s ability to mobilise the entire system has allowed Germany to emerge as a success story in Europe.
    • In Kerala, State Chief Minister Pinarayi Vijayan convened a State response team at the earliest possible moment and has provided the full weight of his office in support of a coordinated public health strategy that has been accepted by the State’s citizens who have learned to trust the government in such situations.
    • Yet these two examples stand out in part for how rare they are.
    • Consider again the cautionary tale of the U.S. where some State Governors have yet to issue stay-at-home orders.

    3. The robust public health system

    • We are seeing first hand the consequences of starving public health systems of necessary funds and resources.
    • The comparative advantage of the private sector is efficiency; the need of the hour in pandemic response is redundancy, or, more precisely, excess capacity.
    • Most hospitals do not need invasive ventilators normally, just as they do not need vast stocks of PPE and extra intensive care units beds, but these are essential goods right now as we brace ourselves for a flood of sick patients into hospitals.
    • Watching the advanced health-care system of northern Italy buckle under the unimaginable pressures to which it was exposed over the past six weeks should be a cautionary tale for all countries that thought turning health care over to private actors was responsible governance. It is not.
    • Again, consider Kerala, which has consistently ranked at the top of State rankings for health expenditures.
    • Kerala has, a well-functioning local public health system capable of implementing the test-isolate-trace protocols critical for fighting COVID-19.

    Conclusion

    With the central role of leadership and governance underlined in the successful dealing with the pandemic, leadership across the world need to come together to coordinate at all levels in dealing with the problems that are not bound by any border.

  • [pib] ‘COVID India Seva’ platform for citizen engagement on COVID-19

    The Union Ministry of Health & Family Welfare has launched the COVID India Seva platform to establish a direct channel of communication with millions of Indians amid the pandemic.

    We can take this initiative as an example while answering mains questions like – “India’s fight against Coronavirus pandemic is a public movement at large. Discuss.”

    COVID India Seva

    • This initiative is aimed at enabling transparent e-governance delivery in real-time and answering citizen queries swiftly, at scale, especially in crisis situations like the ongoing COVID-19 pandemic.
    • Through this, people can pose queries @CovidIndiaSeva and get them responded to in almost real time.
    • @CovidIndiaSeva works off a dashboard at the backend that helps process large volumes of tweets, converts them into resolvable tickets, and assigns them to the relevant authority for real-time resolution.
    • The dedicated account will be accessible to people be it local or national in their scope.
    • The Ministry will respond to broader queries and public health information. This does not require the public to share personal contact details or health record details.

  • A virus, social democracy, and dividends for Kerala

    This article is an analysis of Kerala’s success in dealing with the Covid-19. Factors that emerge are-strong emphasis on the social democracy, the participation of civil society and strong social compact between the government and citizenry. We have also covered the same subject in a previous article but focus there was more on the administrative level.

    Kerala’s success story

    • Kerala was the first State with a recorded case of coronavirus and once led the country in active cases.
    • It now ranks 10th of all States and the total number of active cases (in a State that has done the most aggressive testing in India) has been declining for over a week and is now below the number of recovered cases.
    • Given Kerala’s population density, deep connections to the global economy and the high international mobility of its citizens, it was primed to be a hotspot.
    • Yet not only has the State flattened the curve but it also rolled out a comprehensive ₹20,000 crore economic package before the Centre even declared the lockdown.

    Why does Kerala stand out in India and internationally?

    • Kerala’s much-heralded success in social development has invited endless theories of its cultural, historical or geographical exceptionalism.
    • But taming a pandemic and rapidly building out a massive and tailored safety net is fundamentally about the relation of the state to its citizens.
    • From its first Assembly election in 1957, through alternating coalitions of Communist and Congress-led governments, iterated cycles of social mobilisation and state responses have forged what is in effect a robust social democracy.
    • The current crisis underscores the comparative advantages of social democracy.

    Kerala’s success is built on social democracy in the state. Following are the factors that constitute the social democracy in the state which is helping it fight against the Covid-19 pandemic with considerable success. These factors are also important from the Mains point of view if the question is framed on Kerala’s success story.

    How social democracy is practised in Kerala?

    • Social democracies are built on an encompassing social pact with a political commitment to providing basic welfare and broad-based opportunity to all citizens.
    • In Kerala, the social pact itself emerged from recurrent episodes of popular mobilisation.
    • Popular mobilisations include the temple entry movement of the 1930s to the most recent various gender and environmental movements.
    • These movements nurtured a strong sense of social citizenship.
    • These movements also drove reforms that have incrementally strengthened the legal and institutional capacity for public action.
    • Second, the emphasis on rights-based welfare has been driven by and in turn has reinforced a vibrant, organised civil society.
    • This civil society demands continuous accountability from front-line state actors.
    • Third, this constant demand-side pressure of a highly mobilised civil society and a competitive party system has pressured all governments in Kerala.
    • The pressure made governments to deliver public services and to constantly expand the social safety net, in particular a public health system that is the best in India.
    • Fourth, that pressure has also fuelled Kerala’s push over the last two decades to empower local government.
    • Nowhere in India are local governments as resourced and as capable as in Kerala.
    • Finally, all of this ties into the greatest asset of any deep democracy, that is the generalised trust that comes from a State that has a wide and deep institutional surface area.
    • That on balance treats people not as subjects or clients, but as rights-bearing citizens.

    How the built-in social democracy is helping in dealing with the pandemic?

    • A government’s capacity to respond to a cascading crisis such as the COVID-19 pandemic relies on a very fragile chain of –(1)mobilising financial and societal resources, (2)getting state actors to fulfil directives, (3)coordinating across multiple authorities and jurisdictions and maybe, most importantly, (4)getting citizens to comply.
    • First, an effective response begins with programmatic decision-making.
    • From the moment of the first reported case in Kerala, Chief Minister convened a State response team that coordinated 18 different functional teams.
    • The CM held daily press conferences and communicated constantly with the public.
    • Kerala’s social compact demanded no less.
    • Second, the government was able to leverage a broad and dense health-care system.
    • The health-care system, despite the recent growth of private health services, has maintained a robust public presence.
    • Kerala’s public health-care workers are also of course highly unionised and organised, and from the outset the government lay emphasis on protecting the health of first responders.
    • Third, the government activated an already highly mobilised civil society.
    • As the cases multiplied, the government called on two lakh volunteers to go door to door, identifying those at risk and those in need.
    • A State embedded in civil society — the women’s empowerment Kudumbasree movement being a case in point.
    • Kudumbasree movement was in a good position to co-produce effective interventions, from organising contact tracing to delivering three lakh meals a day through Kudumbasree community kitchens.
    • Fourth, you can get the politics right and you can have a great public health-care system, but its effectiveness in a crisis like this will only be as good as the infamous last kilometre.
    • And this is where two decades of empowering local governments have clearly paid off.

    Conclusion

    At a time when India is dealing with this unprecedented crisis, it is important to be reminded that Kerala has managed the crisis with the most resolve, the most compassion and the best results of any large State in India. And that it has done so precisely by building on legacies of egalitarianism, social rights and public trust. Other states and the Central government must learn from Kerala’s experience.

  • What nation can learn from Kerala in the fight against Covid-19?

    With figures emerging of Kerala’s success in dealing with the Covid-19, the rest of the nation has lessons to learn from it. This article describes the approach adopted by Kerala, and how various factors like robust health infrastructure, past experience etc. are helping it.

    Kerala stands out in India: some figures and facts

    • The COVID curve in Kerala is flattening.
    • Every day, for a week now, the number of recoveries has exceeded the number of new infections.
    • The recovery rate in Kerala is nearly 50 per cent while the all-India average is around 11.
    • While the mortality rate among the infected is 5 per cent in Kerala, the all-India average is 3.4 per cent.
    • The transmission rate of a primary carrier is 6 while in Kerala it is only 0.4.

    With Covid-19, we are in unknown territory in many ways. If Kerala emerges as the success model, the question can be framed from that perspective. So, note down the factors described below that are helping the state in tackling Covid-19 successfully.

    Preparing for the next challenge

    • Kerala is preparing for the next challenge, the outcome of which will determine the result of the war against COVID.
    • Lifting of the lockdown is going to result in an influx of returning migrants from foreign countries and other states.
    • Hundreds of thousands would have to be quarantined, tested and, if positive, treated, ensuring there is no secondary spread.
    • State authorities have already identified accommodation and other facilities for more than two lakh persons.
    • Use of big data analytics: The state is also exploring the possibility of big data analytics to plan a strategy and, if necessary, for reverse quarantining.
    • Authorities have access to WHO data covering nearly two-thirds of the state`s population.
    • Integrating this data with the information currently being generated, we will be able to map vulnerable sections of the population, simulate scenarios and plan ahead.
    • Exit strategy: An exit strategy from the lockdown is being prepared to protect livelihoods and stimulate the economy.

    Strength of the public health system of Kerala

    • The single most important factor that enabled Kerala to be prepared for the COVID is the strength of the public health system.
    • Kerala’s health system is a proud legacy of our past.
    • It has had a big push in infrastructure and equipment investment of around Rs 4,000 crore from the Kerala Infrastructure Investment Fund Board.
    • Five thousand seven hundred and seventy-five new posts have also been created.
    • The Aardram Health Mission was launched with a focus to transform the PHCs into family health centres.
    • Distinctive feature: There is also the distinctive flavour of Kerala — mass participation in preventive and palliative healthcare.
    • Training to health workers: The morale of health personnel has been exceptionally high.
    • Special training, protective gear, scientific duty rotation and, most importantly, societal empathy and solidarity, have all contributed.

    Learning from the past experience

    • Nipah outbreak experience: The recent experiences of successful containment of the Nipah outbreak and management of the two post-flood health situations have provided a kind of herd immunity to the health workers to crisis situations.
    • Covid-19 preparedness: Once news of the Wuhan pandemic came, the Kerala health system scrambled to readiness — the control room was set up, mock drills were organised and the first influx was contained.
    • Once migrants from the Gulf and Europe began to return, things began to get out of hand.
    • But now this battle has been successfully concluded.

    Testing and tracing in Kerala

    • A route map of each COVID positive case is prepared and given publicity, alerting everybody who might have been in contact.
    • The protocol of cycles of intense test, trace, isolate and treatment has been the norm.
    • Kerala has the highest test rate in the country.
    • Break the Chain Campaign to promote social distancing has been successful.
    • Lockdown by itself is not going to contain the COVID spread. It would continue to multiply within households and dormitories.
    • Testing has been woefully insufficient in the national response so far.

    Welfare payment in Kerala more than the rest of the country

    • In Kerala, 55 lakh elderly and disadvantaged have received Rs 8,500 as welfare payments.
    • An equal number of workers have been paid Rs 1,000-3,000 each from the welfare funds.
    • Every family has been provided with a food kit.
    • Interest-free consumption loan of Rs 2,000 crore has been distributed.
    • Besides, nearly 4 lakh meals are distributed every day to the needy from community kitchens set up by local governments.
    • Local governments are also duty-bound to monitor the camps of migrant workers, set up new ones and ensure medicine and food to them.

    Decentralisation paying off in Kerala

    • All the above was not made possible by the state government alone.
    • It is the synergy generated by integrating state government plans and programmes with the local governments, the co-operatives, women neighbourhood groups (Kudumbashree) and civil society organisations that make Kerala distinct.
    • The floods and the pandemic have given testimony for the potential of democratic decentralisation.
    • It is a case of multi-level planning with technical committees and groups working at the state level coordinated by the chief minister.

    Conclusion

    Though it is too early to declare Kerala as a success story, still there are many lessons to be learned by the rest of the country in its fight against Covid-19.

  • What is Post-intensive Care Syndrome (PICS)?

    • Various news reports in recent weeks have pointed out that for some COVID-19 patients who needed intensive care, the journey to recovery is a long one.
    • After leaving the ICU, they may suffer from what is known as post-intensive care syndrome (PICS), which can happen to any person who has been in the ICU.

    Infectious disease outbreaks, like the current Coronavirus (COVID-19), can be scary and can affect our mental health. This pandemic is going to leave a bigger trauma for those who had lost their dear ones as well those who recovered.

    What is PICS?

    • PICS comprise impairment in cognition, psychological health and physical function of a person who has been in the ICU.
    • Further, such patients may experience neuromuscular weakness, which can manifest itself in the form of poor mobility and recurrent falls.
    • The psychological disability may arise in a person in the form of depression, anxiety and post-traumatic stress disorder (PTSD).

    Its symptoms

    • The most common PICS symptoms are generalized weakness, fatigue, decreased mobility, anxious or depressed mood, sexual dysfunction, sleep disturbances and cognitive issues.
    • These symptoms may last for a few months or many years after recovery, the authors of the aforementioned article note.
    • Patients who develop this may take at least a year to fully recover, until which time they may have difficulty in carrying out everyday tasks such as grooming, dressing, feeding, bathing and walking.

    What causes PICS?

    • A combination of factors can affect aspects of an ICU survivor’s life.
    • PICS may be induced if a person was on prolonged mechanical ventilation, experienced sepsis, multiple organ failure and a prolonged duration of “bed-restore deep sedation”.

    Treatment

    • It is recommended that to avoid PICS, patients’ use of deep sedation is limited and early mobility is encouraged, along with giving them “aggressive” physical and occupational therapy.
    • Further, patients should be given the lowest dose of pain medications when possible and should be put on lung or cardiovascular rehabilitation treatments along with treatments for depression, anxiety and PTSD.