Decentralise, localise Covid-19 battle in Bengaluru

“Health administration and Covid management have to be quickly decentralised,” wrote former Prime Minister H D Deve Gowda to Prime Minister Narendra Modi. Why would a former Prime Minister with more than 50 years of experience in governance as MLA, MP, Minister, Chief Minister and PM, choose to make that the first of 16 points in a four-page letter?

Because decentralisation can save lives. But how?

Here’s the current scenario in Bengaluru. When a person gets tested for Covid-19, the samples (swabs) are collected at the local Primary Health Centre (PHC) and then sent to a laboratory. The lab performs the test and uploads the results to a national portal maintained by the Indian Council for Medical Research (ICMR).

The results then travel back to Bengaluru, and those who are determined to be positive will receive a special number called BU (Bengaluru Urban) number, which is required for any hospital admission. At this moment, this takes 48-96 hours.

But these are precious hours that could make a huge difference. In most cases, the test itself is done after experiencing symptoms or coming in contact with an infected person. A few more days of waiting for the test result means more time given to the dreaded virus.

Localised approach

Now consider this approach: the test is being performed locally at a laboratory. The result can be delivered locally too. If the lab informs the local health workers as soon as they see a positive case, even while they follow the process to upload results in the portal, the health worker now has an opportunity to reach out to the patient within a short time and do the necessary triage.

Triage will help determine if the patient needs to be hospitalised or isolated. If isolation is the course of action, would it be home isolation or at a Covid care centre? Triage can help educate the patient about prone positions if oxygen levels are dropping while waiting for an ambulance. Triage can also help determine if the person needs a bed with oxygen or ICU bed. The health worker can also ensure all the primary contacts get tested immediately.

Besides increasing the chances of survival, this approach also gives reassurance to the patient and ensures others get tested sooner than later. Early triage also helps us better utilise our extremely scarce resources and helps us streamline the requests for beds, ICUs, oxygen at home, medicine etc.

Making this happen

It is abundantly clear that we need a hyper local approach. Ward Committees are units of governance at hyper-local level of administration. Every ward has a PHC, Health Inspector, Ambulances, several General Practitioners and most importantly, selfless citizens that contribute time and energy in times of crises.

The ward committee offers an institutionalised mechanism to bring all these resources together, and execute a hyper-local action plan to fight this deadly virus. We need to make ward committees functional urgently and empower them to act as ward disaster management cells.

As of April 29, 2021, the Government of Karnataka has appointed a nodal officer and a committee to focus on decentralised Covid response at the constituency and ward levels. This is a recognition of the urgent need for hyper local response to beat this second wave.

We are trying to stop the wave with one big net, but what we need is 198 smaller nets. Since the geographic area is limited, they have a much better chance of containing the spread, identifying critical cases earlier and even ensuring vaccination reaches everyone, even those without access.

There are already many individuals working on relief activities. The ward committees will attract all those working in the field and help consolidate their efforts, recruit more local volunteers and build a strong local network.

Power of the panels

If you are not convinced about the power of ward committees in managing this crisis, imagine a slum in a city. Imagine a Covid review meeting being chaired by the PM or CM or the city Mayor with officials. Will they ever be able to inquire about that slum and take any actions?

It is obvious that they simply cannot, even with the best of intentions, because they are too far away from that slum. Literally and figuratively. Now imagine the ward committee meeting of the ward where this slum exists. They can actually review the situation in each of the slums in the ward and take appropriate action. That is the power of the ward committee.

(Srinivas Alavilli is Head, Civic Participation, Janaagraha)