<p>After receiving applause for its handling of the pandemic crisis in the initial phase, Karnataka has slipped badly. The state is now India’s fourth most-affected in terms of Covid-19 cases. Bengaluru, in particular, has witnessed a surge in the number of cases and deaths. Why have things come to such a pass?</p>.<p>The explanations given for the deteriorating situation are: Lack of adequate health infrastructure such as beds in hospitals, testing equipment, masks, personal protective gear, etc; lack of adequate manpower -- doctors and other health workers; inflow of people from highly infected states and abroad after the first lockdown was lifted and restrictions relaxed; non-observance by many people of government guidelines on wearing masks, maintaining social distance and washing hands frequently; and, deficiencies in the three Ts -- tracing, testing and treatment.</p>.<p>While all these may be correct, the question is whether the government could have dealt with the situation more effectively. In other words, has there been a governance failure? In a crisis situation, governance essentially involves organising the resources required to implement a set of measures aimed at providing relief to the people and minimising risk. This is not as easy as it sounds when confronted with a pandemic that has affected the whole world and for which there are no clear solutions. All countries in the world are tackling the problem in their own ways, as are the states in India. Let us see how the situation developed in Karnataka.</p>.<p>In Bengaluru, a ‘war room’ was set up at BBMP, and in the districts, Deputy Commissioners were made responsible. Each district was assigned to a minister for the purpose of monitoring. At the state level, the responsibility was shared between the Minister for Health and the Minister for Medical Education, with the chief minister providing overall leadership. The cabinet was reviewing the position periodically. This arrangement seemed to work well in the initial stages when the number of cases were low and we were patting ourselves on the back and wondering why states like Maharashtra and Delhi were faring so badly.</p>.<p>As the number of cases started mounting, problems multiplied. We discovered that the number of beds in government hospitals was insufficient and then decided to approach private hospitals. It took some time to persuade them to earmark 50% of their beds for Covid-19 patients. Thereafter, the rates had to be negotiated. Some patients, refused admission in one place after another, were running from pillar to post and in the process, some lost their lives. Making arrangements for quarantining, especially for those coming from abroad added to the woes. While those who could afford were lodged in hotels, others were accommodated in places with poor facilities, causing much dissatisfaction. Dealing with migrant workers who lost their jobs posed another kind of problem. First, they were encouraged to go back to their hometowns and villages; a few days later, they were asked to stay back; and some days later, they were again allowed to go.</p>.<p>In the midst of all this, health workers decided to go on strike. Doctors serving on temporary basis demanded regularisation, ASHA workers wanted a raise in their wages, and the medical community as a whole was unhappy being denied personal protective equipment (PPEs). When BBMP wanted to recruit new doctors, only 11 turned up for the walk-in interview, reflecting either their disinterest to serve during the prevalence of Covid-19 or their reluctance to serve in the municipal organisation.</p>.<p>While appreciating the complex problems to be tackled, it is necessary to take note of the failures. First, the lack of clarity in defining the roles and responsibilities of functionaries at different levels. What exactly is the role of the BBMP ‘war room’? A perusal of the related website reveals only the newsletter showing the data pertaining to the number of cases, with details like positive cases, recovered, deaths and some comparative figures with other states. Is BBMP responsible for all matters relating to Covid-19 in the city? Are there any other agencies generating data? Some experts have questioned the accuracy of government data. For instance, a patient reported dead was listed as having been discharged 11 days later. Hearing a batch of writ petitions, the High Court observed that BBMP had failed to answer vital questions pertaining to real-time online data on availability of beds, ventilators and the timeline fixed for getting test reports from laboratories; further, it had failed to implement the standard operating procedures (SOP) in containment zones. </p>.<p>Secondly, lack of proper communication leads to confusion in the minds of people. Ministers speak in different voices and official spokespersons keep changing. Too many ministers representing Bengaluru may be adding to the problems of the chief minister. During a crisis, what is required is decisiveness, quick implementation and clear channels of communication.</p>.<p>Third, we possibly missed the opportunity during the earlier longer lockdowns to prepare ourselves in terms of procurement of materials and mobilising additional manpower. Perhaps, it was presumed that we would not have to sail in boats similar to Delhi and Maharashtra at a later date. Call it complacency or naivete, we are paying the price today.</p>.<p>Finally, government could have benefited from adopting a decentralised approach in dealing with problems at the ground level. The ward committees could have been involved in executing the containment policies, and resident welfare associations used to provide information about the compliance with government guidelines and to educate people at the grassroots.</p>.<p>While waging a war, nothing can be taken for granted. Indeed, we must be prepared for the worst. We set up the first ‘war room’ in the country to fight a mighty but unseen enemy, but we failed to foresee the coming dangers and perhaps declared victory too soon. Nevertheless, the government has shown seriousness by declaring another lockdown, which though brief, provided the time to redesign strategies and act with renewed vigour. Let us not forget that in this war, we the people, are also soldiers and must follow the rules of the game in our own interest and in the interest of society.</p>.<p><span class="italic"><em>(The writer is a former Chief Secretary, Government of Karnataka)</em></span></p>
<p>After receiving applause for its handling of the pandemic crisis in the initial phase, Karnataka has slipped badly. The state is now India’s fourth most-affected in terms of Covid-19 cases. Bengaluru, in particular, has witnessed a surge in the number of cases and deaths. Why have things come to such a pass?</p>.<p>The explanations given for the deteriorating situation are: Lack of adequate health infrastructure such as beds in hospitals, testing equipment, masks, personal protective gear, etc; lack of adequate manpower -- doctors and other health workers; inflow of people from highly infected states and abroad after the first lockdown was lifted and restrictions relaxed; non-observance by many people of government guidelines on wearing masks, maintaining social distance and washing hands frequently; and, deficiencies in the three Ts -- tracing, testing and treatment.</p>.<p>While all these may be correct, the question is whether the government could have dealt with the situation more effectively. In other words, has there been a governance failure? In a crisis situation, governance essentially involves organising the resources required to implement a set of measures aimed at providing relief to the people and minimising risk. This is not as easy as it sounds when confronted with a pandemic that has affected the whole world and for which there are no clear solutions. All countries in the world are tackling the problem in their own ways, as are the states in India. Let us see how the situation developed in Karnataka.</p>.<p>In Bengaluru, a ‘war room’ was set up at BBMP, and in the districts, Deputy Commissioners were made responsible. Each district was assigned to a minister for the purpose of monitoring. At the state level, the responsibility was shared between the Minister for Health and the Minister for Medical Education, with the chief minister providing overall leadership. The cabinet was reviewing the position periodically. This arrangement seemed to work well in the initial stages when the number of cases were low and we were patting ourselves on the back and wondering why states like Maharashtra and Delhi were faring so badly.</p>.<p>As the number of cases started mounting, problems multiplied. We discovered that the number of beds in government hospitals was insufficient and then decided to approach private hospitals. It took some time to persuade them to earmark 50% of their beds for Covid-19 patients. Thereafter, the rates had to be negotiated. Some patients, refused admission in one place after another, were running from pillar to post and in the process, some lost their lives. Making arrangements for quarantining, especially for those coming from abroad added to the woes. While those who could afford were lodged in hotels, others were accommodated in places with poor facilities, causing much dissatisfaction. Dealing with migrant workers who lost their jobs posed another kind of problem. First, they were encouraged to go back to their hometowns and villages; a few days later, they were asked to stay back; and some days later, they were again allowed to go.</p>.<p>In the midst of all this, health workers decided to go on strike. Doctors serving on temporary basis demanded regularisation, ASHA workers wanted a raise in their wages, and the medical community as a whole was unhappy being denied personal protective equipment (PPEs). When BBMP wanted to recruit new doctors, only 11 turned up for the walk-in interview, reflecting either their disinterest to serve during the prevalence of Covid-19 or their reluctance to serve in the municipal organisation.</p>.<p>While appreciating the complex problems to be tackled, it is necessary to take note of the failures. First, the lack of clarity in defining the roles and responsibilities of functionaries at different levels. What exactly is the role of the BBMP ‘war room’? A perusal of the related website reveals only the newsletter showing the data pertaining to the number of cases, with details like positive cases, recovered, deaths and some comparative figures with other states. Is BBMP responsible for all matters relating to Covid-19 in the city? Are there any other agencies generating data? Some experts have questioned the accuracy of government data. For instance, a patient reported dead was listed as having been discharged 11 days later. Hearing a batch of writ petitions, the High Court observed that BBMP had failed to answer vital questions pertaining to real-time online data on availability of beds, ventilators and the timeline fixed for getting test reports from laboratories; further, it had failed to implement the standard operating procedures (SOP) in containment zones. </p>.<p>Secondly, lack of proper communication leads to confusion in the minds of people. Ministers speak in different voices and official spokespersons keep changing. Too many ministers representing Bengaluru may be adding to the problems of the chief minister. During a crisis, what is required is decisiveness, quick implementation and clear channels of communication.</p>.<p>Third, we possibly missed the opportunity during the earlier longer lockdowns to prepare ourselves in terms of procurement of materials and mobilising additional manpower. Perhaps, it was presumed that we would not have to sail in boats similar to Delhi and Maharashtra at a later date. Call it complacency or naivete, we are paying the price today.</p>.<p>Finally, government could have benefited from adopting a decentralised approach in dealing with problems at the ground level. The ward committees could have been involved in executing the containment policies, and resident welfare associations used to provide information about the compliance with government guidelines and to educate people at the grassroots.</p>.<p>While waging a war, nothing can be taken for granted. Indeed, we must be prepared for the worst. We set up the first ‘war room’ in the country to fight a mighty but unseen enemy, but we failed to foresee the coming dangers and perhaps declared victory too soon. Nevertheless, the government has shown seriousness by declaring another lockdown, which though brief, provided the time to redesign strategies and act with renewed vigour. Let us not forget that in this war, we the people, are also soldiers and must follow the rules of the game in our own interest and in the interest of society.</p>.<p><span class="italic"><em>(The writer is a former Chief Secretary, Government of Karnataka)</em></span></p>