Kerala's way of running the state has neither been overtly business-friendly nor conducive to short-term economic growth. But over decades, the state has spotlighted public health and social systems, involving the participation of local civic organisations. And once again these investments are paying off as India struggles with a devastating second Covid-19 wave. What stands out from Kerala's approach to healthcare and welfare is the vital resilience it offers in confronting the mounting health and climate dangers.
Despite high levels of recorded infection rates and spikes from periodic mismanagement, Kerala's Covid-19 record remains a favourable outlier. The state has a 0.3% death rate from Covid infections; this is the same as Singapore's, which has the world's lowest death rate from the virus. Kerala showed similarly strong resistance during 2018's Nipah virus outbreak, and the massive floods of 2018 and 2019.
The common denominators are the commitment of the leadership to crisis preparedness, high investments in health and education, and community participation in state policies. A vibrant media, even as it may slow actions, contributes to the effectiveness of the spending.
In the battle against Covid, early detection, swift isolation and speedy contact-tracing have helped keep death rates low. The use of frugal methods as platforms for decision-making has been effective, as has been Kerala's oxygen management partnering the state government and business, the direct procurement of vaccines, and a policy of zero vaccine wastage.
During the Nipah outbreak, Kerala's Break the Chain public awareness campaign promoted hand hygiene, physical distancing and cough etiquette. Less than a year after the outbreak, the Institute of Advanced Virology was set up in Thiruvananthapuram, the first in India linked with the Global Virus Network coalition. During the pandemic, health officials have launched a state-wide telemedicine portal, offering psycho-social support for the sick and vulnerable. The government has met the needs of frontline workers, the elderly living alone and migrant labourers – challenges in other states too.
These actions seem rooted in the mindset generated by the state's investments and outcomes in health and education. Because of Kerala's decentralised public health system, each level of administration has a primary health centre and at least one hospital. In 1996, People’s Campaign for Decentralised Planning devolved authority and resources to panchayats, mandating the direct involvement of citizens in state finances. Local actors, such as women's self-help group Kudumbashree, not only get heard but also influence decisions.
Despite the delays and frustrations involved, local empowerment has encouraged citizens' initiatives during the pandemic. Grassroots efforts have played a critical role in Delhi, Guwahati and Jaipur as well as gram panchayats. In Kerala, if one person tests positive, designated health workers call the patient regularly with guidance till cure. Because of the work of health workers, like those belonging to Asha, a trained community of female workers, Kerala has seen timely hospital admissions while remote areas have received attention.
So, has Kerala got a winning formula? It should be noted that missed opportunities and setbacks abound in Kerala's development path. An illustration of what could have been comes from a comparison with some of the Southeast nations like Malaysia and Thailand. Starting from comparable per capita incomes half-a-century ago, their average incomes have risen to a multiple of Kerala's today. Other states, including Gujarat and UP, are ranked higher than Kerala on certain measures of doing business.
But on matters of resilience and people's wellbeing in a crisis, as reflected by the state's low Covid mortality rate, Kerala has lessons for its own improvement and for others to note. The Public Affairs Index 2020 ranked Kerala as the best-governed large state in 2019 on the basis of 50 indicators reflecting equity, growth and sustainability. In health, Kerala's infant mortality is one-third of Gujarat's, and life expectancy 10 years longer than UP's.
Economic growth, still the biggest motivator of India's investments, is but a partial proxy for resilience to crisis situations. Kerala's lesson is that investments in health and education that bolster human capabilities, on the one side, and decentralised decision-making that empower those very capacities, on the other, make a decisive difference to resilience during catastrophes.
This article was first published in The Times of India on 18 May 2021.
(Photo credit: Trinity Care Foundation)