COVID-19 Pandemic: Maharashtra – Civil Society Response and Challenges Ahead

By Sanchita Das and Peehu Pardeshi

For the state of Maharashtra, the year 2019 ended with political upheaval, unexpected political alliance and infighting. In due course, this was followed by the announcements to form a coalition government of three parties (Shiv Sena, National Congress Party and Congress). Despite their differences, they formulated terms of power-sharing and functioning to work cohesively.

Maharashtra, especially Mumbai and its suburbs have been the worst-hit areas of the country. In these challenging times, Deputy Chief Minister and Home Minister have favoured and supported decisions taken by Chief Minister of the state, even though each one of them belongs to a different political party. The Congress and National Congress party ministers have not tried to overshadow the role of Uddhav Thackery as the Chief Minister. This is a remarkable aspect of state governance in Indian history that the political parties in the coalition have not tried to surpass each other.

In this political setting, it is important to also shed some light on the state’s burgeoning economy. The state has the highest-ranking per capita income in India (Kamdar 2005:28). Meanwhile, although the state’s economy grew at a faster rate the proportion of poor has continued to be the same as the country’s average (Mishra and Panda 2005). The manufacturing industries moved towards being more capital-intensive and communication, transport and public administration accounted for a large part of service growth. However, there is looming inequity in the distribution of its benefits, which partly explains the prevalence of poverty compared to states with equivalent mean income (ibid).

Even though the poor might not benefit proportionately from the growth process, this economic and industrial powerhouse of the country is leading in urbanization. In 2011, more than 40 percent of the state’s urban population was in Mumbai and its surrounding areas, including Thane, Nasik and Nagpur (Khadke et al. 2017). Urbanization in Mumbai is characterized by the growth of informal settlements. The city with a population of 12.44 million and almost 5.2 million live in urban informal settlements (Kshetrimayum 2020: 5). Despite the city’s impressive economic statistics, a report argues that Mumbai is in ‘reverse gear’ in terms of economic growth and quality of life, noting a drop of 7 percent to 2.4 percent in the city’s GDP per annum between 1994 and 2002. Further, it also highlighted the increasing population in informal settlements alongside growing anxieties over congestion (McFarlane 2008: 6).

It is in this backdrop of political and economic advances and based on our experience of outreach through various relief activities in Mumbai and its suburbs that we would discuss the state’s preparedness and response to COVID-19 outlined below.

State’s response to Covid-19: A timeline

The first confirmed case of Covid-19 was reported in Pune on March 9, where a couple returning from Dubai tested positive. This was followed by cases in Nagpur, Mumbai, Ahmednagar, Yavatmal, Pimpri-Chinchwad and Aurangabad. By March 12, the state has registered 11 cases of Covid-19. Subsequently, several health measures, mobility restrictions, administrative services and food distribution measures were adopted before the declaration of lockdown. Below is the list of all measures adopted by the Maharashtra State to tackle COVID-19 from mid-March to early May.

• On March 13, Maharashtra government constituted a committee of ministers and secretaries under the chairmanship of the Chief Secretary to evaluate the humanitarian crisis and formulate a plan of action to prevent, contain and mitigate the spread of Covid-19. The responsibilities of the committee included implementing guidelines issued by the WHO and the Ministry of Health.
• In exercise of the powers conferred by invoking provisions under the Epidemic Diseases Act, 1897 on March 13, the government notified of COVID-19 Maharashtra Regulations 2020 to prevent and contain the spread. Key features of the regulations include:
  • Home quarantine for people with travel history from the affected areas.
  • Preparing hospitals (both government and private) for screening suspects and testing.
  • Imposing restrictions by authorized officers on mass gathering and isolating and/or admitting people with symptoms.
  • Concerned District/Municipal Commissioner to be competent for implementing containment measures on sealing borders, initiating surveillance, restricting the movement of vehicles and banning mass congregations. The government taking full responsibility of having given permission initially to a religious gathering retracted and denied it later. Subsequently, it was also careful to ensure that there was no communalising the pandemic and no spread of messages with intent to malign.
• On March 15 and 16, the state-wide total rose to 38. The state further ordered the closure of theatre, gyms, museums, cinema halls and schools in rural areas until March 31. Followed by the closure of educational institutes and deferment of examinations.
• On March 16, the state allocated ₹ 45 crores to the districts with confirmed cases.
• As the number of cases began rising, Mumbai had to arrange for the arrival of a few thousand Indians from the Gulf nations between March 15 and March 31. The state also directed officials at hospitals and airports to stamp people with details of their quarantine period in order to home quarantine them. This was a measure taken soon after many people suspected of being infected fled from the isolation wards of hospitals. The measures that followed subsequently were imposing an indefinite curfew, and closing state and district borders.
• On March 17, Section 144 was imposed in Nagpur and Nashik. Later that day, the first casualty was reported in the state. The state government approved the circulation of an awareness campaign on social media to adopt hygiene practices and to remain fearless. The state also cautioned against the circulation of inappropriate messages or distorted information and non-compliance was made a punishable offence.
• On March 19, the government issued restrictions and safety guidelines to be followed in government offices for holding meetings. Deferment of elections of cooperative societies for six months was declared.
• On March 20, the state also ordered for the closure of all official establishments, excluding essential services and public transport in Mumbai, Mumbai Metropolitan Region, Pune, Pimpri-Chinchwad and Nagpur until March 31. Though there was resistance from the cabinet ministers but the state CM was keen on undisturbed social life, with busses and sub-urban trains running minimally. Keeping in mind the significance of the commuter’s need to report for work, especially the frontline workers, like health staff, medical practitioners and police officials.
• On March 20, considering the unmitigated spread of COVID-19, the state ordered limitations on operations and attendance in government offices to 25 percent, which was subsequently reduced to 5 percent on March 23, across the state for both private and public offices.
• March 22, the CM declared the enforcement of Section 144 across the state with effect from March 23 and further locking down the entire state until March 31.
• The rise in the number of confirmed cases in the state called for sealing buildings and clusters into containment zones to avoid community spread. These areas included Islampur in Sangli (March 28); Worli Kolivada in Mumbai (March 30), Peth area and parts of Kondhwa in Pune (April 6) and almost 381 areas were sealed within the city (April 9). Until this point, there were no major restrictions on the movement of people.
• In line with the zoning of districts based on the extent of the spread, 14 districts in Maharashtra were identified as Red Zones implying Covid-19 hotspots. Henceforth, lockdown relaxation was only applicable in districts with less than 15 confirmed cases.
• On March 29, the Maharashtra government released the standard operating procedures to be followed by all healthcare facilities in the face of COVID-19 pandemic. All healthcare facilities were directed to remain operational and all healthcare professionals were required to carry out their respective duties. An SOP for reallocation of medical residents, PG students and nursing students for hospital management of COVID-19 was also released.
• On April 8, Municipal Corporation of Greater Mumbai (MCGM) released a regulation under the Epidemic Diseases Act 1897, necessitating all persons in the city of Mumbai to wear face masks in all public places and offices.
• On April 10, the Commissioner of Police of Greater Mumbai issued prohibitory orders against the dissemination of any incorrect, derogatory or discriminatory messages through text messages or social media platforms.
• On April 13, the Government of Maharashtra extended the lockdown to April 30 to contain the spread of COVID-19. The Public Health Department also released an order to constitute a task force of specialist doctors to minimise death rate and suggest measures for clinical management of COVID-19 patients in specialized hospitals in Mumbai.
• On April 17, the government of Maharashtra extended the lockdown till May 3 in line with the directive issued by the Central Government. Along with that, it issued guidelines for measures to be taken in containment zones and hotspots as well as a list of activities to be permitted to operate from April 20 onwards. Certain industrial operations fell within the ambit of lockdown relaxation including agriculture, construction and manufacturing activities with certain clauses for operation.
• On April 21, all the relaxations applied on April 17 were cancelled for the Mumbai and Pune metropolitan regions and all rules before the April 17 notice were reinstated in the backdrop of increasing Covid-19 positive cases.
• On April 23, the Public Health Department of the Government of Maharashtra encouraged all the District Collectors to seek the help of WHO-National Public Health Surveillance Project for capacity-building, containment activity, as well as other micro-planning for COVID19 response and coordination. The department also issues a revised case investigation form to enable the availability of correct data on several COVID-19 cases for analysis and decision-making.
• On April 24, the Public Health Department of the Government of Maharashtra communicated to all the District Collectors to supervise the surveillance and other allied activities based on the SOPs and protocols for identification of cases with severe acute respiratory illness.
• On April 30, the Government of Maharashtra issued guidelines and SOPs for movement of stranded persons including migrant workers, pilgrims, tourists and students within and outside of the state. On May 1, the government issued revised guidelines for better implementation of intrastate movement of persons, prohibiting any movement into and out of containment zones.
• On May 2, the state government extended the lockdown until May 17, 2020 along with detailed guidelines on the allowed activities in each of red, orange and green zones.
• On May 3, the Government of Maharashtra issued an order stating that all the malls and markets in the urban areas will remain closed, except shops selling essential goods. Up to 5 single shops were allowed to be open in urban areas except those in containment zones, irrespective of essential or non-essential goods being sold by them. All shops in rural areas were allowed to be open, except those in malls.
• On May 4, the Government of Maharashtra, in line with the government of India, issued orders allowing free movement of Kharif season agriculture produce and other related activities.
• On May 5, MCGM issued an order prohibiting all non-essential shops including liquor shops to remain closed in Mumbai city.
• On May 7, migrants stranded in the state were allowed to travel to their respective states of domicile after thorough thermal screening and symptomatic examination before commencing the journey.

The Covid-19 pandemic has had an unprecedented impact on society. The state has been careful to modify or rescind orders and permission from time to time depending on the ground realities. The pandemic has posed unique challenges to urban local governance. An empowered local administration is a key to reducing the negative impact of the pandemic as examples of collaborative governance pours in from Kerala. An empowered local administrator is entrusted with relevant powers to be able to better address the challenges.

A few decentralised initiatives in Maharashtra include the closure of marketplaces and shops (during operating hours) and coloured pass system for regulating social distancing protocols. While the state of Kerala has shown that a decentralized model is effective to solve local challenges, in Maharashtra these powers have been given to the ward commissioners. Meanwhile, we foresee few challenges in the state’s crisis management responses at the ground level, especially addressing the needs of dense urban settlements at the ward and neighbourhood levels, care workers and the lakhs of inter and intra-state migrants stranded in the city.

The state government’s plans did not take cognisance of the realities of the frontline workers, especially the care workers, despite them being assigned with vital roles. The limited preparedness of the government in ensuring sustenance to lakhs of migrants and homeless in terms of food, healthcare facilities and shelter homes is notable in this regard. Even before the government could set up the infrastructure (though minimally), significant action has been taken by the civil society organizations in reaching out to the vulnerable population. Some of these aspects are highlighted in the following sections.

Limitations in pandemic response: Governing civic body of Mumbai

Soon after the lockdown was declared, the state government’s response measures were geared towards enforcement through coercive means (punishing people who ventured out) to stay at home. The State Reserved Police Force (SRPF) was used to ensure rigorous lockdown protocols in densely populated settlements. Instead, the government should have attempted to set up services and provisions so that the need and desperation to move out could have been reduced. Further, containment zones were declared, followed by the imposition of strict confinement measures in areas where cases have been reported. Within the state of Maharashtra, MCGM has taken firm steps in monitoring through mapping, on-ground movement in containment zones and geo-tracking of Covid-19 patients under quarantine. However, there is not enough focus on understanding the challenges in dense urban settlements.

Most people in the informal settlements lack tenurial security, inhabiting cramped houses vulnerable to monsoons, lack of access to sufficient and clean water and sanitation, suffer from frequent state or private demolition, live in highly polluted environments prone to illness and disease (McFarlane 2008). As their population continues to grow (Swaminathan, 2003), the task of providing adequate access to food and basic health services becomes more challenging. For instance, the densely populated Dharavi is the production centre for  international market. The footfall or connections with foreign investors are inevitable. The threat in these settlements is palpable. As the privileged and entitled avoid the impact of COVID-19 by self-isolating, the most vulnerable, especially in the informal settlements are suffering immense precariousness. The insecurity, uncertainty and existing socio-economic inequities put these residents at high risk of being infected thereby, compounding their vulnerability.

The role of the civil society organizations has been instrumental much before the friendly appeal made by the Central Government’s planning organization- Niti Aayog to the non-governmental organizations on March 30. The appeal was made to support the centre and state governments in their efforts to tackle the Covid-19 pandemic. Meanwhile in Mumbai since March 24, when the lockdown was announced, more than fifty organizations were already at the forefront of relief activities in different pockets of the city. They have pooled in their resources (existing funds) for distributing ration, setting up shelter homes, community kitchens, distributing protective medical equipment’s and creating awareness in vernacular medium. Those with FCRA (Foreign Contribution Regulation Act) licenses or without have sought for foreign funding and donations through different crowdsourcing platforms to support the stranded, jobless and homeless people. Although for the past five years, most of these NGO’s and grassroots organizations had to deal with stringent regulations, intense scrutiny of their activities based on suspicion and mistrust. However, all this has not deterred these organizations from taking the big leap and responding in this hour of need.

Food distribution

Assuring food provision remains an enormous challenge for the state government in such times. Specifically feeding a little more than half of the city’s population apart from the PDS system. PDS is a vital institution in enabling food security. However, it was not until April 7 that PDS shops became accessible. The state government was striving hard towards stocking the PDS by overcoming human resource crunch. There are, at the moment, an estimated 75 million BPL (below poverty line) beneficiaries and about 7 million APL (above poverty line) beneficiaries in the state. Under the PDS, 3kg of wheat and 2 kg of rice are provided to the BPL families (yellow card holder) at a subsidized rate. For others, it was not before April 24 that these essentials were made available at Rs 8 and Rs 12 per kg, respectively. However, other essential commodities like edible oil, sugar, pulses and cooking fuel were not included.

Meanwhile, some of even those with functional ration cards were denied access to PDS. This is due to two reasons, one, the long queues outside ration shops and the second, shopkeepers’ selective ration distribution practices. In such times of health, economic, social shock or uncertainty, the compulsion of identification documents like Aadhar linked ration card is all the more exclusionary. This denies access to a large number of beneficiaries. The portable ration card (under the scheme one nation, one ration card) which is making highlights after the Union Finance Minister’s announcement on May 14, was declared in early January by Union Minister Ram Vilas Paswan (Economic Times, January 21, 2020). It was claimed to have started in 12 states in early January (including Maharashtra) and to be fully implemented by June 1, 2020. However, there is an urgent need to ensure that the portable PDS network will be functional and accessible to all during the present pandemic. Furthermore, since the March ration was already distributed, for the next 3 months, ration (instead of 2 months declared) should be made available to anyone who approaches with a valid photo ID, a signed affidavit and a mobile number (as found effective in Kerala).

The PDS is a domicile-based entitlement with a requirement of address proof, ration cards and other identification documents which is not available to the migrants. This will leave a million starving, those who are stranded in the city where they are not able to prepare meals or observe physical distancing. This includes the homeless, people in transition mostly the migrants, self-employed migrant labourers who work as rickshaw pullers, street vendors and other petty service providers. Under the Shiv Bhojana Yojana, the state has set up 198 centres, providing subsidized meals at Rs 5 and 305 community kitchens in the city. However, the numbers are far from adequate to ensure sustenance of 54.9 percent (percentage of migrants to total population) of informal migrants in Greater Mumbai (Bhagat et al. 2020:5).

In the low-income group settlements, which underwent intense lockdown, access to both PDS food supplies and cooked food gradually became an emerging crisis for the state to mitigate. The problems were of two kinds, either the food was not received as promised or it was insufficient. The quality of food served through these distribution centres needs to be monitored closely for quality control and meeting the nutritional needs of the people. At several places, food is distributed only once a day which is not sufficient to maintain health and immunity. To avoid overcrowding in these centres, community volunteers can be deployed for crowd management. Secondly, overcrowding or long queues can be avoided when these centres are spread out in good numbers within localities with high population density.

The existing food distribution in the scheduled areas to pregnant and lactating mothers and children in the age group of 7 months to 6 years under APJ Abdul Kalam Amrut Ahar Yojana has been scaled up in the tribal areas. However, there are real concerns for pregnant women and lactating mothers, the disabled and elderly in the informal settlements too. Distribution of food can be carried out by encouraging physical distancing and especially reaching out to this group who may not be able to arrive at the distribution centres due to fear or risk of infection.

Proactive testing, quarantine facilities and access to healthcare

Aggressive or rapid testing is an important measure in being able to combat the pandemic. It is to measure the actual status of the spread of the virus. Various countries, including few states in India, have been able to flatten the curve through proactive testing, tracing, isolating and support. There have been a few initiatives by the BMC towards enhanced testing centres in the form of ‘drive-through’ and ‘photo booth’. However, they may not be enough in terms of reach and spread of the population.

Covid-19 can be controlled and defeated by increasing testing manifold to identify positive cases, symptomatic or not, followed by quarantine and/or isolating them and making arrangements for supportive treatment if and when required. The state can also deploy mobile vans with an in-built testing kiosk in the public spots for easy collection of swab samples. The advantage of these vans is their easy entry to narrow lanes and the doctors will be prevented from being directly exposed due to the structure of the operation. Testing facilities must be improved, both public and private hospitals must make the testing subsidized. Unless testing is made completely free, poor people may not report their symptoms causing higher morbidity and mortality.

Similarly, in the informal settlements home isolation is impossible in the absence of sanitation and water inside homes. One room is shared for household chores, working and sleeping. They do not have adequate space to isolate or even maintain physical distance to prevent the transmission of the disease to others. With the number of COVID-19 cases rising in these settlements, it is necessary to move people who are suspected of the risk of infection in specially provided quarantine centres. It is important to isolate those who are suspected of an infection when the infection level is rising. Since adequate facilities for home quarantining, and isolation do not exist, community isolation centres created at the Primary Health Centre and Sub Centres will be effective. Only those who require institutional treatment should be sent to hospitals. Proper written and verbal information about the results of the tests and progress of the treatment should be communicated to the family of the patient. Most often, the family is home quarantined, with no communication about the patient admitted in the hospital, leading to anxiety in the family and stigmatization from the neighbours. Lack of available beds, ambulances to carry patients, oxygen supply during transferring to ICU wards, ambiguous and delayed test reports are making the patients panic and may lead to unnecessary deaths. Few constructive moves in these crucial times have been, (i) the state’s appeal to medical workers who were yet to find work and others like retired medical practitioners and paramedical staff, to come forward to help and they have responded positively; (ii) the advisories to take over private hospitals and recruit private health professionals to meet the increased demand.

The health of frontline workers including medical staff, community health volunteers, municipal workers, primary healthcare workers and other essential service providers is of utmost importance, especially when there is distressing news of life at risk of care workers which includes police officers, BMC workers, doctors and nurses as well as primary healthcare workers. The work of these community health volunteers is physically and emotionally demanding and they are equally vulnerable due to the lack of recognition of their rights and labour dignity. Since their work is voluntary, it pushes them in the informal labour force with no access to state social security benefits like health benefits, leave etc. In the times of the global health crisis, they are the ones who have been working on a war footing but without any protective gear. The community health volunteers are at the lowest rank in the public health systems of the BMC. They are in charge of screening 60 households and report patients with COVID-19 symptoms. Risk communication at the community level is very crucial at such times. It is time to reckon the significance of community health volunteers and the vital role they are playing in the functioning of our society during this time.

In many households, currently, there is no money for medicines, especially for TB patients who need extra supplements to fight the disease. Also, specific requirements of the diabetics, heart patients, BP patients need to be catered to, hence, cash transfers or subsidized non-COVID healthcare facilities are needed. Patients with non-COVID related ailments are either turned down from hospitals or are at risk of contagion. Non-COVID-19 care should be available to all needy patients.

Shelter Homes

Homelessness characterises large cities with both inter and intrastate migration. People have made footpaths and spaces under the flyovers, their homes. For these people, the increasing sermons of ‘staying at home’ presupposes threat of eviction rather than secured shelter and food during the lockdown. These people who are otherwise forced to move in search of necessities, must not be treated as violators of the law but be provided with shelter, food and free medical aid.

Until mid-April, lakhs of migrants have been left to fend for themselves. With the loss of work and income, not being able to pay rents, they were almost at the brink of starvation and threat of eviction. This has led the migrants to resort to the desperate means of leaving for their villages with the desire to unite with their families. It was almost after a week of the lockdown and the Centre’s guidelines that the state began to set up relief camps to host the migrants. The CM announced  the approval of Rs 45 crore to provide for food and accommodation to the migrants. The number of relief camps has risen from 262 (on March 29) to 4808 in which 5.50 lakh migrants have been provided with sheltered facilities (May 6 press release). There are a large number of these relief camps functioning as a state-civil society engagement. Many grassroots organizations have taken the initiative of running these camps. However, this approach of providing temporary shelters is not a sustainable measure as it is keeping them away from their social support systems. It is thus advisable to make arrangements for a free, safe and comfortable return of the migrants to their homes.

Mitigating the impact of the pandemic: The real challenge

• Nearing the end of the third phase of lockdown, the number of new cases has been increasing and the trend is less encouraging and we seem to be far away from flattening the curve. This undoubtedly calls for a significant increase in the government’s expenditures on health systems by ramping up testing, tracing, isolating and meeting the health requirements.
• With the recent central order for safe travel of stranded migrants to their domicile states, the states are concerned about the cost of transporting these migrants. Owing to the economic slowdown, the state of Maharashtra was already forced to slash government employees’ salaries. It is already expected to not fulfil its 2020-21 revenue targets. Apart from the pay cut of government employees, there is equally a need to tax the richest 1 percent as COVID-19-Wealth Tax. This tax amount and additional revenue collected through lockdown violations in the state amounting to 3.51 crore (as on May 6) could be used to substantially increase the relief package for the workers in the unorganized sector, for them to survive the crisis. Apart from food, the migrant workers would need income to provide for other sustenance needs including healthcare and arrange for their travel (presently migrants are incurring all travel expenses).
• There is an urgent requirement of engaging civil society networks to support organised community outreach as an extension of the state’s decentralised initiatives in containing the pandemic and providing access to basic services. A systematic state-civil society interface must be initiated by BMC in sharing the responsibility of mobilizing resources (in terms of ration, cooked meals and PPE kits) where each organization may be responsible for providing ration at the ward level to prevent duplication.
• The levels of anxiety and stress have reached an unprecedented level due to the distress of managing food, water and healthcare needs of the family among the informal settlers, homeless and migrants. Psychological research has repeatedly shown that hypertension and stress reduce immunity and contributed to deteriorating health. Hence, there is a need for dedicated psychosocial helplines to address the concerns of the general public, people in relief camps and frontline workers.
• As the government approves relaxation for manufacturing industries, including factories using hazardous chemicals, it is advisable that Maharashtra being an industrial hub must adopt industry safety practices to restart these safely.

As such, we are being optimistic that in addition to the existing strategies and action, the state will continue to devise effective, socially and ethically appropriate strategies to mitigate the threat of the pandemic and protect the rights and welfare of its citizens.

AUTHORS

Sanchita Das, Ph.D. Scholar Tata Institute of Social Sciences, Mumbai

Peehu Pardeshi, Assistant Professor, Centre for Disaster Management, Jamshedji Tata School of Disaster Studies Department, Tata Institute of Social Sciences, Mumbai

* This note is based on the advisories and announcements by the Centre and the State until May 14.

Disclaimer: The views and opinions expressed in this article are those of the author/s and do not necessarily reflect the official policy or position of Azim Premji University or Foundation. 

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