Covid-19: The five lessons of the Bhilwara model

On Tuesday, Prime Minister (PM) Narendra Modi extended the lockdown by another 19 days, till May 3. But there was a nuanced policy measure that the PM introduced in his speech. He spoke about hotspots — which represent clusters where a high number of cases have been identified and which can become sites of community transmission. These hotspots, he emphasised, had to be contained; the administration had to ensure that areas which were vulnerable were strictly monitored; and the overall objective had to remain to prevent the emergence of new hotspots. States, districts and sub-regions which are able to do so will see a relaxation of restrictions after April 20.

Through this approach, the PM is attempting to balance the dual, often, conflicting objectives the country has to meet. On the one hand, it must soften the blow of the pandemic in a country of 1.3 billion people whose lives and livelihoods were forced to a grinding halt. On the other, it must spend time, money and resources on the containment of the disease, and eventually, its eradication.

To do the latter, the PM’s reference to hotspots is crucial. It comes in the wake of several states in the country declaring certain areas as containment zones. In these zones, the lockdown is more strictly enforced; even essential supplies are delivered to houses; there is aggressive screening; testing is ramped up; isolation is enforced; the patients are treated; and the effort is to first flatten the curve and then ensure that the zone becomes free of disease.

This model assumed national prominence because of the measures adopted in the textile town of Bhilwara in Rajasthan, which came to be known as “ruthless containment”, a phrase coined by the state’s additional secretary (health), Rohit Kumar Singh. The measures merit detailed examination because the model is now serving a broader template.

Once it was discovered that the disease had arrived, and spread in the town, the Rajasthan state government, led by chief minister Ashok Gehlot and Singh, along with a determined and capable local district administration, aided ably by health care professionals and police personnel, worked tirelessly on two fronts: Precaution and treatment. The Bhilwara model proved to be a difficult, but necessary, method. It was difficult because the model caused large-scale public inconvenience — it is not easy for any regime, especially democratic regimes, to disrupt the lives of citizens. But this was done. The first lesson from Bhilwara, therefore, is that state governments must remain alert, have a constant feedback mechanism from the ground, respond promptly, and be ready to take decisions, purely on grounds of the spread of the disease and expert input.

When the first case was reported on March 19, the administration did not hesitate to implement an inside-out curfew. Remember this was before the national lockdown was imposed. Restrictions were put in place, albeit leniently, and essential services were allowed during this time. However, fearing a greater spread, the administration gradually extended the geographical reach of the curfew by creating buffer zones, which ultimately covered the whole district. It then began tightening essential supplies. This was a Herculean, multi-pronged approach that required agencies to go door-to-door to deliver essentials. This, then, is the second lesson — adapt according to circumstances, implement even tougher measures when necessary, but do it sensitively and with a humane face to ensure that citizen needs are met. This was then supplemented with the aggressive screening of all residents, and continuous testing of symptomatic individuals. This is particularly praiseworthy since the nearest testing centre is in Jaipur, about 250 kilometres away from Bhilwara. Over time, government agencies established dedicated Covid-19 hospitals and arranged for vehicles to ferry people from the rural areas to get tested. Thousands of hotel rooms, and beds in other institutions and hostels, were set up as quarantine centres to keep symptomatic patients in isolation. This, then, is the third lesson. Hard measures are not an end in themselves. They are the means to ensure better health outcomes. And therefore, the period of strict lockdown has to be used to ramp up health infrastructure, test, isolate and treat.

To keep local officials motivated, teams of elected village representatives right up to the subdivisional magistrates, were given special and specific responsibilities. This is the fourth lesson. India has robust institutions on the ground; it has leaders with roots in the community who have legitimacy with the people; it is important to make the entire process participatory by using these institutions and leaders. That will ensure popular buy-in.

There is, however, a troubling trade-off involved in the Bhilwara model, as in other containment zones. Pandemics trigger health emergencies which demand coercive measures and the curtailment of some civil liberties that often don’t feature in democracies. These include restrictions on the freedom of movement — through curfew, quarantine, sealing borders and so on — and the rationing of supplies. But perhaps, in times of unprecedented crises, this is the only way forward. And that, then, is the final lesson. There will be short-term restrictions on rights — but it is for a larger public good, and conditional on the rights being restored when public health improves.