Author : Ramanath Jha

Expert Speak Urban Futures
Published on Apr 08, 2020
In any appraisal of the remarkable work done in Bhilwara, the first object that catches the eye is speed. Soon after a worsening situation came to notice, Bhilwara did not waste time in reacting. The action that followed was swift and hammer-like.
Modelling COVID19 response on the Bhilwara prototype

Bhilwara, a district named after its capital city, around 250 km from the state capital Jaipur, is in the Mewar region of Rajasthan with a modest population of around 2.4 million. The city itself, by Indian standards, is small with a demography of 370,000. The district shot to fame, first on account of the large number of COVID19 cases reported from the district and then for its spectacular turnaround of the situation in a matter of just few days days. The response of the district and state administration and the strategy that it used received wide applause and became famous as the Bhilwara model.

The district had no positive cases of Corona infection till 18 March this year. The first of its cases appeared on 19 March when a doctor tested corona-positive. But, by 30 March, the virus was spread and 26 such patients were located. The fact that a far-off district had suddenly these many cases appeared to suggest that the district was moving towards becoming a major hotspot for COVID19. The mounting numbers caused great concern to the district and the state administration. However, to the great surprise of outsiders, by 6 April, the number of COVID19 cases in Bhilwara rose by only one. And of the total 27 cases, the latest reports convey that 17 have been cured and 13 of them have been discharged.

To the great surprise of outsiders, by 6 April, the number of COVID19 cases in Bhilwara rose by only one.

What achieved this transformation was the delineation of an anti-COVID19 strategy and its implementation with an iron hand. The strategy included, firstly, the sealing of the district borders and blocking inflow and outflow of people and vehicles. For rigid implementation, 24 check posts were erected at all entry and exit points of the district. Secondly, the Bhilwara city was put under curfew and a comprehensive lockdown was declared. Both these measures were aimed at containing the spread of the virus.

The third step comprised mapping positive cases, tracing their contacts, identifying clusters and secondary level contacts. Six areas were identified and special teams were deployed for continuous screening of suspected cases. A containment zone of one square km was then delineated within Bhilwara city and the entire population resident in that area was surveyed. Some 3,000 teams of health surveyors were employed covering all homes and persons in the zone. Over a period, this survey was extended to the district, leading to a screening of the entire district population and the collection of 2,816 samples.

Six areas were identified and special teams were deployed for continuous screening of suspected cases. A containment zone of one square km was then delineated within Bhilwara city and the entire population resident in that area was surveyed.

With a view to reach the containment and treatment strategy to all villages of the district, village-level corona fighters were appointed. These were village level education functionaries (PEEO), development functionaries (Gram Vikas Adhikari), revenue functionaries (Patwari) and social workers (former Sarpanch). They were designated with the responsibility of keeping vigil on all such people identified with cold, cough, fever and respiratory illness, admissions in hospitals and arrange home quarantine in consultation with health workers. They were to keep higher authorities informed of any development at the village level that related to COVID19.

The screening strategy preparation itself was elaborate. Appropriate capacity building of survey teams was undertaken by doctors well-versed in the nuances of COVID19. To avoid any crisscrossing, the areas of each team were neatly demarcated. To oversee the output quality, a supervisor was appointed for every ten teams. A 24-hour war-room was set up with support of the state rapid response team, health workers and the police.

Appropriate capacity building of survey teams was undertaken by doctors well-versed in the nuances of COVID19.

The district administration then took over all 27 hotels in the district and brought them under its jurisdiction. These hotels, with a combined total of 1,547 rooms, were turned into quarantine centres where nearly a thousand people were quarantined until just this weekend. Currently, there are 730 people under quarantine at these hotels. So also, with a view to buttress bed and treatment strength, four private hospitals along with their staff were requisitioned. These had isolation wards with a capacity of 25 beds each. Besides, the district hospital had a total capacity of 200 beds with a further ability to add another 227 beds. Additionally, 22 institutional buildings and hostels with a capacity of 11,659 beds were also taken over. Meanwhile, lockdown restrictions, which were in place since 20 March, were further tightened to curfew-like levels from 3 April. No exception was made for public representatives, media and community organisations.

Between 20 March and 2 April, stores selling essential commodities were allowed to stay open. However, on 3 April, even these stores were ordered shut and only home delivery of essentials is currently allowed. Nobody is permitted to venture out of homes without prior permission. “All essential facilities also are shut such as medicine shops, ration shops, vegetable shops etc. Everything is provided as home delivery or door to door delivery,” Rajendra Bhatt, the Bhilwara collector said.

The Cabinet Secretary, it is reported, felt that Bhilwara provided two key takeaways in regard to containment of COVID19 — aggressive containment and proactive preparation of scaling up hospitals and quarantine facilities.

In the last one week, as cited above, Bhilwara has had just one new case of the corona virus, almost completely flattening the spiraling upward curve noticed elsewhere. Such has been the district’s success that the central government has advised other similar affected areas of the country to implement the strategies employed by the Rajasthan district. The Cabinet Secretary, it is reported, felt that Bhilwara provided two key takeaways in regard to containment of COVID19 — aggressive containment and proactive preparation of scaling up hospitals and quarantine facilities.

In any appraisal of the remarkable work done in Bhilwara, the first object that catches the eye is speed. Soon after a worsening situation came to notice, Bhilwara did not waste time in reacting. The action that followed was swift and hammer-like. This allowed the district administration to get on top of the disease that may have got out of hand had there been delay. Secondly, the containment strategy and the care strategy were worked out in minute detail, plugging all possible gaps. That clearly demonstrates that a great deal of effort went in devising a foolproof strategy. Thirdly, an equally detailed implementation strategy was drawn up assigning roles and tasks for each functionary of the massive machinery that was employed. These functionaries were trained so that there was no confusion about what each was tasked to do. Lastly, there appears to be complete teamwork among the various arms of the district and the state. The clock-like synchronisation allowed the full implementation of the strategy.

An advantage that naturally accrues to a remote district with a small headquarter town is that the administration operates from a position of great strength.

Is this possible to be repeated in other districts, large metropolitan cities and mega cities? One would say that the elements of the strategy are standard. They, therefore, would be broadly as applicable elsewhere. What would differ, however, would be the terrain and the complexities of larger masses of diverse populations. Bhilwara district has an area of 10,509 sq. km with a demographic density of 228 sq. km. The city area comprising the Bhilwara Municipal Council is spread over an area of 118,49 sq. km with a population density of a little above 3,000 persons per sq. km. Social distancing, therefore, is under no spatial pressure. This would be in complete contrast to say, Dharavi, in Mumbai where densities are anywhere between 100,000 to 150,000 per sq. km., where ideas such as social distancing sound as preposterous as a square circle.

An advantage that naturally accrues to a remote district with a small headquarter town is that the administration operates from a position of great strength. The proclivity to criticise administrative decisions, the presence of media and its ability to censure and the presence of a strong citizenry are all limited in comparison to a very large city. All this contributes to a single-minded administrative capacity to push through tough measures as long as they are not seen to be completely at odds with local welfare and culture. Mega cities have a highly vocal citizenry, an all-pervasive media, analysing and commenting on each move, political big-wigs with their own concepts, egos and expectations. Contending with a multitude of powerful stakeholders compels the administration to factor them into their decisions. Quite naturally, the implementation of the Bhilwara model in the latter kind of settlements would call for a reasonable degree of adaptation.

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Author

Ramanath Jha

Ramanath Jha

Dr. Ramanath Jha is Distinguished Fellow at Observer Research Foundation, Mumbai. He works on urbanisation — urban sustainability, urban governance and urban planning. Dr. Jha belongs ...

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