Authors: Nadeem Ahmed Moonakal, Dr Dhanasree Jayaram and Dr Peter Lloyd-Sherlock.
The state of Kerala, in southern India, has long been recognised as exceptional, in terms of its successful approach to human and social development. Experts in international development refer to the “Kerala Model”, which has achieved higher levels of gender equality, and access to health and education than more affluent regions.
It is not entirely surprising that Kerala has, to date at least, appeared to have been relatively successful in meeting the new challenges of the COVID-19 pandemic. In March, Kerala had the highest number of COVID-19 positive cases in India: it is now ranked tenth (as of April 22). Of course, it is too early to say that Kerala has flattened the curve, as the numbers of recoveries and freshly infected cases are varying every day.
Experts attribute Kerala’s relative success to a decentralised healthcare system, as well as a strong tradition of primary health care in rural areas and high rates of female literacy. Additionally, Kerala has a very strong tradition of public action by grassroots organisations, which have been actively engaged in past crises -most recently the 2018/19 floods.
Population ageing in Kerala
Kerala is ageing faster than any other Indian state. In 2011, 13 per cent of the population were aged 60 or over. A higher proportion of older people live alone in Kerala than in other parts of India, since rates of labour migration of younger family members are especially high. Kerala was one of the first Indian states to introduce an ‘Old Age Policy’ in 2006, and this was upgraded in 2013’s ‘State Old Age Policy’.
Before the COVID-19 pandemic, initiatives included the Age-Friendly Panchayat scheme which aimed to transform all panchayats (village councils) into age-friendly ones and the Vayomithram scheme which extended the state’s well-developed primary health services to meet the needs of older people. These programmes supplement central government schemes, such as the National Old Age Pension Scheme (for people aged over 59 below the poverty line).
The arrival of COVID-19 in Kerala
The first wave of cases in Kerala entailed the successful recovery of three infected students who had returned from Wuhan, China. There is no evidence that this led to secondary infections or related deaths.
A second wave began with the return of three members of a family from Italy to Kerala’s Pathanamthitta district. It was clear that secondary infections were unavoidable since the family had visited many places before being tested. Among the recorded secondary infections are a 93-year-old man husband and his 88-year-old wife. Despite having illnesses such as diabetes and hypertension, the couple survived. This boosted the confidence of Kerala’s healthcare authorities and workers, particularly since more infections quickly began to appear across the state.
More than the pandemic itself, measures adopted by the central and state governments such as lockdowns have affected older people immensely. The provision of essential supplies, non-COVID-19 related medical support, and social/psychological support systems have all been disrupted. When the lockdown was announced, the state government took a few prompt measures and some were joint with civil society groups and non-governmental organisations. Working with Anganwadi (centres providing care for mothers and young children in rural areas) state workers and village officials have rapidly collected information about older people’s general circumstances and health status. Specific measures have included advancing the distribution of social pensions, food aid and medicines to vulnerable older people through a new Senior Citizen Cell scheme.
Lockdowns and care homes
In a state where the number of old age homes has skyrocketed in the past decades, these institutions play a huge role in safeguarding the lives of its older population. Government-run homes have conducted disinfection programmes with the help of local fire brigades and have installed additional washbasins. To enhance the immunity of residents, dietary changes have been made, including providing more fruits and vegetables.
Residents of old age homes across the state are being encouraged to engage in recreational activities, including new yoga classes and the acquisition of books and newspapers. In the Kannur district government care home, a resident provides weekly briefings about the situation to fellow residents, through an in-house public address system. Advice and comments from medical practitioners and healthcare experts are also shared through this mechanism.
Kannur district is one of the biggest COVID-19 hotspots in Kerala, with over 100 positive cases as of April 22. Hence, lockdown-related measures have been extremely stringent there, with special measures in care homes. Despite these restrictions, the Kannur district government care home has succeeded in establishing an unusual and inspiring new activity: the development of an in-house hand-wash production facility. As well as being used in the home, this hand-wash is now provided to other organisations across the state. According to Mohanan Bharghavan, Superintendent of the home, “The in-house hand wash manufacturing programme motivates the residents to engage with society, and this helps in mainstreaming the rehabilitation process.”
This is only one of several positive stories that have emerged out of Kerala in these distressing times. All the stakeholders in the state at different levels of governance are proposing and implementing new measures for older people.
Nadeem Ahmed Moonakal is a Dr TMA Pai fellow and Doctoral candidate at the Department of Geopolitics and International Relations, Manipal Academy of Higher Education (MAHE), Karnataka, India.
Dr Dhanasree Jayaram is Co-Coordinator at the Centre for Climate Studies and Assistant Professor at the Department of Geopolitics and International Relations, Manipal Academy of Higher Education (MAHE), Karnataka, India. She can be reached at @dhanasreej (Twitter).
Dr Peter Llyod-Sherlock is a Professor of Social Policy and International Development at UEA and researches on social protection, health and the wellbeing of older people in developing countries.