India should gain inspiration from Kumbh

The coronavirus pandemic offers an opportunity for countries around the world to invest and expand their healthcare capacity to fit the needs of the modern world. It is a rare opportunity, where the stress test of our healthcare system, help us improve and if needed redesign the system to dramatically expand preventive, hospital and critical care capacity using new technologies.

Can India fight coronavirus, and rapidly scale its health capacity? If you have visited Kumbh at Prayagraj, you will believe yes it can. Kumbh is simply put - astonishing. Beyond the spiritual domain, administratively and in terms of planning and management, Kumbh is an event with no global parallel. A massive city catering to tens of millions a day emerges out of nowhere at the bed of Ganges for a few months, with almost every amenity one could look for. And then it dissolves into the river. India organizes the Kumbh periodically and has learned the ability over time to live in organized chaos. It is a skill that not every country has acquired. Hence, can India deal with coronavirus? Can its health capacity expand drastically to meet the challenging needs ahead? Yes it can. 

I was member of a IIMB based study that studied the 2019 Kumbh at Prayagraj. Kumbh is a floating city serving 3-5 crore visitors on its peak day. The Kumbh was incidence free and deployed a temporary sanitation system, healthcare infrastructure, transport and housing facilities for millions of visitors. How could such high levels of effectiveness be achieved at scale, when otherwise India's state capacity is considered weak? Some features of Kumbh governance model are worth emulating for the rest of India.

• Clear Accountability: The government established a Mela Pradhikari Model who was empowered and fully accountable for Kumbh. This enabled long-term planning and effective leadership at Kumbh. The administration worked tirelessly with a sense of mission, and similarly, India's coronavirus response requires war-time leadership, with significant autonomy and associated accountability for the administrator who understands the underlying science on matters related to epidemic control.
• Mission Based: Kumbh had clear performance guidelines: Safety, Cleanliness and Sanitation. Such clarity over non-negotiable performance parameters led to the entire local machinery putting its full attention on these key performance parameters, which had a clear deadline. What is the core objective (minimising deaths, minimising spread  maximising herd immunity?)? In the case of coronavirus response, the central mission needs to be clearly stated both to the administrative staff and the public, with focus on both preventive and curative steps. Taiwan has done a good job with disease prevention, where proactive centralised leadership and a data-based social isolation and quarantine system has led to very few cases. Germany, anticipating a large outbreak has started to expand its healthcare capacity ordering large numbers of ventilators.
• Focused Attention: The government publicly committed to a divya, bhavya and swachha Kumbh, with scrutiny from the international media. This created a do or die performance pressure for national, state and most importantly the local administration. In case of coronavirus pandemic, such attention is inevitable, but nonetheless media attention can go a long way in ensuring accountability of all stakeholders.  
• Decentralized Governance: The local Kumbh administration utilized diverse governance models for different days and districts in cooperation with stakeholders like Akhadas and locals, which led to effective delegation and distribution of responsibilities and quick feedback. While central leadership matters, both the free media and local stakeholders play an inalienable role in scaling up, as providers of timely information and accountability, and as the hands that reach out to the remotest corners of the society. A central leadership will be overwhelmed if it tried to do every thing by itself. In startup language, it needs to outsource activities that are not core to its job. Local stakeholders need to be empowered, and put on the decision making table, to coordinate an effective response at scale.

Each of these factors helped the government achieve scale in a manner that is uniquely suited for a diverse multistakeholder democracy like India's. 

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Can India fight coronavirus, and rapidly scale its health capacity? If you have visited Kumbh at Prayagraj, you will believe yes it can. Kumbh is simply put - astonishing. Beyond the spiritual domain, administratively and in terms of planning and management, Kumbh is an event with no global parallel. A massive city catering to tens of millions a day emerges out of nowhere at the bed of Ganges for a few months, with almost every amenity one could look for. And then it dissolves into the river. India organizes the Kumbh periodically and has learned the ability over time to live in organized chaos. It is an ability, not every country has the ability to deal with. Hence, can India deal with coronavirus? Can its health capacity expand drastically to meet the challenging needs ahead? Yes. Absolutely. It can.

A post shared by Prateek Raj (प्रतीक राज) (@prateek.raj_) on Mar 15, 2020 at 9:37pm PDT