Covid-19

Maverick Citizen: Op-ed 

Covid-19 needs a strategic war effort

Covid Virus (Photo: economist.com/Wikipedia)

In an interview published in Rediff.com on 13 April, 2020, Dr Abhay Shukla of Jan Swastha Abhiyan of People's Health Movement said the fight against Covid-19 has to be nuanced, strategic and integrated. It cannot be treated as business as usual. He also added that we are facing a war-like situation.

Read the paper here.

If the government feels that the fight against Covid-19 is strategic and warlike, then its actions will explicitly demonstrate such conviction. Wartime management should come into place to replace the normal business as usual management and governance.

It practically means that just like in war, there should be a clear strategy, the strategy should be implemented by providing direction and the wherewithal to the war machinery. Mechanism for tracking and monitoring should be in place to evaluate whether the strategy is being properly implemented and whether the strategy itself is working or not. War-time situations require a higher level of agility there has to be real-time steering measures.

So, what should we expect the governments to be doing while implementing a strategic programme in a warlike situation?

First a digression, there are business as usual elements in the economy itself including normal medical needs which are impacted by the ravages of Covid-19 and the combatting of the coronavirus. This paper does not address these aspects, except to say that supply side capacity will need to be reapplied to the provision of medication, medical equipment and infrastructure and whatever is needed to combat the virus.

This paper only addresses at a high level the direct fight against the virus and managing the compliance of the populace during a lockdown (later referred to as the medical and administration fronts).

Strategic programmes usually have two important characteristics. The programme is provided with overwhelming resources and secondly, the programme is managed using different rules and norms to that of the business as usual. Governments worldwide are fighting this war on two main fronts. One, on the medical front and the other on the administrative front.  

Medical front   

On the medical front there are two streams of actions. One is testing and the other is treatment of the infected. In both these streams, we find that there are three elements the governments are grappling with on a daily basis, they are; methods (used for testing or treatment), the protocols followed (who, when, where, in what order etc..) and the wherewithal (medical equipment, infrastructure and medical personnel).

This is where the fight gets difficult, as the normal business as usual capacity and the procedures are no longer capable of dealing with the situation. This is where the research institutes like Indian Council for Medical Research (ICMR) and other such institutes come to the forefront and take charge of knowledge aspect of the strategy, they play an important role in defining the problem and the possible solutions, they also establish the medical protocol that need to be followed both by the medical professionals and also the public in general.

The testing is an integral part of this grand strategy, in-fact there are widespread discussions about the types of tests and the capacity or the lack of capacity of testing. Testing needs testing kits, medical personnel and the laboratories. There are two aspects of testing, one, is to find if an individual is either positive or negative for the sole purpose of treating the individual and the other is to collect data, which is strategic in nature, to find out the actual spread of the infection in the community.

The other part is the treatment, this needs the infrastructure to hold people in isolation, hospital beds both ordinary and Intensive care (ICU), ventilators and medicines. This capability also needs to be established. The activity should be well organised and supported with required supplies. These should be organised with the help of medical professionals who can formulate the required protocols.

Administration front

On the administrative front there were two strategies under discussion at the beginning of the pandemic. One that was quickly discontinued, was the strategy based on the theory of herd immunity and the other which is widely followed now, is a risk minimisation strategy through physical distancing.

The physical distancing itself is implemented through lockdowns. The intensity with which the lockdowns are implemented is based on perceived risk of infection spreading, the compliance culture of the society, the population density, the local cultures and the socio-economic situation of the geographical location. When seen in that light it is obvious that individual countries just cannot copy what the other counties have done. It becomes even more difficult in a country like India, which is large, densely populated, has large urban populations, many underdeveloped cities, and a large number of migrant workers.

The success of the physical distancing strategy hinges on the compliance of the general population with the medical and administrative protocols. These protocols can only be implemented effectively if each individual knows what to comply with and is willing to comply and has the capability to comply.

This is where the compliance management framework comes into play, which says that to make a large population comply with rules and regulations, governments should follow a three-pronged approach of Education, Service and Enforcement.

Managing compliance

Different governments manage compliance differently. The style differs from the totally autocratic, top down manner to the totally liberal bottom up manner. India and South Africa cannot afford to follow either one of the extreme styles, it should follow a mid-path, which makes it more complex.

This is when the metaphor of war, though useful, can be very dangerous. This is about a war against a virus and not a war against the people. In managing compliance, the authorities have to elicit voluntary compliance in the main. It can only do so, by putting itself into the shoes of its citizens and residents and answer the questions: “what do I need so that I can comply?  What makes it difficult for me to comply?”

Service

The central part of the three-pronged strategy is the service stream that helps the people to comply.

In a country like India or South Africa one can never assume that we are a homogenous population either socio-economically or culturally. The population has to be segmented into various groups that need assistance to enable it to comply with the protocols developed by the government.

There are three types of segments:

  • the general population which covers most of the people residing in the county;
  • a second segment of groups that need special attention, like the medical and enforcement professionals, people who have travelled abroad, migrant labourers etc;
  • the third are leverage points/people like the media, large organisations, religious groups, community groups etc.

The assistance provided by the service stream is over and above the economic packages announced by the government to overcome the economic difficulties faced by the nation. These are in essence support and assistance that will enable compliance with lockdown measures.

Education

The Education stream is actually an explanation and a communication stream that ensures that the general population, the special groups and the leverage points/people all know what they need to know.

The communication is done in three ways:

  1. Mass communication which focuses on simple rules that everyone should follow; even this communication should have multiple content and channels to ensure that it reaches everybody.
  2. The second type of communication is meant for special groups like the migrant workers who speak different languages, people who do not have access to mass communication channels like television etc..
  3. Then the third type are leverage points/people like community and religious leaders, body corporates, school teachers, local government representatives etc…

Enforcement

Enforcement comes into play once the Education and Service streams are in place and some people are still not compliant. The enforcement should always be fair and proportionate to the intent and the gravity of non-compliance. There are also has three categories of Enforcement:

  • That which is applicable to large areas and the vast majority of the people where and when basic and simple infringements take place. Usually the equivalent of the police on the beat or on patrol, points out the non-compliance and firmly asks for compliance, explaining its importance. Enforcement actions will be designed to take place along an escalating curve consistent with the nature of the infringement. Fairness and proportionality inform the choice of actions from law enforcement.
  • The next is in-depth enforcement which takes place because there are a large number of infringements and or there is organised non-compliance in an area. The intention here is to arrest and prosecute and penalise.
  • The third attempts to get the enforcement message to all people. It also includes achieving a measure of mandated self-enforcement by other structures and organisations. Private security capabilities in companies and residential body corporates fall into this category.

The framework

So, to sum up the above discussion on the implementation of the war strategy:

  • There are two major fronts, medical and administrative.
  • The medical front has two streams namely “Testing” and “Treating”.
  • The administrative front has three streams namely “Education”, “Service” and “Enforcement”.
  • In all, there are five streams to be managed by the government.
  • The three administrative streams will have to address three types of target segments namely “Breadth” which is the general public, “Depth” which is a set of special groups that need special attention and “Leverage” which is a set of influential institutions or individuals that will help the population to comply.

This framework can be used to understand the strategy of a government by observing what and where the government places extra emphasis. It can also be used by the government to organise itself to manage the fight against Covid-19. Or the same framework can be used to compare the operational styles of the various governments. In the current context we would like to focus on the organisation of the government to combat the pandemic.

Both the central and state/provincial governments have employed a strategy of minimising risk and have implemented it using the lock down route. They have also employed all the five streams discussed above, though with various levels of effectiveness.

So, how should a government go about organising for implementing such a strategy?

Before we go into the real organisation let us discuss the principles that govern such an organisation.

Organising principles

The first principle to recognise is that, as said above, this is a strategic intervention, hence it should be treated as one, by providing overwhelming resources to it and switching over operations  from Business-As-Usual to a programme mode; at least the part of the government that deals with this intervention should make that shift. All resources, human and material, have to be dedicated to the programme.

The second principle to consider is that such a programme is organised at three levels, namely at the central government level, at the state/provincial government level and at the district level. Hence the instructions, guidelines, protocols, funding and information flow should follow this path.

The third principle is that, it should be recognised that the government and resources at its disposal alone cannot implement such a programmeme. Hence entities such as social organisations, volunteers, influential individuals, industry sector formations, religious groups all should be co-opted into the programme.

Organising

Based on the three principles the central and the state/provincial governments should form intervention teams headed by a senior professional and a steering committee consisting of a political executive to steer the team. The team should have five operational streams that manage Testing, Treating, Education, Service and Enforcement aspects of the programme, supported by finance and procurement teams with the required authority. The central government team should focus heavily on the medical streams as medical norms and protocols should be developed centrally and individual states/provinces usually do not develop such protocols.

We are sure that the current governments have formed similar main teams and some other forces to assist the main teams. These teams should coordinate all activities performed within their respective streams irrespective of whether the activity is performed by a government agency or any other entity. The most important aspects of finance and procurement should be as transparent as possible and should follow procedures that are used for programmes and projects rather than that of procedures used by the departments in Business-As Usual mode.

Budget availability and effective decision-making at the front end are fundamental to success. This cannot be managed using the normal delegation of authority/powers. The budget for the programme should be at the programme office. All the departments, if part of this programme, should access this budget for the programme rather than their individual departmental budget.

Conclusion

In a country with a multi-party political system the efforts of all the parties will have to be coordinated; otherwise duplications and counterproductive activities can ruin the efforts of the government. Just like in wartimes the ruling party of the day should co-opt other political parties into the programme.

In many ways what has been said so far are obvious and many governments are doing what has been suggested, even if they do not follow the exact framework. Then why have this discussion now?

Even though most governments eventually do organise themselves in the manner suggested, it is through a hit-and-miss process and valuable time is lost. Before they know it, they would be reacting to events rather than follow a strategy.

The suggested framework can help governments to become more efficient and effective in the fight against Covid-19. DM/MC

Sridharan Kesavan is a PhD Scholar at Symbiosis Deemed University Pune India, Management consultant and Ex South African Revenue Service (SARS) executive; Ivan Pillay is Ex Deputy Commissioner, South African Revenue Service (SARS); Yolisa Pike is a Management consultant and Ex South African Revenue Service (SARS) executive; Dr. Tarun Kumar Singhal, is Professor, Symbiosis Center for Management Studies, Noida, India.   

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