How Mumbai & Delhi Handled COVID Differently — and What Worked

The Brihanmumbai Municipal Corporation (BMC), and its Municipal Commissioner Iqbal Singh Chahal, have gained international acclaim for Mumbai’s handling of COVID.When one talks of municipal services, the populations of Mumbai and Delhi are roughly comparable; but unlike Mumbai, Delhi was in shambles during most of April and May 2021.This article is not aimed at lauding or belittling the efforts made by those who worked tirelessly to save lives. It strives to show Delhi’s manmade structural disadvantages and the gaping holes in its healthcare delivery, even as citizens gasped for beds, oxygen and ventilators, with the realisation that there was no organisational strength to back the efforts.How to Triage COVID Patients: What Delhi Must Learn From MumbaiHow the BMC Functions & What Makes It EffectiveThe BMC did a stellar job precisely because of its age-old organisational strength. Its jurisdiction extends over the entire island of Mumbai, from Colaba in South Bombay to Mulund and Dahisar in North Bombay, which are serviced through 24 municipal services which include water supply, drainage, sewerage, health, sanitation, fire services and solid waste management.The corporation’s council consists of 227 members elected every five years. The city is subdivided into 24 administrative wards, each headed by an Assistant Commissioner who is responsible for all that impacts civic life.The ward-wise details of every official are easily accessible on a common website along with the number of hospitals, NGOs, bus depots, police chowkis, thereby providing — from a citizen’s point of view — quick access to key people in charge. Citizens’ services are decentralised, needing zero intervention from the municipal bosses in the headquarters of the BMC, and much less in the Mantralaya.Mumbai’s city governance is self-contained and effective. It has nothing like Delhi’s Lieutenant Governor. Nor does it have ministers of the government and almost five score IAS officers managing some 100 Departments of the Delhi Government.The Commissioner of the BMC is a senior IAS officer who heads the administrative and executive wings of the Corporation, assisted by some 30 senior officers of which only a handful belong to the IAS.Despite a 15 million population and the second-highest city density in the world, the monolith BMC has a unified command system operated through Municipal Departments that function autonomously at the ward level.India Crosses 3 Lakh COVID Deaths: Recalling Those We Loved & LostStrengthening of COVID War Rooms for the 2nd WaveLearning from the 2020 experience, war rooms which had been set up then and had not been dismantled, were strengthened.As the second wave showed signs of revival, each of the 24 war rooms was equipped with 30 dedicated telephone lines answered by trained operators in every war room, who could match the caller’s symptoms with a drop-down list and seek orders from the doctor on duty stationed in the room.Dependant on his/her assessment, a team was deployed to check the patient’s parameters, and based on those findings, the doctor decided the next course over the phone — be it further testing, home isolation or hospitalisation. While families could choose between going to a private or a government facility, the ensuing ambulance transfer and hospital admission were the responsibility of the BMC.‘Mumbai Oxygen Model’ That SC Asked Delhi, Centre to Learn FromWhat the BMC Did to Keep Confidence Levels High & Infection Rates LowTo keep confidence high and infection low, the BMC announced a compensation of Rs 50 lakhs on the death of any BMC worker — regular, contractual, or casual — even indirectly engaged in COVID management (for example, bus drivers). This went beyond the Centre’s compensation of Rs 50 lakhs to only healthcare workers. The key staff did not go home but were accommodated in decent hotels with meals left on trays outside each room, plus Rs 300 a day pay for incidentals.Doctors remained on duty for 7 continuous days followed by a 7-day off to monitor their own symptoms and take rest. The idea of using medical and nursing interns was executed by the BMC long before it was flashed over national media as a panacea.How Did BMC Ensure Steady Oxygen Supply?Oxygen was never exhausted because right from May 2020, the BMC had tendered for setting up oxygen tanks with piped oxygen supply to the public sector hospital beds. Previous experience had shown how inefficient and cumbersome it was to have cylinders carried in and out by ward boys, and the need for constant replenishment.For hospitals without piped oxygen supply, procurement was entrusted to the Commissioner of Food and Drugs (FDA) — but the internal distribution was managed by the BMC which had real time data on hospital bed occupancy and oxygen demand. Cryogenic tanks and jumbo cylinders were added to augment the oxygen storage capacity.Draw From the Mumbai Model of BMC: SC to Centre on Oxygen CrisisAll Mumbaikars are Equal in the Eyes of the BMCAll Mumbaikars were on par in the eyes of the BMC. Whether in Malabar Hill or in a typical suburb, one could only opt for either a government or private facility. The ensuing hospital and bed allocation were done centrally using a common dashboard. Slum-dwellers gratefully went to the jumbo facilities. Each private hospital was overseen by a BMC official physically posted there to check the process of admissions, discharges as well as billing. Complaints of jumping the queue and inflating bills thus came to a halt.Delhi’s Clumsy & Top-Heavy Governance StructureI substantially blame the folly of the GNCT (Government of National Capital Territory of Delhi) structure, and not those who worked tirelessly night and day, for much of the distress faced by citizens. The cumbersome arrangements that govern the city have imploded time and again, but during the recent life and death situation, the absence of an organisational structure uncovered a gaping hole.Never has that edifice of governance been exposed as much as during the second wave of COVID in Delhi. Until the amendment to the NCT Government notified in April 2021 designated the Lieutenant Governor as the Government of Delhi, the elected political executive had enjoyed a substantial portion of the authority of a full-fledged state. Despite frequent combats between the constitutional and elected arms and skirmishes with officers, the system bumbled along, going from one flashpoint to the next.But it was the management of COVID that laid bare just how top heavy and clumsy the constitutional and elected pillars holding up that edifice called governance was in reality.Some Living in Ivory Towers: Delhi HC to Centre on Vaccine PaucityHow Delhi Municipal Corporation Has Been Systematically Whittled DownOver the last two decades, instead of strengthening whatever organisation existed in the name of the Delhi Municipal Corporation, it was systematically whittled down, leaving a moth-eaten organisation with limited relevance to the lives of the citizens. Unlike the BMC that was established in 1888, the Delhi Municipal Corporation, although set up nearly 80 years later, has been truncated, shorn of authority, and reduced to near naught by successive governments — both at the Centre and in Delhi — both believing that decentralisation would miraculously improve interface with citizens and build efficiency.Until the late ‘90s, the Delhi Municipal Corporation controlled everything — water, sewerage, electricity — besides the obligatory functions of sanitation, conservancy and solid waste management. In 2011, the body was trifurcated into three corporations for North, South and East Delhi.The GNCT Government and the Corporations have continually been at loggerheads, and that power struggle continued even when both the elected bodies were led by the same political party. The downsizing of the MCD has been a continuous ploy to cut it to size — first by hiving off water supply and sewerage, besides a lot else.Gaps in Delhi’s Governance Structure That Impacted COVID ManagementDuring the entire stretch of COVID management during 2020 and 2021, the three Municipal Corporations were neither seen nor heard of, despite controlling the spread of contagious diseases being a statutory municipal responsibility.While the GNCT’s Department of Health acquired more and more officers, it sadly remained bereft of an organisational structure capable of operating at a local level, much less having the capacity to allot hospital beds, anticipate oxygen shortages or the desperate need for ventilators.The gaps are several. The Revenue Deputy Commissioners in charge of eleven districts in Delhi are bright, young officers full of ideas and initiative, but in Delhi, unlike their peers in districts across the country, they have no organisational back-up, little or no co-ordination with the police which reports to the Home Ministry, and do not control the line Departments at the field-level.Then there are hospitals like AIIMS, Safdarjung and Ram Manohar Lohia, which have enormous bed capacity but report only to the Ministry of Health.For want of a structure and systems, the question of the Delhi government triaging and allocating patients according to location, need and public/private preference, as done in Mumbai, was just not feasible. Put bluntly, it left citizens to manage on their own — by hook or by crook. Patients from outside Delhi swarmed into the city, and coupled with the farmers’ agitation that reportedly triggered the spread of deadly variants which had been raging in Punjab, Delhi was a nightmare. Finally, throughout January to 21 March, the masking and social distancing norms were ignored by public representatives as well as citizens, even as all authorities turned a blind eye to the impending second wave of COVID.BMC Model Can’t Be Replicated in Delhi — What is the Way Forward?The BMC model, excellent as it is, just cannot be replicated in Delhi. But pandemic management also cannot be a knee-jerk response — beds, oxygen, home isolation, ambulances are emergency requirements, and without foresight and planning, nothing will work. This is not the time to talk about constitutional and legal mandates, central and state responsibilities, but simply to put the house in order before the next wave arrives. If the cockfights between different elected bodies does not stop, nothing will improve.A Suggested Organisational Structure Exclusively for COVID ManagementMy common sense suggestion is to set up an organisational structure exclusively for the pandemic, in which the municipal corporation health and allied staff report to the Delhi Government’s health department. Jointly, a single line epidemic control protocol needs to be put in place. Using the authority of the Disaster Management Act, a ward-based structure on the lines of the BMC needs to be set up to manage calls, and to decide on isolation, hospitalisation, or the allotment of an ICU hospital bed. The officer in charge should plan for providing paediatric care at least in the hospitals owned by the Delhi Government, the designated private hospitals in Delhi, and those owned by the MCD, thus forming a common pool. Such an integrated system can provide a single line system to manage future patients residing in 11 districts and the municipal wards that fall therein.This is a health emergency, and the biggest that humankind has seen in 100 years. The capital of India should be a model — not a catastrophe. And for once, politics must stop.(Shailaja Chandra (IAS retd) has over 45 years experience of public administration focusing on governance, health management, population stabilisation and women’s empowerment. She was Secretary in the Ministry of Health & Family Welfare and following that the Chief Secretary, Delhi. She tweets at @over2shailaja. This is an opinion piece and the views expressed are the author’s own. The Quint neither endorses nor is responsible for them.)

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How Mumbai & Delhi Handled COVID Differently — and What Worked

Veteran IAS officer Shailaja Chandra explains how Mumbai’s BMC managed COVID crisis, and what Delhi can learn.

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Topics: Maharashtra Government BMC Delhi Government