Conclusions from the regional administrations

Introduction

Since the onset of the COVID-19 pandemic in India, district administrators have been given a lead role in responding to the pandemic at the sub-regional level by implementing Section 69 of the Disaster Management Act, 2005 (“DMA‘). The central and state government orders mandated district administrators to manage the pandemic within their respective jurisdictions using the powers given to them directly by the DMA and through state-level regulations issued under the Epidemic Diseases Act, 1897 (‘EDA‘). District administrators reportedly performed a variety of roles, including coordinating with state agencies to develop informed pandemic response policies.

However, existing legal and governance frameworks for managing public health emergencies appear inadequate in the face of a major pandemic. The planning and management involved in the nationwide lockdown, containment of contagion and health care capacity – especially in the second wave, the effect of the pandemic on other human rights and the economy – have faced sharp criticism.

It is therefore important to examine the legal and administrative framework within which front-line management in India operated and to understand the experiences and challenges of district-level administrators.

A 2021 study on local government and COVID-19 in India points to empowerment and investment in local governments as having significant potential to facilitate the delivery of public services and other government functions, including notably in coordinating responses to extreme climate events and other disasters. In addition, Vidhi’s March 2021 White Paper titled “What should a Public Health Emergency Act look like for India?” addresses the role of the Act in public health emergencies (“PHE‘) preparedness and response and public health in general. The White Paper states that “…the existing Indian legal framework on PHEs needs to be reassessed to address its various shortcomings and incorporate the necessary aspects of modern PHE legislation in a manner appropriate to the Indian context.”

The following identifies various issues to be addressed as part of this exercise, including the following:

• the need for legislation that:
  1. meets the specific needs of each country;
  2. outline the division of responsibilities between different levels of government;
  3. creates adequate inter-governmental and intra-governmental coordination mechanisms;
• the capacity of the existing administrative infrastructure to handle PHE preparedness and response activities as envisaged in a modern PHE framework;
• the need to ensure the complementarity of law with administrative protocols and the effectiveness of both in practice.

In this context, our project seeks to understand the legal, governance and capacity challenges facing district administrators during the COVID-19 pandemic with a view to informing more modern approaches to PHE management.

Research overview

The purpose of our study was to learn from recent experiences with the practical operation of existing laws and governance structures so as to enable reform that reflects the needs and realities of those at the forefront of preparedness and response efforts. PHE. In particular, we hope that the results of this study will help:

• incorporating a realist third-level perspective in the drafting of effective PHE legislation

• identifying optimal pathways to facilitate participatory governance in PHE governance

• highlight areas of PHE preparedness and response that are better accomplished through administrative or informal channels than legislative provisions.

Methodology

The study used qualitative methods, including personal interviews, supplemented by and analyzed through the lens of literature reviews and lessons learned from related projects conducted by the organization. Semi-structured face-to-face interviews were conducted with fifteen individual administrators at the district level in the country’s eight states. Initially we had selected one district for each state/union territory and also tried to select districts from different geographical zones of the country. However, it soon became clear that working administrators were more likely to respond candidly if they were known to us directly or through indirect networks. Therefore, participants were selected based on availability and willingness to participate in the study through a combination of purposive and convenience sampling methods. Findings from the interviews were analyzed to identify similarities/consensus as well as differences in the problems, solutions and administrative approaches of the different areas.

The scholarship on the practical problems of implementing legislation and executive orders was distilled to formulate specific recommendations regarding PHE legislation.

Findings from the survey

The most significant lessons from the study are as follows:

1. Existing laws related to disaster management and PHE are seen by administrators as enabling legislation to develop PHE management strategies, rather than providing guidance or limitations in the exercise of their powers. Laws were mentioned in administrative orders as a source of authority to issue such orders and enforce their implementation, but were not relied upon for substantive provisions on disaster management. This shows that the content of the law itself was not as relevant to administrators when developing structures or instructions related to the management of PHE.

2. Among the participants, only one stated that their district had developed district-specific guidelines for managing COVID-19. They had developed comprehensive guidelines involving inter-departmental coordination in the field and regularly amended them based on orders and guidelines received from central ministries and state departments.

3. Penalties under criminal law are often cited by administrators in their orders as consequences for failure to comply with their instructions. While some participants mentioned the administrative ease that comes with such penalties, others expressed hesitation about the widespread application of such powers. An overreliance on criminal law is also inconsistent with optimal public health approaches.

4. Rather than the application of legal regulations, informal relationships and communication within the government structure and with the public proved more appropriate for the management of PHE. For example, reaching out to senior staff or administrative colleagues helped administrators understand instructions and best practices. Previous connections with community leaders helped them reach the public and build trust.

5. Administrative ease appears to be prioritized, as opposed to public health approaches that are centered on community and scientific evidence. For example, some districts have been ordered to test contacts of COVID-19 patients for COVID within three days of identifying such contacts so they can transition to other patients. This was at odds with scientific evidence that suggested it could take up to seven days from the date of contact to test positive for the virus.

6. In most cases, coordination between different levels of government was not a major problem and administrators used formal and informal means of communication. Participants mentioned that in addition to regular inter-district video conferences and meetings with state leadership, they will call or send informal messages to other officials for quick communication. Rather, the issue was the rapidly changing details of instructions at various levels that made it difficult to manage on the ground, as it was difficult to communicate these changes effectively to other members of the administration and the public.

7. Approaches to governance during the pandemic depended more on individual administrative styles and culture than on legal or political guidelines. Although some basic instructions regarding blocking, containment, vaccination, etc. remained applicable to all administrators, public participation and communication, the creation of social safety nets (such as strengthening shelter homes and mental health networks), and other community-beneficial initiatives were left to the prerogative and initiative of individual officials.

Recommendations

• District administrative officers need adequate training and support for the multiple roles and diverse range of responsibilities they hold/are charged with.
• Clearer and more comprehensive PHE preparedness and response protocols are needed, in addition to better staff training and capacity building – particularly at local level. Although it may not be possible or desirable to develop standardized protocols for all PHEs, orienting administrators to the fundamentals of people-centered and evidence-based public health management is essential.
• Such a framework should anticipate increased strain on public infrastructure during PHE and provide reserves to facilitate the provision of other essential public services.
• A highly top-down approach to the PHE response may be at odds with ground realities and hinder local efforts; therefore, there is a need for improved investment in and empowerment of the third level to build capacity and facilitate bottom-up input to PHE preparedness and response planning and implementation. The importance of third-level empowerment was also highlighted in our white paper, which examined PHE frameworks in six jurisdictions (UK, US, Canada, South Africa, South Korea and Brazil) and explored their experiences with PHE management.
• There is a need for improved monitoring and evaluation metrics at different levels of governance to align with the goal of people-centred and evidence-based management of PHE.
• Such a framework should facilitate the meaningful involvement of diverse community members and civil society in PHE preparedness and response
• There should be a greater focus on building resilient systems rather than expecting people to be more resilient in times of disaster

For the authors

Shreyashi Ray

Shreyashi is a research fellow at Vidhi and works in public health. Her interests include public health, gender and sexuality, mental health, labor and migration. She completed her B.A., B.L. (Hons.) from West Bengal National University of Law Sciences, Kolkata in 2016. Prior to joining Vidhi, she was engaged as a consultant in the District Administration, Ranchi. She has worked on public health, nutrition and education issues in mining-affected and other underserved areas of the district. As part of this commitment, she prepared Guidelines for Preparedness and Control of COVID-19 in Ranchi – and coordinated the planning and implementation of health and social support mechanisms (domestic violence, mental health, rights of migrant workers) during the pandemic. Apart from this, she has nearly three years of experience as a researcher in open science and knowledge sharing at the Center for Innovation, Intellectual Property and Competition, National Law University, Delhi. She co-authored the Open Science India report, which aims to guide government/institutional policies to implement open science practices and inclusive research and knowledge ecosystems, particularly in the Indian context.

Kim D’Souza

Kim D’Souza is a Research Associate at Vidhi. He is currently working on research related to public health legislation. Prior to Vidhi, Kim worked in real estate and conveyancing law and general corporate consulting for six years, as well as advising social sector organizations on contracts and regulatory compliance. She has an LL.B. from Government Law College, Mumbai, and B.Sc. in Life Sciences and Biochemistry from St. Xavier, Mumbai.