Odisha, a state located on the east coast of India is not new to emergencies. Known for its track record of efficiently handling natural disasters, including the recent cyclone, the state has managed to tackle the COVID-19 pandemic quite efficiently. As of 24 June 2020, the state recorded an impressive recovery rate of 69.4%, and the mortality rate of just 0.29%, which is one of the best in the country.
With cyclone AMPHAN hitting the state amidst the pandemic, evacuating the stranded people safely while adhering to social distancing measures was challenging but the state’s experience in disaster management helped in managing the situation. Effective governance in collaboration with Panchayati Raj Institutions and community-based response strategy enabled the resilient state to contain the spread of the virus. The state’s COVID-19 management strategy offers important insights that kept the caseload low despite the huge influx of migrants.
The state was the first in the country to initiate strict measures. The Chief Minister ordered an immediate closure of many public places on 13 March, even though the state had not reported a single case of COVID-19.
When the first case was reported on 15 March, the state control rooms had been made operational; and capacity building of the district level health officials on preparedness and response activities, and public awareness campaigns on handwashing and respiratory etiquettes were already initiated.
The state laid down a strong governance framework with ‘Empowered Group of Ministers’ for quick decision making and dedicated teams for social distancing, capacity building, containment strategy, isolation and treatment, and awareness campaigns. Each team is led by a senior secretary under the direct supervision of the Chief Minister for effective implementation of the preparedness and response measures. The dedicated teams put up a synchronized effort by working in close coordination with the Department of Health and Family Welfare.
Setting up one of the biggest COVID health facility in the country:
The state was the first to establish one of the country’s biggest 1000-bedded dedicated COVID hospital in a record time of just one week; with the Kalinga Institute of Medical Science and SUM Hospital established as model COVID hospitals. Besides, 30 dedicated district COVID hospitals (DCH) were set up in all districts, out of which 17 hospitals are functioning in tripartite agreement with the government, private hospitals, and finance corporations. “The COVID hospitals operating in partnership mode proved successful in managing the resources under the supervision of authorized medical officer (AMO) of the Government of Odisha”, shared Dr Nihar Ray, Sub-regional Team Leader, Odisha, WHO Country Office for India.
Assessment of the health facilities:
The health facilities were independently assessed by the WHO and UN teams, and the findings were shared with the state authorities. Best performing COVID hospitals like Ashwini COVID hospital, Cuttack were recognized for their state-of-art quality of care. By the end of May 2020, the state managed to build a robust infrastructure with a capacity of 22 340 beds in the dedicated COVID health facilities, with an occupancy rate of only 8.86% as of 28 June 2020. The assessment of infection prevention and control (IPC) parameters of COVID and non-COVID hospitals helped in adherence to the IPC protocols in major health facilities.
Effective monitoring: Utilizing their polio experience, the National Public Health Surveillance Project (WHO-NPSP) team prepared fifteen planning templates, to undertake activities such as control room meetings, supervision, containment zone microplanning, and community mobilization, etc. Control rooms were made functional to review surveillance, quarantine facilities, testing, and treatment measures at the state, district and block level; and daily proceedings were shared with all the key stakeholders for further guidance, providing an opportunity to map the progress and take corrective actions, if required.
Effective monitoring: Utilizing their polio experience, the National Public Health Surveillance Project (WHO-NPSP) team prepared fifteen planning templates, to undertake activities such as control room meetings, supervision, containment zone microplanning, and community mobilization, etc. Control rooms were made functional to review surveillance, quarantine facilities, testing, and treatment measures at the state, district, and block-level; and daily proceedings were shared with all the key stakeholders for further guidance, providing an opportunity to map the progress and take corrective actions, if required.
Expanding the surveillance to trace Influenza-like Illnesses (ILI) and Severe Acute Respiratory Illnesses (SARI) cases
Engagement with the private sector to expand the surveillance to track ILI and SARI cases helped to identify and isolate the risk groups. Weekly reports are collected to track the cases and identify high-risk areas and earmark the containment zones. To strengthen COVID containment measures in high-risk districts, the government has been taking prompt measures and deploying additional task forces comprising of the state’s administrative services officials, doctors, laboratory technicians, and police personnel
Testing strategy: The testing capacity of the state has also been enhanced from one functional lab to 19 labs now. As of 21 July, Odisha had tested a total of 401 644 samples, with more than 8000 RT-PCR tests being conducted in a day.
Patient care: Telemedicine services to enable patients to avail health services through direct consultation with the doctors have started at 41 health institutions including seven Government Medical Colleges and 30 District Headquarter Hospitals from 21 July 2020. The government has also stepped up and initiated the plasma therapy at Tata COVID Hospital in Sitalapalli to provide quality care to COVID-19 patients.
Leveraging technology: Digital application is leveraged in monitoring movement of cases and contacts. The identification of containment zones is also guided through a geographic information system (GIS). Besides, dedicated call centers are established to address public queries. Self-registration of migrants and the issue of ePass services ensures the seamless management of incoming migrants and travelers. Sachetak mobile applications and WhatsApp services are being utilized to create public awareness and gather real-time information on the cases. State COVID dashboard shares real-time information on COVID-19 data, and response measures. A health facility portal has also been created for monitoring the performance of COVID Hospitals.
Managing the huge influx of migrants:
The state witnessed a huge influx of migrants. To manage this, the government adopted multi-pronged approaches such as monitoring of migrant’s movement, issue of online e-pass, contact tracing, provision of food and accommodation, monitoring health and adherence to safety measures, etc. A dedicated online Grievance Redressal Portal exclusively for migrants was also set up.
More than 18 000 temporary medical camps (TMCs) that also served as quarantine centers were set up to accommodate more than 800 000 migrants. All basic arrangements were put in place in TMCs with special attention to vulnerable groups like pregnant women, senior citizens, preschool children, people living with comorbidities, and transgenders. Quality control was ensured through regular supervision at the block and district level and supported by the mentoring team deployed by the state. The government also established COVID care committee at all gram panchayats to take care of the overall operation of TMCs and COVID care homes (CCHs).
Capacity Building: Dedicated COVID capacity building vertical supported by state government officials, WHO, and UN agencies developed courses for various groups focusing on training on ICU management, and psycho-social training, etc. More than 180 000 doctors, nurses, paramedics, AYUSH, sanitary workers, police, frontline health workers, and volunteers were trained during the lock-down period.
‘Mentoring support to program’ initiative: The state deployed an empowered joint team of public health experts and initiated a ‘Mentoring Support to Program’ to provide support to districts in implementation of COVID surveillance and containment strategy micro plan, gap analysis, and sharing feedback for further improvement. The mentoring team comprised of officials from State Health Directorate, medical colleges, WHO, UN agencies, Indian Council of Medical Research (ICMR), and Indian Institute of Public Health (IIPH).
Mentoring support to program’ initiative: The state deployed an empowered joint team of public health experts and initiated a ‘Mentoring Support to Program’ to provide support to districts in implementation of COVID surveillance and containment strategy micro plan, gap analysis, and sharing feedback for further improvement. The mentoring team comprised of officials from State Health Directorate, medical colleges, WHO, UN agencies, Indian Council of Medical Research (ICMR), and Indian Institute of Public Health (IIPH
The decentralized approach in collaboration with Gram Panchayats
Gram Panchayats are entrusted with the responsibility of isolating suspect cases. This decentralized approach has worked well, as identifying and isolating suspects was managed at the local level. Sarpanch, the elected representative of Gram Panchayats is empowered to take decisions that work best in their areas to contain the spread. Activities like provision of food materials at the doorsteps of the migrants were managed smoothly under their supervision.
Pension benefits were provided four months in advance to older adults, disabled, and widows under national and state pension schemes. The government also announced financial benefits to encourage and motivate the COVID warriors, people in quarantine centers, and vulnerable groups. Four months advance salary to doctors and health workers and one-month extra remuneration was given to all contractual & outsourced staff working in Health & Family Welfare Department. The Chief Minister also announced a financial package of INR 5O Lakhs for all health workers.
Involvement of Self-help Groups- Mission Shakti: The self-help groups (SHGs) under the Mission Shakti were trained through a cascade training model supported by UNICEF and UNFPA.
The women-led awareness campaigns across the state to reinforce the messages on social distancing, hand washing, and contributing to supplying essential commodities and cooked meals to poor and vulnerable during the lockdown. The SHGs came together to stitch a whopping 1 million masks in a record time to address the acute scarcity of masks. This also provided an opportunity to improve livelihood of the women.
The government has continuously kept its focus on reducing morbidity and mortality. As of 28 June, the state has one of the lowest case fatality or death rate in comparison to the international and national figures.
“The journey ahead may be an arduous one, but we will continue to fight. The situation is evolving every day and we are learning. It is difficult to predict the nature of the virus and we are keeping ourselves ready for any eventuality to come”, shared PK Mohapatra, Additional Chief Secretary (H&FW).
Early lockdown, setting up the country’s first dedicated COVID-19 hospital, the temporary medical camps to manage the huge influx of migrants, multisectoral collaboration, community-based disaster management, community engagement, and mentoring support programs are some of the key takeaways of the Odisha’s response strategy that have contributed to Odisha’s success in tackling the pandemic. Going forward the need is to sustain the efforts while continuing the collaborative approach with the local leadership and the self-help groups.
(Source: World Health Organisation)