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As of April 17, Madhya Pradesh has 1,120 confirmed cases of COVID-19 - the fifth-highest among all states in India.  The Government of Madhya Pradesh issued one of its initial COVID-19 related orders around January 28, 2020, advising healthcare workers to use appropriate protective gear when examining patients from Wuhan, China.   Since then, the government has taken several actions to contain the spread and impact of COVID-19.  In this blog, we look at key measures taken so far.

Figure 1: Day-wise COVID-19 cases in Madhya Pradesh

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Early stages: Focus on screening international travellers

On January 28, the state government issued directions to monitor international travellers from specified countries, test and maintain surveillance on those who are symptomatic.  A further order required district administrators to monitor and report on all passengers who arrived from China between December 31, 2019 and January 29, 2020.  While efforts were largely focused on screening and testing, the first quarantine restrictions for symptomatic travellers from China, entering India after January 15, were imposed on January 31.  Those leaving quarantine were subsequently kept under surveillance and their health conditions reported on for a period of 14 days.  By February 13, a constant presence of a medical team at the airport was required to test foreign passengers from an increasing list of countries and send daily reports.  

February and early March: Improving public health capacity, restricting social gatherings

The next steps from the government were aimed towards adapting the public health infrastructure to handle the evolving situation.  Following are some of the steps taken in this regard:

  • A helpline, with a dedicated call centre, was set up to inform citizens about COVID-19 and its prevention.
  • The regional directors of the Directorate of Health Services, Government of Madhya Pradesh, were instructed to ensure availability of N-95 masks and PPE kits in their region.
  • The Health Department issued guidelines to the Chief Medical and Health Officials in the State regarding the collection and transport of COVID-19 test samples.
  • Medical professionals in public hospitals were ordered to attend a national training.
  • An order was issued to improve arrangements for quarantine and isolation wards.
  • Leaves were cancelled for all employees/officers of the Health Department. 
  • To grant certain rights to establish effective control over outbreak affected areas and take swift actions, section 71 of the Madhya Pradesh Public Health Act, 1949 was invoked.  This section of the Act provides all Chief Medical and Health Officers and Civil Surgeon cum Chief Hospital Superintendents rights set out therein.  

As the number of cases in India increased through March, the MP government turned focus and issued orders directly concerning their citizens.   Several measures were undertaken to spread awareness about COVID-19 and implement social distancing.  

  • dedicated portal was created for COVID-19 related information.  
  • An order was issued to close several establishments including schools, colleges, cinema halls, gyms and swimming pools.  Biometric attendance was stopped at all government workplaces. 
  • On March 20, the government issued an order (effective till June 15) requiring suppliers of masks and sanitizers to: (i) maintain a fixed price and (ii) keep and present fortnightly, a record of purchase and sales of the essential items.  The order also prevented them from refusing to sell to any customer. 

March 21 Onwards

On March 21, MP reported four cases of COVID-19. On March 23, the government released the Madhya Pradesh Epidemic Diseases, COVID-19 Regulations 2020 to prevent the spread of COVID-19 in the state.  These regulations specify special administrative powers and protocol for hospitals (government and private) to follow while treating COVID-19 patients. These regulations are valid for one year. Over and above general instructions to maintain social distancing and personal hygiene, the government has undertaken specific measures to: (i) increase healthcare capacity, (ii) institute welfare protection for the economically vulnerable population, (iii) strengthen the administrative structure and data collection, and (iv) ensure supply of essential goods and services.  These measures include-

Healthcare measures

  • Preparation of hospitals for the treatment of COVID-19 including postponing elective surgeries, ensuring an adequate supply of PPE kits. 
  • On March 28, the Bhopal Memorial Hospital and Research Centre was designated as a state-level COVID-19 hospital.  This order was reversed on April 15. 
  • District collectors were empowered to appoint doctors and other healthcare workers as required in their districts in a fast-tracked manner.
  • Establishing a telemedicine unit in each of the 51 district hospitals
  • Facilitating the appointment of final year undergraduate nursing students as nurses
  • On March 29, the government launched the SAARTHAK app for daily monitoring and tracking of quarantined and corona positive patients
  • The government released a strategy document to contain COVID-19. This strategy places emphasis on identification of suspected cases, isolation, testing of high-risk contacts, and treatment (called the I. I. T. T. strategy)

Welfare measures

  • One-time financial assistance of Rs 1,000 will be provided to construction labourers
  • One-time financial assistance of Rs 2,000 will be provided to families of Sahariya, Baiga and Bharia tribes
  • Social security pensions for two months will be paid in advance to pensioners
  • People without eligibility slips under the National Food Security Scheme to be allowed to receive ration 

Administrative measures

  • Senior officials were designated to coordinate with various states to resolve issues regarding migrant labour.
  • District Crisis Management groups were formed to coordinate state-level policy and the local implementation machinery.

Supply of essential goods and services

  • On April 8, the government implemented the Essential Services Management Act,1979. The Act among other things, prohibits anyone employed in essential services to refuse to work.
  • E-pass procurement facility was started to ensure smooth inter-district and across states flow of essential goods & services.  

For more information on the spread of COVID-19 and the central and state government response to the pandemic, please see here.

In Budget Session 2018, Rajya Sabha has planned to examine the working of four ministries.  The Ministry of Drinking Water and Sanitation is one of the ministries listed for discussion.  In this post, we look at the key schemes being implemented by the Ministry and their status.

What are the key functions of the Ministry of Drinking Water and Sanitation?

As per the Constitution, supply of water and sanitation are state subjects which means that states regulate and provide these services.  The Ministry of Drinking Water and Sanitation is primarily responsible for policy planning, funding, and coordination of programs for: (i) safe drinking water; and (ii) sanitation, in rural areas.  From 1999 till 2011, the Ministry operated as a Department under the Ministry of Rural Development.  In 2011, the Department was made an independent Ministry.  Presently, the Ministry oversees the implementation of two key schemes of the government: (i) Swachh Bharat Mission-Gramin (SBM-G), and (ii) National Rural Drinking Water Programme (NRDWP).

How have the finances and spending priorities of the Ministry changed over time?

In the Union Budget 2018-19, the Ministry has been allocated Rs 22,357 crore.  This is a decrease of Rs 1,654 crore (7%) over the revised expenditure of 2017-18.  In 2015-16, the Ministry over-shot its budget by 178%.  Consequently, the allocation in 2016-17 was more than doubled (124%) to Rs 14,009 crore.

In recent years, the priorities of the Ministry have seen a shift (see Figure 1).  The focus has been on providing sanitation facilities in rural areas, mobilising behavioural change to increase usage of toilets, and consequently eliminating open defecation.  However, this has translated into a decrease in the share of allocation towards drinking water (from 87% in 2009-10 to 31% in 2018-19).  In the same period, the share of allocation to rural sanitation has increased from 13% to 69%.Figure 1

What has been the progress under Swacch Bharat Mission- Gramin?

The Swachh Bharat Mission was launched on October 2, 2014 with an aim to achieve universal sanitation coverage, improve cleanliness, and eliminate open defecation in the country by October 2, 2019.

Expenditure on SBM-G:  In 2018-19, Rs 15,343 crore has been allocated towards SBM-G.  The central government allocation to SBM-G for the five year period from 2014-15 to 2018-19 has been estimated to be Rs 1,00,447 crore.  Of this, up to 2018-19, Rs 52,166 crore (52%) has been allocated to the scheme.  This implies that 48% of the funds are still left to be released before October 2019.  Figure 2

Construction of Individual Household Latrines (IHHLs):  For construction of IHHLs, funds are shared between the centre and states in the 60:40 ratio.  Construction of IHHLs account for the largest share of total expenditure under the scheme (97%-98%).  Although the number of toilets constructed each year has increased, the pace of annual growth of constructing these toilets has come down.  In 2015-16, the number of toilets constructed was 156% higher than the previous year.  This could be due to the fact that 2015-16 was the first full year of implementation of the scheme.  The growth in construction of new toilets reduced to 74% in 2016-17, and further to 4% in 2017-18.Table 1

As of February 2018, 78.8% of households in India had a toilet.  This implies that 15 crore toilets have been constructed so far.  However, four crore more toilets need to be construced in the next 20 months for the scheme to achieve its target by 2019.

Open Defecation Free (ODF) villages:  Under SBM-G, a village is ODF when: (i) there are no visible faeces in the village, and (ii) every household as well as public/community institution uses safe technology options for faecal disposal.  After a village declares itself ODF, states are required to carry out verification of the ODF status of such a village.  This includes access to a toilet facility and its usage, and safe disposal of faecal matter through septic tanks.  So far, out of all villages in the country, 72% have been verified as ODF.  This implies that 28% villages are left to be verified as ODF for the scheme to achieve its target by 2019.Table 2

Information, Education and Communication (IEC) activities:  As per the SBM-G guidelines, 8% of funds earmarked for SBM-G in a year should be utilised for IEC activities.  These activities primarily aim to mobilise behavioural change towards the use of toilets among people.  However, allocation towards this component has remained in the 1%-4% range.  In 2017-18, Rs 229 crore is expected to be spent, amounting to 2% of total expenditure.

What is the implementation status of the National Rural Drinking Water Programme?

The National Rural Drinking Water Programme (NRDWP) aims at assisting states in providing adequate and safe drinking water to the rural population in the country.  In 2018-19, the scheme has been allocated Rs 7,000 crore, accounting for 31% of the Ministry’s finances.Figure 3

Coverage under the scheme:  As of August 2017, 96% of rural habitations have access to safe drinking water.  In 2011, the Ministry came out with a strategic plan for the period 2011-22.  The plan identified certain standards for coverage of habitations with water supply, including targets for per day supply of drinking water.  As of February 2018, 74% habitations are fully covered (receiving 55 litres per capita per day), and 22% habitations are partially covered (receiving less than 55 litres per capita per day).  The Ministry aims to cover 90% rural households with piped water supply and 80% rural households with tap connections by 2022.  The Estimates Committee of Parliament (2015) observed that piped water supply was available to only 47% of rural habitations, out of which only 15% had household tap connections.

Contamination of drinking water:  It has been noted that NRDWP is over-dependant on ground water.  However, ground water is contaminated in over 20 states.  For instance, high arsenic contamination has been found in 68 districts of 10 states.  These states are Haryana, Punjab, Uttar Pradesh, Bihar, Jharkhand, Chhattisgarh, West Bengal, Assam, Manipur, and Karnataka.Table 3

Chemical contamination of ground water has also been reported due to deeper drilling for drinking water sources.  It has been recommended that out of the total funds for NRDWP, allocation for water quality monitoring and surveillance should not be less than 5%.  Presently, it is 3% of the total funds.  It has also been suggested that water quality laboratories for water testing should be set up throughout the country.