It may take a crisis to wake up Kumbhakarna. If the sleeping giant in question is the Indian public health system, then there is one shining moment of success that can offer lessons for the current battle to manage swine flu.
Surat was felled by plague in September 1994. The port city in Gujarat was notoriously filthy and overcrowded. Rats ran riot. The resultant plague killed at least 37 people, infected hundreds of others and thousands fled the city.
Illustration: Jayachandran / Mint
Led by the city’s municipal commissioner S.R. Rao, the city administration used the crisis to clean up the city. Two years later, the Indian National Trust for Art and Cultural Heritage even declared Surat the second cleanest city in India.
What did Rao and his team do? The clean-up was started in May 1995, which included desilting the city river, cleaning sewage lines, widening roads and improving slums. More money was spent and revenue collection was stepped up, but that was not the entire answer.
Rao shook the city administration. Each city department was being run like an insulated fiefdom. Administrative barriers were broken down through decentralization and joint teams that tried to overcome the old malaise of one department laying roads and the other digging them up a few months later. Ward officers were expected to listen to citizen complaints and act on them promptly. A “six-month, six-page” rule was introduced: Any city official who did not complete a task in six months was asked to explain the reasons in a six-page note.
Rao once described the change in the administrative culture as a move from AC to DC, or from air-conditioned offices to daily chores.
Swine flu may do more damage than the 1994 Surat plague. These are early days in what could be a year-long battle against the virus. The government has done a good job in assuaging fears till now and stocking up on Tamiflu. Doctors and staff at under-funded and equipment-starved public hospitals and institutes have been doing their best. There have been complaints of delays and chaos at testing centres, but that is more to do with the utter neglect of the public health system over many decades.
Swine flu is likely to spread in the coming months before the virus hopefully becomes more benign. The public health system will be tested. The turnaround in Surat some 15 years ago shows how great leadership and radical transformation of governance can make a difference.
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