Sri Lanka has been working with a centrally implemented and a state-centric approach to COVID-19 from the inception of the epidemic. Judging by the slow progress of the pandemic in Sri Lanka during what is broadly referred to as the first wave, it worked well in terms of identifying those with the virus, contact tracing, developing and implementing quarantine operations, introduction of preventive practices and broadly in terms of monitoring and control of the pandemic. This was reflected in the low prevalence of the COVID-19 related morbidity and mortality during the first seven months of the onset of the disease in Sri Lanka. Now that we are in the threshold of a possible community transmission of the disease with related challenges, we need to rethink about our approach to control the disease and minimize its fallout in the society, economy and the body politics in the country.
This is because a purely state-centric approach implemented by the health workers with ample support of the police and the security forces has its limitations when dealing with a large number of infections in multiple clusters some connected with economic nerve centres in the country as well as its wide ranging social and economic fallout affecting livelihoods, marketing arrangements, social cohesion, trust in systems and democratic governance in general. In order to address these challenges effectively, we need to have a broader community participation at all levels, inclusive decision making and a two-way flow of information in place of a purely top down communication pattern that dictates do’s and don’ts for people at all levels without having a sound understanding of ground realities and how the decisions made at the top will affect the various stakeholders, including the people who are most vulnerable to infection and related complications of a life threatening nature. A consultative process involving a broader spectrum of stakeholders is necessary in order to deal with a constantly evolving pandemic and its wide-ranging impacts.
Why a Change of Approach is Necessary at this Stage?
In dealing with the problem at hand we have to learn from Sri Lanka’s own rich experience in addressing massive public health emergencies in the past. For instance, the devastating malaria epidemic of 1934 to 35 that actually led to the emergence of several progressive social and political movements in Sri Lanka, including the Leftist movement itself. Many emerging political leaders in the country at the time, such as Dr. N.M. Perera, Dr. Colvin R. de Silva, Philip Gunawardena and A. Rathnayake actually grasped the grass root level realities and living conditions of a wide array of local communities through their direct participation in relief work in the affected areas. This, in turn, shaped their political thinking and contribution to the development of Sri Lankan welfare state in time to come.[i] While we have to understand that COVID-19 is a different kettle of fish altogether when it comes to control and prevention, with restriction of movement and social distancing as a prerequisite for the control of the new disease, it is nevertheless the case that informed decision making is necessary in responding to a health emergency of this magnitude and social justice must be ensured in reaching out to the most vulnerable.
With a significant spread of the corona virus and related challenges particularly among vulnerable groups such as the urban poor, female garment workers, informal sector workers, prisoners, natamis, fishermen, elderly and the like, quite apart from handling the disease burden, the critically ill, diagnostic and curative services, including ICU beds, the affected families and communities will need a whole lot of other services as well. This includes the need for counselling, social connectivity, livelihood support, food provisioning, relief services and addressing social issues such as stigma, discrimination and rights of patients and their family members too. This is where community participation is essential at all levels in order identify and overcome the gaps and deficits in the systems in place and establish a feedback mechanism whereby decision making responds to the felt needs from below as well as the need for compliance with disease prevention guidelines formulated by the health authorities.
Also it has to be noted here that blaming the upsurge of the pandemic on these vulnerable groups will be tantamount to blaming the victims. This is because they have become exposed to the disease largely due to circumstances beyond their control, circumstances imposed upon them by the institutions or social settings in which they are part of. The relevant organizations must be accountable and involved in identifying remedies for the problems encountered by the specific groups of vulnerable people within their ambit. As some commentators on the pandemic elsewhere in the world have pointed out, vulnerability cannot be narrowly defined in demographic or public health terms alone, as new clusters of vulnerability have emerged side by side with established social fault lines in the wake of this devastating pandemic all over the world.
As of now, the COVID-19 response in Sri Lanka relies entirely on a combination of a widespread use of electronic and print media for reaching out to the public with the latest information and legal enforcement of the relevant interventions. While this has its advantages in responding to the pandemic at a time when messages have to be disseminated to the public instantly expecting them to fall in line, this is unlikely to be successful in the long run unless there is an engaged social process beyond one-way communication leading to a broader community acceptance of the conduct proposed and established through a dialogue that also seeks to respond to ground level realities and problems encountered by people in implementing the safe practices introduced.
Effective social mobilization and broader community participation are necessary for prevention of COVID 19 infections and more importantly in containing the social and economic fallout of a rapid disease transmission. For effective control of the disease, all people with disease symptoms or have been in contact with possible infected persons must come forward to the authorities and get themselves tested or go through quarantine as required by the circumstances. This can be effectively ensured when the number of cases is small and the flow of information from the affected people to the relevant authorities is unrestrained. However, when the disease breaks out in a large number of clusters simultaneously the process of contact tracing becomes too complicated also due to stigmatization, criminalization of certain behaviours and an increased tendency towards a punitive approach to public health interventions. Potential vulnerability of health workers and other service providers including security forces personnel for infection due to lack of safety equipment or the need to deal with potentially infected persons who might not divulge their exposure to infection are other complications that may affect the disease response at a time of rapid transmission. While a suitable legal framework is certainly needed for addressing some of the relevant issues, beyond legal obligations we need a high level of trust and a sense of community responsibility among all parties concerned. The more we try to enforce laws and dispense punishments without simultaneously developing a sense of community responsibility and a sense of social justice, the more we may encounter transgressors who want to bypass laws and seek to pass through loop holes in law enforcement in order to attain their private goals at the risk of harming the community at large.
COVID-19 will certainly be a major blow to the Sri Lankan economy. This is because almost all our foreign exchange earning enterprises will be or have been adversely affected by the global pandemic. Tourism will be one of the most adversely affected as international tourists are unlikely to visit Sri Lanka and most other tourist destinations in the near future. Secondly, many of the overseas migrant workers have started returning to Sri Lanka and some are stranded overseas without any kind of social protection due to loss of employment, air travel restrictions and high cost of limited flights available in the wake of the pandemic. Migrant work overseas will not be a viable option for many people for a foreseeable future. The closure of certain garment factories following the outbreak of the epidemic initially in the Brandix factory in Minuwangoda have added to the economic burden of the country, hit another leading foreign exchange earner and resulted in livelihood losses for many male and female workers. This is an unprecedented macro-economic crisis for the Sri Lankan economy as a whole. Moreover, this is a personal disaster for the affected people, having reached a seemingly dead end situation where the livelihoods they were engaged in would no longer be feasible. This situation calls for a serious reflection and collaborative action involving the state, private sector and any support groups among the relevant people, including civil society organizations themselves. Self-employment and micro-enterprise may be one option that should be explored particularly with returnees from overseas employment due to their international experience, any savings they may have accumulated over time but severely depleted due to COVID-19 related loss of income also utilizing concessionary bank loans, start-ups and training provided where necessary. All these require a serious assessment of where we are, possible state, private-sector and civil society partnerships and picking up the fallout from the pandemic and proceeding in completely new directions where necessary.
While it is always good to build on our own experiences where possible, there are also some important lessons we can learn from COVID-19 response in some other countries as well. The successful COVID-19 control in the urban low-income community called Dharavi in Mumbai, India, for instance, has received worldwide attention and admiration from international organizations such as WHO.[ii] Unlike the rest of India where the pandemic has spread like bush fire, the crowded community of Dharavi with limited water supply and sanitation facilities and congested housing did manage to gradually bring down infection due to a combination factors such as good leadership, active collaboration between the Mumbai municipal authority (BMC), community groups, private sector agencies in the city and all categories of health workers in the municipality, community workers including social workers. In an approach titled ‘chasing the virus’, community members took the initiative in encouraging fellow community members with symptoms to go for PCR tests and the contacts of COVID-19 positive people to go through quarantine in a makeshift quarantine centre established in a small playground, the only open space available in this crowded and poorly serviced community. The private sector agencies in the city contributed funds for running the quarantine facility and provided food and dry rations to the community members throughout the lockdown.
Several civil society organizations in Indonesia have developed strategies for digital marketing of farm products in order to overcome travel and marketing restrictions imposed by the pandemic. This has involved the development of simple Apps that can be easily used by ordinary farmers on their smart phones for identifying and contacting possible buyers in the local areas. In some instances, this has also made it possible to overcome market monopolies of middlemen, minimize post-harvest losses, reduce the time-lag between farm gate and outlets and empower women producers and small time traders. The important point is that producers and consumers equally demobilized by the pandemic and the resulting lockdowns have developed innovative responses in addressing the new challenges they face. These innovations have come from creative partnerships among different agencies including the state, private sector and civil society organizations. I am also aware of similar initiatives in Sri Lanka by organizations such as the Women’s Development Centre in Kandy.
In order to develop a participatory approach to COVID-19 pandemic, I propose the following strategies:
First, broadening the scope of the national task force for control of COVID-19 to include other important stakeholders including civil society, private sector and a diversity of social actors and researchers drawn from relevant fields such as economics, social sciences and community health. This forum should have a capacity to understand, respect and respond effectively to social and cultural diversity in the country. Another possibility would be to establish a number of smaller committees with a diversified membership with participatory decision making and information feedback mechanisms supporting decision making on critical issues.
Second, an assessment that seeks to understand the reasons for the higher exposure to the pandemic by certain vulnerable groups such as residents in urban low income communities and flats, fish traders, garment workers, prisoners and construction workers, identify their health care and other socio-economic needs and explore possible ways of facilitating their economic recovery and livelihood development. Similar assessments will also be needed regarding the new police cluster of infection and the navy cluster before that in order to minimize their exposure to infection safeguard these frontline workers.
Third, identify civil society organizations including CBOs that are currently engaged in services to the communities affected by the pandemic, initiate a dialogue with them about possible ways of improving their services to vulnerable groups in order to facilitate prevention, care and economic and social recovery.
Fourth, critically examine available information about patterns of infections in diverse population groups so as to minimize infections and prevent the emergence of new clusters of infections.
Fifth, secure the inputs of those who recovered from the disease so as to tap their experiential knowledge about the disease and its cure, prevention of stigma and discrimination and identify ways and means of facilitating their livelihood recovery.
Sixth, efforts should also be made to revive the program of community policing where necessary from the angle of raising public awareness of health and safety issues and lockdown and quarantine procedures and securing public participation in maintaining law and order as well as in prevention and health promotion work.
Finally, a 24-hour telephone hotline must be established in Sinhala, Tamil and English for people who seek to get advice and clarifications about any health problems and interventions related to the pandemic. The public should also be encouraged to report any stigma or discrimination they experience due to infection or contact with potentially infected using the same hotline.
-Prof. Kalinga Tudor Silva-
[i] . For a detailed contextual analysis of the social history of this epidemic see Silva, K.T. Decolonisation, Development and Disease: A Social History of Malaria in Sri Lanka. Delhi: Orient Blackswan, 2014. For a novelist reflection on how the malaria epidemic touched the lives and political imagination of rural people, see Sumithra Rahubadda. Thammanna. Nugegoda: Platform for Alternate Culture, 2019.
[ii] . The author is thankful to Veranga