THE World Health Organisation has termed the novel coronavirus as a global emergency which has before, during, and after dynamics. The pre-emergency time is decision-making and execution phase and is not relevant in Bangladesh as we are now facing the emergency. By Wednesday, more than 1.4 million people became infected; more than 82,000 of them died and 300,000 patients were struggling to recover in 209 countries and territories and two international conveyances. In Bangladesh, 218 were infected by Wednesday; 20 of them died and 165 patients were struggling to recover.
The post-emergency period will depend on our governance performance in this emergency time. The country is a champion in disaster management although this health emergency provides for a new learning pad and a lifelong experience for us, the majority of Bangladeshis born after the birth of the country in 1971. As the virus is contagious and no medicine is available to cure the disease that the virus causes, social distancing is the only way to head off the life-threatening virus. The concern is that people are somewhat wary of maintaining the social distancing protocol to avoid transmission despite the government’s maximum efforts? Do they not care much about their life? The questions remind me of the challenge for the COVID-19 governance and the importance of a participatory approach — especially three major points: (i) institutional quarantine or isolation for Bangladeshis returning from abroad, (ii) health care system, (iii) home isolation, quarantine, or stay-at-home approach to avoid any community transmission.
Governance approach in decision-making
THE government is trying to avoid this emergency with preventive and curative approaches. The government, thus, needs to have the coordination among different stakeholders: (i) health care practitioners, (ii) the law enforcement agencies, (iii) local government, (iv) civil society and, (v) non-governmental organisations at the ground level under the directive of the prime minister and with a strong coordination of the health ministry. It, thus, calls for vertical and horizontal coordination and cooperation to ensure the effectiveness of institutional quarantine, self-isolation, home quarantine, stay-at-home protocol, or test for coronavirus. The vertical coordination incorporates the range from the World Health Organisation to the local government such as union council; every level also needs to have the horizontal coordination by ensuring the participation of multiple stakeholders. The government formed a 500-member committee to fight the virus. I hope that the committee includes every major stakeholder group representative such as political parties, business organisations, civil society, physicians, pharmaceutical companies, non-governmental organisations, communication experts, print and electronic media, sociologists, the law enforcement agencies, religious leaders, mental health professionals and the local government. I firmly believe the committee first identifies major issues such as the supply chain, health and well-being, stress, family planning, relief coordination, harassment, right to information, personal protection, and social protection programmes by considering different stakeholder groups on the basis of class, religion, gender, disability, employment group, and geographic locations. We shall overcome this emergency with the help of their expert opinions, coordination, and cooperation and that is an essential requisite to ensuring people’s participation. For this purpose, the government needs to understand the global trend of the new coronavirus: it suggests a lower level of transmission in early stages with a probable increase later, possibly by the 50th day since the identification of the first case. In this context, Bangladesh is in the early stage and the real situation will be visible in the latter part of April.
Governance approach at execution level
SINCE the beginning of the coronavirus concern in Bangladesh, about 667,000 people entered Bangladesh from different countries. At first, the government decided to ensure their institutional isolation at the Hajj camp but later changed its decision and allowed them to leave on the condition of self-isolation in their houses. In urban and rural area, most of them respected this decision; but some of them were very relaxed, non-compliant and enjoyed their time with their friends and family constraining the fight against community transmission. I am, thus, not certain about the effectiveness of this self-isolation as a handful of people who returned from abroad are more than enough to spread the virus even before knowing of their health status. The local government is now executing a case-specific ‘lockdown’ approach and this need to have specific guidelines from the national committee.
On the curative side, healthcare system includes public medical college and hospitals, private medical college and hospitals, university medical centres and independent research organisations related to healthcare services. Their coordination in services delivery is very much essential in the fight against the virus transmission under policy directives of the national committee. This decision can be helpful in fighting the virus and continuing regular services for other patients.
The stigmatisation of simple sneezing or coughing is becoming a major social problem in describing the people involved in the negative lens and this causes multiple healthcare, mental, and social problems. Side by side, migrant people are facing a negative impression from society; many of them are encountering physical and mental harassment, including stealing and robbery. I hope everyone will get the proper support under the governance framework, eg, the government, the media and social psychologists in coordination with local people, health professionals and the law enforcement agencies.
Everybody who is directly or indirectly involved in contributing to others, from relief distribution to cleaning in localities, need proper protection keeping to WHO guidelines. Sometimes volunteers with lesser protection are distributing foods in localities. Some small healthcare facilities are getting higher quantity of medical supplies while large facilities are left with limited supplies. The national coordination committee needs to address the issues.
The third point is to reduce the transmission with the stay-at-home protocol at the community level. Since the beginning of this emergency, the government focuses on law enforcement agencies in implementing the decision. I think this is a social issue and it needs a socio-psychological model along with health care services. Law enforcement could be a supportive resource in executing this model. Most of the people are at home now despite their chronic condition of diabetes and high blood pressure. They do not have the scope of going outside for physical exercise or getting the regular check-up. Many people with disabilities need to have the regular medication as well. People staying at home for a prolonged period are faced with an extreme level of stress for their own safety, food, and concern about their dear ones. Children are stuck at home. Mental health professionals can be very helpful resources to deal with this stress in coping with this emergency time. Different types of media for different groups may provide additional supports in this context.
Family planning mechanisms need to be streamlined to ensure a healthy life of people staying at home. For this purpose, birth control devices need to be available with local pharmacies. The media could play a significant role in creating awareness of family planning issues. Otherwise, population growth may increase in the next years; it will increase the government expenditure and slow down the economic development.
The government needs to know why some people are going outside despite the government’s instruction for stay-at-home protocol. A lower number of test means a lower number of results whether it is positive or negative. This may raise questions about the term ‘corona emergency.’ As far as I am informed, a significant portion of vegetables, fruit and egg are rotting whereas city dweller are suffering from their scarcity and higher prices because of the social isolation policy. This has long-term effects on farmers. If they fail to get prices, they will lose their investment that may cause their downward mobility or poverty. This may be one reason that some people are going outside breaking the decision on social distancing.
Religious affairs leaders play a better role following the code of conduct of the holy books related to religious gatherings and the importance of staying at home. Their statement could be circulated on the print and electronic media as other statements contributed by singers and actors. This could reduce the gap between the government approach and people who practise religion. Every political party as part of the national committee could convince party supporters to stay at home and contribute to this government effort. We have trained volunteers for thousands for disaster management in Bangladesh. They can perform an active role in coordinating with the local government under the directives of the national committee. Large NGOs such as BRAC, Grameen Bank, and Proshika have their own organisational system and have millions of active beneficiaries that can, in coordination with local government, play an effective role in creating social awareness and ensuring that people stay at home.
WHO suggested using hand sanitisers and surgical masks to reduce the risk although these items are not readily available on the market. At times, it is sold for prices higher than the regular market prices. The local government needs to monitor the market in coordination with pharmaceutical companies to ensure the availability and prices under the directive of the national committee. Again, many pharmacies are found closed and this is not a good approach to making life stable.
Here, the major question is social justice. Poor people staying at home because of the lockdown cannot maintain their decent life without supports from the government, private organisations and well-to-do citizens as they live from hand to mouth. The government allocates Tk 5,000 crore for export-oriented industrial sectors to pay workers their wages. This is a very good initiative. I hope the money goes to the people who need it most and is used in a transparent and accountable way. The government is also also offering food grains through its open market sales programme in the city. I saw this in Dhaka and would like to see it in other cities. Again, I hope every group of people such as people with disabilities and the elderly get this service in a proper way to lead a decent life. Again, the government is repeating its commitment to continue with different social services such as Food for Work, Vulnerable Group Feeding. As far as I know, social protection programmes of this type are not enough to ensure a minimum decent life for all of the poor people. The government may increase the number of beneficiaries, specifying the geographic aspect such as rural-urban, coastal area, drought-prone areas or hill areas. The rich may begin their donation from home for domestic helps, drivers, poor relatives, poor community members, and own farm workers before stepping on to the macro level.
However, donation needs better coordination on small and large scales to ensure inclusion, transparency and accountability. On a smaller scale, multiple aid work is moving in to local areas to supplement the government’s social protection programmes. Many people, individually or collectively, are providing grocery items, rice, medical supplies, money, or food to them. A better coordination may help to avoid duplication and to fulfil the needs of the people in demand. Union councils in rural areas and municipal or city corporations in urban areas can make this coordination successful with the supports from the law enforcement agencies under the directives of the national committee.
On a large scale, different companies such as the Bashundhara Group are planning to set up hospitals. Non-governmental organisations such as BRAC are donating hospital supplies to ensure better services to patients. Different institutions are donating employees’ salary to ensure a descent life for the poor. I hope that they do this on humanitarian grounds without any intention or private interests. I firmly believe the government has better plans in using this donation in reducing the poor people’s sufferings with the special considerations of geographic locations, class-specific identities, gender dimension and disabilities.
Local government agencies such as city corporations, municipal corporations district councils, upazila councils and union councils can coordinate all of such activities to make this effort successful as they are elected representatives. Every union council member or ward councillor has every possible information such as who is new in the locality and who is suffering from what types of health problems. The task, stay-at-home or lockdown, can be easier with their active roles. As this is an emergency time, parliament members can coordinate with the local government to fight this virus. Here, local non-governmental organisations and civil society can actively take part in this coordination committee. The army can be an active part of this committee to ensure good governance in relief distribution and in implementing the stay-at-home order.
Future direction of governance approach
GOVERNANCE approach is dynamic. Decision and execution strategies may be revised depending on field-level feedbacks of different professional groups such as health services providers, law enforcement agencies, army, and other service providers to reduce the infection and make people’s life normal in terms of health care and access to food. Definitely, we are encountering new experiences every day and this will be helpful in reviewing our understanding of vertical and horizontal governance about institution, participation, research, development, environment and humanity in the context of before, during, and after coronavirus emergency perspectives.
Dr M Anwar Hossen is a professor of sociology in the University of Dhaka.
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