ABSTRACT
The world is likely to remain vulnerable to health emergencies of different types and scales due to many precipitating factors acting individually or jointly. Experience has shown that states that have confronted emergencies in the past and are better prepared, having learned their lessons from experience, respond better. Kerala has been dealing with a series of emergencies in recent years. These include the Nipah outbreaks of 2018 and 2023, the floods of 2018, and the COVID-19 pandemic. In a crisis, community engagement, along with risk communication, is an important component of crisis management. A strategy for engaging the community is decentralising governance to levels as near to the community as possible. Kerala has implemented decentralisation as envisaged in the 73rd and 74th amendments of the constitution, along with financial delegation, including public health.
Objective: This chapter will examine how lessons from the way Kerala handled these crises can contribute to preparation in handling future health emergencies. While the chapter deals specifically with Kerala, the recommendations can be generalised to other low-resource settings.
The chapter uses the framework on pandemic preparedness to review past performance and future preparedness in Kerala. Governance and health system characteristics that can impact pandemic preparedness, past performance of the state, and reforms that emerged from experience have been collected from the literature and analysed using the World Health Organisation (WHO) frameworks. Policy recommendations have been derived from this analysis. The factors that precipitated COVID-19 could create new health emergencies of a similar or even larger magnitude in the future. This makes it possible for us to use the experience to identify factors that need strengthening. Such preparation is expensive. However, the cost of prevention is insignificant compared to the cost of economic and social disruption a health emergency can cause. Therefore, it is sensible for states to develop a roadmap for building capacity and systems to respond to such crises. The best guidance for such preparation can be provided by studying past crises.
