Wednesday, July 22, 2020

How Dharavi, Asia’s biggest slum, fought against COVID-19

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Inshiya Nalawala

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How Dharavi, Asia’s biggest slum, fought against COVID-19

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Global Views 360

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July 22, 2020

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A still from Dharavi, Mumbai

A still from Dharavi, Mumbai | Source: M M via  Flickr

Imagine a place where 8-10 people live in 100 square feet structures. A place which squeezes close to 6,50,000 people, 5,000 small factories, and about 15,000 single-room workshops in just 2.5 square kilometer area. Welcome to  Dharavi, the biggest slum of Asia situated in the heart of fashion, entertainment, and commercial capital of India, Mumbai.

When the first COVID-19 case was discovered in Dharavi, it caused massive panic among the citizens as well as officials. Social distancing is virtually impossible to achieve in Dharavi, which is a maze of narrow congested lanes with tenements on either side of it and where 80% of the population use community toilets.

With their fingers crossed, people were speculating about Dharavi turning into a graveyard. These fears turned out to be misplaced and three months later Dharavi won praise from the WHO for effectively restricting the spread of coronavirus. According to the official data, the COVID-19 case doubling rate improved greatly, from 18 days in April, to 43 days in May, to 108 days in June, and 480 days in July.

Mr. Kiran Dighavkar, Assistant Commissioner of the top civic body of Mumbai, Brihanmumbai Municipal Corporation (BMC) said that their undertaking of an aggressive strategy of 4T’s - Tracing, Tracking, Testing & Treating, is the key to Dharavi’s successful fightback against the pandemic. The fightback plan was aptly coined "Mission Dharavi".

Extensive screening and testing of residents was done to detect the symptoms for coronavirus in "fever camp" which were set up by medical workers in different parts of the slum everyday. Many buildings such as schools, wedding halls, and sports complexes were overtaken by the civic authorities and were repurposed as quarantine facilities. A 200-bed hospital was also set up in record 14 days.

The BMC commissioner, I S Chahal said “Proactive screening helped in early detection, timely treatment and recovery.” Close to six hundred thousand people were screened, 14,000 people tested and 13,000 quarantined in nearby institutions, schools, marriage halls, and sports complexes. Furthermore, continuous monitoring of people’s movement using drones helped reinforce containment measures and scaled progress swiftly.

To further strengthen the measure, locals of the community emerged as “COVID Yodhas” (warriors) to address the concerns, a senior official said.  Many well endowed citizens and NGO’s provided Free meals, ration, PPE gear, oxygen cylinders, gloves, masks, medicines, and ventilators to residents and doctors.th July

On 8th July 2020 Dharavi recorded a total of 2,335 COVID-19 out of which 1,735 patients have recovered and there are only 352 active cases at present. Only 82 deaths were recorded in Dharavi till 8th July as against more than 4500 in the whole of Mumbai.

This phenomenal success has given the world a yet simple and effective technique in curbing the spread of the deadly virus. World Health Organization (WHO) chief Tedros Adhanom Ghebreyesus, in a virtual press conference in Geneva, acknowledging the efforts of various nations and Dharavi to contain the virus, said that “There are many examples from around the world that have shown that even if the outbreak is very intense, it can still be brought back under control”. Further, he added, “And some of these examples are Italy, Spain, and South Korea, and even in Dharavi -- a densely packed area in the megacity of Mumbai -- a strong focus on community engagement and the basics of testing, tracing, isolating and treating all those that are sick is key to breaking the chains of transmission and suppressing the virus.”

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February 4, 2021 4:52 PM

Randomised Control Trials and the Alleviation of Poverty in India

Abhijit Banerjee and Esther Duflo won the 2019 Nobel Prize in Economics for their “experimental approach in alleviating global poverty”. Their experimental approach encompassed a variety of novel methods to understand and analyse interventions and Randomised Control Trials (RCTs). Their research has been used by policy makers to make informed policy decisions to best help the marginalised.

What are RCTs?

To understand the effect of a policy, intervention, or medicine, decision makers try to measure the efficacy of the treatment. Do deworming pills given to children improve test scores? Does providing chlorinated water improve the health and economic outcomes of villages? These are some causal (read causal, i.e. caused by, not casual) questions researchers are interested in. The best way to analyse causal effects is to randomise the selection of people in the treatment and the control group (for example: children who are given deworming pills versus children who are not given the pills). This random selection of the two groups removes many statistical biases that might affect the results.

RCTs in India:

Many of the RCTs performed by Banerjee and Duflo were in India. They involved short- and long-term impact assessments of various interventions, policies, models, and treatments. We look at a few RCTs implemented in India:

Teacher absenteeism rates:

Troubled by the low attendance rates (or high absence rates) of public-school teachers in India, Duflo assessed the impact of financial incentives on the absence rates of teachers in Rajasthan. The study monitored teacher attendance by cameras, which was tied to a financial incentive if the attendance was high. From a baseline absence rate of 44%, teacher absenteeism in the treatment group fell by 21%, relative to the control group. High teacher attendance caused child test scores to improve too.

COVID-19 and health-seeking behaviour:

In the context of COVID-19, Banerjee tested the effect of sending messages via SMS that promoted health preserving behaviour. The results were very positive. By sending a short, 2.5-minute clip to 25 million randomly selected individuals in West Bengal, the intervention i) found a two-fold increase in symptom reporting to village health workers, ii) increased hand washing rates by 7%, and iii) increased mask-wearing by 2%. While mask-wearing rates increased only marginally, the spillover effects (wearing a mask stops the virus from infecting more people) were moderately high and positive.

Asset Transfers and the Notion of Poverty:

An RCT by Banerjee in West Bengal involving a productive asset transfer accompanied with training found large and persistent effects on monthly consumption and other variables. The treatment group reported 25% higher consumption levels relative to the control group, who did not receive the asset transfer and training. Implications of such RCTs are huge. The notion that the poor are lazy and unwilling to perform strenuous labour is falsified by this RCT. Often, what the poor lack are opportunities that are hard to come by, given their financial status. A small nudge, like the asset transfer, can cause large and positive effects on their well-being.  

Salt fortification to reduce anaemia:

RCTs also help rule out less cost-effective interventions. Duflo and Banerjee evaluated an RCT which distributed fortified salt in 400 villages of Bihar, to reduce the prevalence of anaemia. However, this intervention found no statistically significant impact on health outcomes like anaemia, hemoglobin, etc.  Thus, while RCTs help introduce novel methods of impacting the lives of the poor, they also help in ruling out in-effective measures. A policy maker might try other alternatives to reduce the prevalence of anaemia.

Are RCTs the gold standard?

Maybe. Extrapolating results from a regional RCT to national policies could present problems. Contextuality matters. A study that indicates positive gains for one region might present different, and rather adverse effects for another region. Nation wide effects might not be as prominent as regional results of a single RCT. The good part is that Banerjee and Duflo have a solution. Just perform more RCTs!

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