23 minute read
A- Faridabad
FARIDABAD
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Apoorvi Gupta PG190172
A1. About the City
The city of Faridabad lies in the South-eastern part of the state HARYANA and is also situated in the NATIONAL CAPITAL REGION bordering the Indian Capital New Delhi. It is one of the major satellite cities of Delhi (25kms) and is located 284 kilometres south of the state capital Chandigarh. It is an essential Industrial Hub for Haryana and a prominent stakeholder for driving the economy of the state. Around 50% of the income tax collected in Haryana is from Faridabad and Gurgaon. The city is also famous for henna production from the agricultural sector, while tractors, motorcycles, switch gears, refrigerators, shoes and tyres constitute its primary industrial products. It was included it in the fast track list of Round 1 of Smart Cities Mission on 24May,2016 by the Government of India.
A1.1. City Demographics
The city shares its boundaries with New Delhi to the north, Noida to the east, Palwal to the south and Gurugram to the west. Delhi-Mathura National Highway No. 2 (SherShah Suri Marg) passes through the middle of district/city. Longitude: 77°18’28” E Latitude: 28°25’16” N The city has an area of 741 sq km with a population nearly about 18,09,733 (Census 2011). Density/km2 is 2,442 with a projected population growth rate of 32.54%. Migration Influx for the state: 8Lakh (registered) with majority of them belonging from Uttar Pradesh, Madhya Pradesh and Bihar. Altitude: 198 metres above sea level STD Code: 0129
Figure A1 Map of Faridabad with it’s adjoining cities Source: https://bharatmaps.gov.in/map.aspx?dtcode=088
A1.2. Organizational Capability
During COVID, apart from the Corporation of Faridabad, various other segments amalgamated for a successful management of the pandemic within the city, namely: 1. COVID Control Room Responsible for public assistance with a 24*7 helpline number and Co-ordinating with the other segments 2. MCF Control Room Sanitization of the City, Dead Body Management, COVID Medical Waste Management and Identification of cases. 3. CMO Control Room Collecting and Monitoring Data, maintaining and updating data, Reporting the status to DC Office everyday and Assisting the people. 4. Police Control Room Maintaining law and order within the city and monitoring the follow up of norms and strategies
A2. Current COVID19 Scenario in the City
The first case in the city was registered on 20th March 2020 and ever since then Faridabad has been the highest affected city in Haryana. As of 31st October,2020 the city had 25,297 Confirmed cases, 1,258 Active cases, 23,793 Recovered cases and 246 Deceased cases. The active and recovered ratio are 4.9% and 94% respectively. The city reached its peak by the mid of Unlock phase 1 or Lockdown 5.0 and had started decreasing in terms of confirmed and active cases, but a second wave of the virus can be seen taking over the city. Post unlock phase 3, wherein the majority of activities were back to their course of action; an increase in the number of cases is visible, requiring some change in actions and strategies.
Figure A2 Timeline Source: https://www.covid19india.org/state/HR
A2.1. Strategies
To combat the pandemic various strategies were implemented in the city both during the lockdown and unlock phases, namely:
A2.1.1. During Lockdown Phases
• Essential Services (did not shutdown): Firstly, all the Kirana shops, petrol pumps, street vendors, milk shops; were allowed to function between 11AM to 5PM every day except on Sundays. Wholesale vegetable and fruit markets were allotted a time slot form 6AM to 11AM. Secondly, all Hospitals, Banks, Telephone services, Media, IT Services etc, were granted the permission to operate for whole day. Services like petrol pumps, LPG stations and chemist shops were allowed to function throughout the day. Lastly, all government offices related to providing services such as: Sanitation, Water Supply, Sewerage, Electricity were permitted to function without any restrictions. • Labourers and the poor To restrict the movement of unwanted labourers, accommodation to the same was arranged ensuring social distancing norms at community centres, dharmshalas, schools, colleges etc where proper arrangement of toilets and drinking water exits. It was mandatory that they should be provided two meals a day in form of cooked food packets or dry ration, and the expenditure for the same could be booked to State Disaster Relief fund for which an amount of Rs, 1 Crore has already been sanctioned to each district. Other than this a list of 47 NGO’s was listed down for each ward which is responsible for supplying the essentials to poor and needy people. • Mandatory Restrictions A lot of activities and services went through mandatory restrictions and boundations, in order to prevent the outbreak and control the cases. Few of them were: Sealing of the borders, Issuing of the movement pass for moving inter as well as intra city, Rapid testing, demarcating the containment zones (160 approx.), IEC Activities to spread awareness and persuade people to come forward and get tested. Apart from that, Section 144 was implemented throughout the city and movement for non-essential items within the city was “strictly prohibited” between 7PM to 7 AM. A COVID mitigation plan was set up by the city. Gathering was restricted to a total number of 50 people and sanitization of public spaces took place on regular bases. Cinema halls, shopping malls, gymnasiums, sports complexes, swimming pools, entertainment parks, theatres, bars, and auditoriums were shut down.
A2.1.2. During Unlock Phases
The unlock phase 1.0 throughout the state initiated from 1st June,2020, wherein for Faridabad, the city being demarcated as a red zone, it was more of Lockdown5.0. The actual unlocking commenced from 1st July,2020 with opening up of few services and with a motive to bring back the city on the track. Few of the activities that opened post Lockdown5.0 are: Firstly, all government offices opened in full capacity, interstate movement of goods and people were permitted (no e-permit required) and sporting activities could now start from 5AM instead of 7AM. Secondly, hotels, restaurants, malls, salons, beauty parlours reopened in accordance with a defined SOP, ensuring social distancing and sanitisation of focal points. (Timing: 9AM to 8PM) (Visitors >65 and <10 years of age not permitted). Lastly, wearing of masks became compulsory throughout the city and challans were filed in case not found wearing. Gyms came into functioning from 5th August,2020 and various other public spaces like temples also reopened
A3. Overview Of the COVID19 Management in the City
The city can be classified into three major aspects for management, starting from identification to prevention.
A3.1. Identification and Testing
Identifying can be described as the process of recognizing the people who have been a victim of COVID19. It comprises of locating, examining and testing the patient/suspect, and on the basis of the result, carrying on the further process of quarantining, treatment and finally discharging. Faridabad abides by the rules and regulations laid down by the state government of Haryana. According to the COVID19 Management Plan for the city, there are two ways of identifying and surveying the suspect: 1. Active Surveillance 2. Passive Surveillance The city follows SOP’s for molecular testing, i.e., RTPCR, Rapid Antigen and CB-NAAT/True NAAT. The cost of the testing at government labs is borne by the government, wherein for the authorised private labs it has been fixed to a maximum rate of Rs. 2200. Post testing, the case is classified into four categories, i.e., • Asymptomatic or very mild symptoms (Fever) • Mild Case (Fever) • Moderate Case (Pneumonia with no sign of severe disease) • Severe Case (Having Respiratory issues and requires to be on ventilators)
A3.2. Treatment
(A) Quarantine The process initiates when, either the person has a travel history, or the person has been tested positive or if the person came in contact with a positive tested patient and is taking precautionary measures oxygen supply] depending on the grade of the symptoms. Treatment Costing: The cost of treatment at the Government dedicated hospitals is free of charge including medicines, food and other services Dead Body Management: In case the person dies during the COVID process, the dead body is managed by the Municipal Corporation. The Corporation has 4 teams in total that are responsible for carrying the body till the cremation ground while abiding by the laid down norms. The Corporation needs to make sure that not more than 20 people are allowed to be at the cremation ground.
to prevent it from spreading further. Apart from this, quarantine can be defined as the separation of people and restriction on the movement with a purpose of preventing transmission. People with very mild or mild symptoms (Stage 1 and 2) are quarantined. On testing positive with very mild or mild symptoms, the person is mandatorily advised to home isolate or get admitted to an institutional based facility depending on the grade of infection. In Faridabad there are a total of 17 non-medical government COVID Care Centres, 3 medical government COVID Care centres and 33 private COVID Care centres.
Figure A3 Types of Quarantine Facilities in the City Source: Primary
(B) Hospital Moderate and Severe case patients (Stage 3 and 4) are admitted to Dedicated COVID Health Centres (DCHC) [they are basically hospitals or separate blocks in hospital having beds with oxygen supply] OR Dedicated COVID Hospital (DCH) [they are hospitals with fully equipped ICU, ventilators and
A3.3. Monitoring and Surveillance
To prevent the outbreak of the of the pandemic within the city, the government took various measures, including: 1. Imposing of Strategies 2. Sanitization of the City -The sanitization of the public spaces is done by the Corporation of Faridabad. The corporation has: • 6 Vehicles (Fire Tenders, Road Sweeping Machine having spray facility) • 70 non-motorized manual back loading machines • 6 motorized back loading machines A positive tested citizen can also avail the sanitization facility by placing a call at the corporation, free of charge. Private sanitization starts at a cost of Rs. 200 according to the house area 3. Barricading the Containment Area The police are responsible for barricading the red zones/ containment zones and keeping a surveillance over the same. 4. Penalization on Violation The police department is responsible for imposing the challans and penalties over the ciizens to oppose following of the norms and the guidelines.
A4. COVID19 Management Process Analysis A4.1. SWIMLANE Diagram
Inferences: The swimlane tool helps understand the process flow and how the activities are connected to one another. It swimlane gives an intricate detailing of how the process works in the city, starting from the feeling of the symptoms to the patient finally being recovered. In Faridabad the process initiates from
Suspect Or Patient
Doctor
Medical Officer at IGI Airport Priavte Or Government Technician COVID Control room Supervisor Civil Dispensary MO/ANM Worker Institutional Facility Supervisor Dedicated COVID Hospital MO Chief Medical Officer: CMO (ESIC Team)
The person having ILI/SARI symptoms or Travelling inter-state/city
Symptoms still prevailing
On call consultation with the doctor and receiving medication
Received at the Airport by Medical Team and asked about travel history
Seeking assistance from control room for the further procedure
Going to a private lab for RT-PCR testing Going to a government lab for RT-PCR testing
Directed towards nearest civil dispensary for rapid antigen testing
D
Result Awaited
identification and testing, to the patient being quarantined or admitted to an institutional facility or the hospital based on their grade of infection and ultimately recovering. People over the age of 60 are mandated to be admitted to the hospital irrespective of them having any grade of symptoms. Corporation Employees, Police Officers, Health Workers, Medical Officers, Lab Technicians and DC are the few major stakeholders in the process of managing COVID within the city.
Recovered Patient
Negative Very Mild/Mild Moderate Severe
Home Quarantine Non-Medical Govt. CCC Private CCC
Admitted to hospital depending on the grade of infection
The ANM worker puts a sticker and demarcates the property
Information of daily cases updated, collected and monitored at CMO Room Reporting to DC
Call received for next 14 days Day 6-20
Notified for re-testing
Inferences: After understanding the process via swimlane, the COVID19 management within the city can be bifurcated into three major categories, namely, Identification, Treatment and Monitoring and Surveillance.
Key Process Area: COVID19 management services Trigger Event Process Name The person falling sick A-Identification and and feeling symptoms Testing such as: fever, cough, sore throat etc. The person tested B-Treatment: positive with mild Quarantine symptoms The person tested B-Treatment: positive with moderate or Hospital severe symptoms Patient mandatorily asked C-Monitoring and to Quarantine Surveillance
Table A1 Process Identification
A4.3. Process Profile Worksheets
A4.3.1. Identification and Testing
Inferences: The process profile worksheet for Identification focuses on identifying th positive cases in the city with its major service risks being: Unavailability of a doctor, Miscommunication, Error with the reports and shortage of antigen kits; to which the corresponding key controls identified are: having a contact information of more than one doctor, reconfirming what was communicated, Trained and skilled staff and maintaining and inventory. Process Name – Number Process Owner
Identification and Testing
Identifying the positive cases in the city Civil Dispensary Medical Officer Description
Event beginning
Event ending
Triggers The person falling sick and feeling symptoms such as: fever, soar throat, body ache, etc. Confirming the result post COVID testing Additional events Calling the doctor, Receiving the medication, Seeking assistance regarding the nearest authorized civil dispensary, Providing information on the recent whereabouts and travel history, Going for the test. Inputs – Items and Sources Call(Suspect), Information on Travel History(Suspect), Assistance with locating of dispensary(COVID Control Room Supervisor), Submitting the sample(Suspect) Outputs – Items and Customers Test Result(Civil Dispensary Medical Officer) Process Units Process Unit Owners Placing a Call Suspect Assistance with locating of dispensary COVID Control Room Supervisor Conducting the test ANM Worker Service Objective(s) Service Risks
To identify the maximum number of people in the city with utmost accuracy
Miscommunication/Lack of understanding Shortage of rapid antigen testing kits Unprofessional Sample Collection Error with the Report Key Controls Measure of Success Re confirming what was communicated Maintaining an inventory No. of people assisted by the control room via calls (Reaching out to max. people)Properly trained and skilled team Number of Positive Feedbacks (Assistance) SOP for sample collection and testing Maximum no. of samples collected and tested
Process Name – Number
Process Owner Treatment: Quarantine CMO Control Room Description The patient asked to self quarantine or admitted to an institutional non medical government COVID Care Centre according to the grade of infection Triggers
Event ending
Patient Recovery Additional events Informing the patient, Monitoring the patient and having a daily status update, Notifying for a retest post 14 days, Co-ordinating with CMO Control Room Inputs – Items and Sources Call(Civil Dispensary Medical Officer), Quarantine Facility(Civil Dispensary Medical Officer), Call(CM Office Employee)
Outputs – Items and Customers
Recovery(Patient) Process Units
Process Unit Owners Informing the patient Civil Dispensary Medical Officer Quarantining at Institutional Facility Institutional Facility Supervisor Monitoring patient’s health status CMO Employee Service Objective(s) Service Risks
Key Controls SOP for maintaining hygiene Regular Food Quality Check Keeping a regular check on the patient SOP for testing Untidy Environment Degraded Food Quality Patient avoiding getting retested Error with the new report Measure of Success
Maximum Number of Recovered Patients Positive Feedback/Rating received for the Institutional Facility
A4.3.2. Treatment: Quarantine
Inferences: The process profile worksheet for Quarantine focuses on asking the patient to self quarantine or admit to an institutional non medical government COVID Care Centre according to the grade of infection with its major service risks being: Untidy Environment, Degraded Food Quality, Meals not provided timely, Patient avoiding getting retested or Error with the new report; to which the corresponding key controls identified are: SOP for maintaining hygiene, Regular Food Quality Check, Management plan for food distribution indicating duties and responsibilities, Keeping a regular check on the patient (till proven negative), Properly trained and skilled Team and SOP for testing.
Figure A4 Vector Image depicting the visual of Identification and Testing Source: https://pngtree.com/
Process Name – Number
Process Owner Treatment: Hospital Dedicated COVID Health Medical Officer Description The patient admitted to a hospital due to high grade infection Triggers
Event ending
Patient Recovery Additional events Informing the patient, Admitting the patient, Providing the suitable treatment, Monitoring the patient and having a daily status update, Notifying for a retest post 14 days, Coordinating with CMO Control Room, Death (If unable to recover) Inputs – Items and Sources Call (Civil Dispensary MO), Hospital (Dedicated COVID Health Medical Officer, Call (CMO) Outputs – Items and Customers
Recovery/Death (Patient) Process Units Process Unit Owners Admitting the patient to the hospital Dedicated COVID Health Medical Officer Monitoring patient’s health status CMO Employee Co-ordinating with the CMO Control Room Dedicated COVID Health Medical Officer Service Objective(s) Service Risks
Shortage/Miscommunication regarding beds Shortage of medicines, medical equipments Patient avoiding getting retested Untidy Environment Key Controls Measure of Success Centralized bed management system Maximum Number of Recovered Patients Having an inventory for both Positive Feedback/Rating received for the Keeping a regular check on the patient Hospital SOP for maintaining hygiene
A4.3.3. Treatment: Hospital
Inferences: The process profile worksheet for Hospital Treat focuses on making sure that the patient is admitted to the dedicated hospital facility due to his/her high grade infection, with its major service risks being: Unavailability of the beds, Shortage of required medicines and medical equipments, Untidy Environment, Patient avoiding getting retested, Error with the new report, Dead body mismanagement; to which the corresponding key controls identified are: Co-ordinating with the increasing cases and laying new facility if required, Maintaining an inventory both for medicines and medical equipments, SOP for maintaining hygiene, Keeping a regular check on the patient (till proven negative), Properly trained and skilled Team and SOP for dead body management.
Figure A5 Vector Image depicting the visual of Hospital Treatment Source: https://pngtree.com/
Process Name – Number
Process Owner Monitoring and Surveillance Government Description Prohibiting further spread of the symptoms in the area due to a COVID positive tested patients Triggers
Event beginning Patient tested positive and mandatorily asked to quarantine
Event ending
No new cases suspected Additional events Demarcating the house, Sanitizing the area, Restricting the movement outside the house, Barricading the Containment areas, Ensuring following up of the norms Inputs – Items and Sources Sticker outside patient’s house(ANM worker), Sanitization(MCF), Barrication (Police Officer) Outputs – Items and Customers Abridgment of the symptoms(Government) Process Units Process Unit Owners Demarcating the property ANM Worker Sanitizing the house and the surroundings MCF Employee Penalising for violation Police Officer Service Objective(s) Service Risks
To prevent further spread of the disease Unavailability/Breakdown of the Sanitizing Vehicle/Equipment People removing the stickers People violating the norms Negligence towards Contact Tracing
Key Controls Measure of Success
A checklist ensuring proper maintenance and availability of the Vehicle Daily surveillance on the demarcated houses Heavy Penalty for violation SOP for Contact Tracing No new cases suspected in the area Timely Monitoring
A4.3.4. Monitoring and Surveillance
Inferences: The process profile worksheet for Monitoring and Surveillance focuses on prohibiting the further spread of the symptoms in the area due to a COVID positive tested patients with its major service risks being: Unavailability of the Sanitizing Vehicle/Equipment, Breakdown of the vehicle, Negligence towards Demarcating the house, People removing the stickers, People violating the norms, Negligence towards Contact Tracing, Lack of monitoring, Internal Staff miscommunication; to which the corresponding key controls identified are: A checklist ensuring proper maintenance and availability of the Vehicle, Daily surveillance on the demarcated houses, Heavy Penalty for violation, SOP for Contact Tracing, Rapid Response Team, Monitoring the monitoring team and a Proper laid out monitoring plan.
Figure A6 Vector Image depicting the visual of Prevention Source: https://pngtree.com/
Process Name Patient/ Suspect Doctor Medical Officer at IGI
Identification and Testing Treatment: Quarantine Treatment: Hospital Monitoring and Surveillance R C R
R
R
R Private/Govt. Technician
CCC Supervisor
Civil Dispensary MO/ANM
R R A
R
R
R Institutional Facility Supervisor
I
R
DCH Medical Officer CMO (ESIC Team) DC
I I
A I
A R I
A
Table A6 RACI Chart depicting Roles and Responsibilities of all the Stakeholders Inference: The RACI Diagram shows the various stakeholders, i.e., the patient, doctor, medical officer at IGI Airport, Government and private lab technicians, COVID Control Centre Supervisor, Civil Dispensary Medical Officer, ANM Team, Institutional facility Supervisor, DCH Medical Officer, Cheif Medical Officer and District Commissioner who are Responsible, accountable, consulted and informed respectively in all the processes that are followed in the COVID-19 management in the city. The above chart infers that all the tasks require involvement of the dispensary MO of every ward and DC is informed at every stage.
A4.5. Servqual: RATER Analysis
Servqual Tool helps digging into the depthness of an issue by supporting it with the help of citizen’s opinion. For the city of Faridabad, a survey was conducted on 3 parameters, namely: Mobile Testing, Helpline Assistance and Sanitization. The survey contained the expectation and the perception for each service and was floated among the citizens, wherein the citizens were asked to rate each of them on a scale of 1 to 7, where: 1 meant Highly Disagree and, 7 meant Highly Agree A total of 25 questions were framed, euqually distributed among the 5 aspects of RATER, i.e., Reliability, Assurance, Tangible, Empathy and Responsiveness. The questions that received the maximum P-E gap were established as the areas of improvement within the city while the ones that has the minimum gap were benchmarked as good practices for other cities.
A4.5.1. Mobile Testing Inferences: Good Points:
1. The sample collection team in the city wears proper medical gears abiding by the norms. 2. A new kit is unpacked prior to every new test. 3. The FLW is polite and trained enough to explain the procedure before testing and assist the patients throughout the process 4. The result of the report comes within the promised timeframe.
Areas of Improvement:
1. The city lacks the facility of government based door to door testing, which can be an area to improve for a better and an efficient management.
A4.5.2. Helpline Assistance Inferences: Good Points:
1. The staff is polite and patient enough to answer to all the queries being asked, making them empathetic towards their citizens.
Areas of Improvement:
1. There is no proper awareness and display of respective control room numbers for the citizens on any platform. 2. There is a lack of system that reconfirms the citizens about their issues being administered or not. Also, no complaint redressal service is available to cater to the problems being faced by the citizens within the city.
A4.5.3. Sanitization Inferences: Areas of Improvement:
1. Majority of people lack awareness about the facility of sanitization being provided by the government, of which few who know, are unaware of whom to reach to. 2. Of those who manage to reach out to the concerned authority, are unsatisfied with the service not being provided on time. 3. No initiation can be seen from the government end in terms of sanitizing the house/area of the affected person. An integrated internal communication system seems to be lacking within the government segments.
Figure A7 Gap Analysis for Mobile Testing Source: Primary Figure A8 Gap Analysis for Helpline Assistance Source: Primary Figure A9 Gap Analysis for Sanitization Source: Primary
The FMEA (Failure Mode and Effect Analysis) Tool helps in root cause analysis of an issue. The RPN (Risk Priority Number) defines the most critical aspect of the parameter. FMEA identifies the potential effects of failure and it’s causes. Higher th RPN value, higher is the risk. For the city of Faridabad, FMEA was performed for two processes: 1. Decentralized Treatment: Bed Allotment at Institutional Facility 2. Sanitization of the area RPN over here is calculated based on the score of severity, frequency of the occurance and probability of detectability.
RPN: S*O*D
The criteria for risk assessment: RPN < 64 - Tolerable risk 64 < RPN < 480 - Controlled risk RPN > 480 – Unacceptable risk, needs to be priorotised and modified immediately.
Inference:
From the FMEA for Decentralized Treatment: Bed Allotment at Institutional Facility, it can be inferred that the potential failure mode is improper data being provided by the authorities. Internal Miscommunication within the segments and Misrepresentation os data are the key causes of failure. The RPN Scoring of 512 depicts that this parameter needs to be catered on priority basis and a recommendation in it can make the system more organised and efficient.
The key recommendation would be introducing a centralized bed allotment system, wherein for all the hopitals in the city, a common live dashboard would exist, which shall be managed by the team of CMO and the team shall be responsible for updating and managing the status of bed availibility in the hospitals everyday. Such a system will influx transperancy within the management and people will be more inclined towards the efforts being made by the government.
Inference:
From the FMEA for Sanitization of the area, it can be inferred that the potential failure modes are both long waiting period and Inefficient Sanitization. Lack of a proper communication channel for and on time service (C2G) and Lack of internal communication (G2G) are the key causes of failure. With a RPN Scoring OF 648 and 630 respectively, both the parameters need to be administered paralelly in order to have a system that is seamless, userfriendly and structured. The key recommendations would be introducing a one call service system, wherein the citizen needs to make a single call, and the responsible authority shows up within the promised timeframe. Other than that, another solution can be a centralized portal, wherein all the responsible segments for COVID management are integrated on one single platform and are automatically updated with the everyday cases and perform their duties accordingly without creating any chaos.
A5. Service Concept
Organization: Government of Faridabad. Organizing Idea: To incessantly cater the people of the city, while minimalizing their movement, providing services to look after their health and nurturing their needs during the pandemic. Service Concept: The service concept is centered around creating an ecosystem that serves to the needs of its citizens by providing healthcare, food, shelter and a secured environment –all available at one place. It also focuses on spreading awareness about the measures to be taken to prevent it from spreading further, i.e., mandatory masks, sanitizing and social distancing.
Service Provided:
• Screening and monitoring • COVID Care Centres • Demarcation of Containment Zones • Rapid Testing • 24*7 Helpline Numbers • Isolation Check • Provision of PPE kits • Medical Supplies to the first respondents • Shelter homes for migrant workers • Relaxation in paying bills/taxes • Online App integrating essential services • Listing down of NGO’s for providing food to the poor • IEC to create awareness • Defining SOP’s for opening and monitoring of public amenities
Service Received:
• Quality and timely treatment • Regular and responsible monitoring • On call services through helpline numbers • Provision of safety gears • Sanitized and safe surroundings • Free Testing
Figure A10 Service Audit Profile Source: Primary
