30 minute read
D- Ahmedabad
Table C9 Service Audit Profile
Inference:
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The left side depicts the existing scenario whereas the right side are the suggestions for example in the case of reliability door to door testing is not taking place which is due to lack of man power or their optimization, hence staff recruitment is the suggested recommendation. Similarly under assurance staff training and maintaining a resource inventory is the most optimum suggestion for inefficieny in sanitization.
C7. Conclusion
After an elaborate study of the existing scenario of COVID Management in Lucknow using various management tools and studying the benchmarks of the cities across the country, it can be concluded that Lucknow has a few good services while there are certain areas that need improvement. Teleconsultation services, an integrated COVID control room, and a DSO portal for data record and maintenance are a few key takeaways from the city. The city is performing comparatively good in the Identification and Testing of COVID ‘19 patients whereas lacks the Monitoring aspect. Certain areas of improvement that can be administered are inadequate infrastructure, inefficient sanitization, implementing door to door testing, and contact tracing. These aspects if taken care of, can help the smooth and efficient working of the city in such times without creating an atmosphere of panic among the citizens and also help curb the spread of Coronavirus in the city.
AHMEDABAD
Karanbir Singh PG190439
D1. About the City D2. Current COVID19 Scenario in the City
The city of Ahmedabad, now the seventh largest metropolis in India and the largest in the state of Gujarat, was founded in 1411 AD as a walled city on the eastern bank of the river Sabarmati. It is the home of several scientific and educational institutions of national, regional and global importance. The Municipal Corporation was formed in 1950.
D1.1 Administrative Setup:
The corporation is headed by a Municipal commissioner (Shri Mukesh Kumar), an IAS officer appointed by the government of Gujarat. The city is at present divided into 7 zones - central, east, west, north and south and new west zone. Each zone is further split into wards. There are at present total 48 wards (area 463 sq km and total population of 55,77,940 according to 2011 census). Each ward is represented by 4 corporators. The Mayor (Smt. Bijalben Patel) heads the party with the largest number of corporators elected.
D1.2 Economic Activities:
Ahmedabad has been one of the most important centres of trade and commerce in western India. Modern textile technology further oiled the Gujarati virtues in ‘reinventing’ Ahmedabad. Pharmaceuticals, Construction and Textiles are the main industries of Ahmedabad of today. The town contributes 14% of the total investments in all stock exchanges of India. In Ahmedabad the first case was detected on March 19th , 2020 during the first lock down phase. As of 31st October 2020 (COVID19 India, 2019) the total number of: • Confirmed cases= 42,514 • Recovered Cases= 37,334 • Deceased Cases= 1,902 • Total number of tests done= 16,40,974
Ahmedabad Municipal Corporation was among the early birds who responded actively in containing the COVID19 pandemic. Ahmedabad municipal corporation, in comparison to other municipal corporation, was way ahead in taking immediate actions to cope up with crises situations. Learning from the situations in Italy, China and the United States of America, Ahmedabad city was able to take those measurements which were taken at a later stage to minimise the collateral damage. Even before anyone died or WHO declared Corona as a threat to the human race (30th January 2020), AMC called for an emergency meeting with the all the departments on 24th January 2020. The timeline highlights the 7 major phases in which Ahmedabad
Figure D1 Administrative structutre of Ahmedabad Municipal Corporation Source: https://ahmedabadcity.gov.in/portal/jsp/Static_pages/corp_elec_intro.jsp Figure D2 Zone wise Active Cases of COVID19 in Ahmedabad City Source: https://ahmedabadcity.gov.in/portal/jsp/Static_pages/corp_department.j
Figure D3 Timeline Source: https://ahmedabadcity.gov.in/portal/web?requestType=ApplicationRH&actionVal=loadCoronaRelatedDtls&queryType=Select&screenId=114# Municipal Corporation took necessary steps to tackle to spread of COVID19 (as shown in Figure D3). In Lockdown 1.0: To tackle the immediate spread AMC conducted a Public space Sanitization drive in most vulnerable places of the city. The first order was to issue 3 lakh face masks and bulk orders for sanitizers and Personal Protection Kits to be provided to the Employees. Since Gujarat is well connected with china due to trade and business, it helped them to anticipate the kind of damage which could be caused in Indian cities. Due to this a lot of people were supposed to come back to India from China. AMC started screening of passengers at the Airport.
In lockdown 2.0: AMC launched the Door to door testing van called the Dhanvantri Rath along with Designated COVID treatment hospital with all facilities for a capacity of about 1800 patients. Facility to quarantine up to 5000 patients was set up initially. AMC Started sanitizing AMTS and BRTS bust stands and 950 buses every day which carried 5 lakh people.The daily medical inspection was conducted for the people who were home quarantined after coming back from foreign visits. 17 floors of Sardar Vallabhbhai Patel Hospital were dedicated to the patients of coronavirus, each floor is of the size of a football field. Apart from the existing hospital facilities, different hotels and trains were utilised to accommodate at least 5,500 patients.
In Lockdown 3.0: All the essential requirements of home quarantined people was delivered to them by AMC employees. About 6,000 people received food from good restaurants while being home quarantined. Essentials were delivered at the door step to the citizen with the help of E-rickshaws. During this period Cashless digital payments were made mandatory. In Lockdown 4.0: During this period the positive cases started rising rapidly. To tackle this AMC monitored the super spreaders in 2 stages. 1st stage included the vegetable and fruit vendors. Red stickers were pasted outside on the gates of the houses of patients tested positive for COVID19, and the ones who have completed spending 14 days of quarantine, AMC is pasting green stickers outside their houses. AMC deployed 36 supermarkets (Big Bazar, D-mart, Reliance and Osia).
In Unlock Phase 1 that is AMC has also started an initiative call #SponsorATest in which the donor organizations and individuals can sponsor tests
In Unlock Phase 2.0– Educational institutions were reopend after consultation with local authorities In Unlock Phase 3.0 Permission for managing international travellers was the focus point with other relaxations in the protocols. Other spots of social gathering were given green flag to function at 50% capacity.
In Unlock Phase 4.0: To ramp up the testing process AMC installed kiosks at various locations. Eventually movie theatres, parks and other social gathering areas are getting permission to fuction at full capacity.
FigurFigureFfFigure D4 Newspaper article regarding identification strategy in Ahmedabad Source: Source: https://ahmedabadcity.gov.in/portal
D3. Overview Of the COVID19 Management in the City
Ahmedabad Municipal Corporation along with Ahmedabad Urban Development Authority has set up a COVID war room at Paldi (ICCC office) where all the operations are handled in an integrated manner. Starting from identifying to bring in the patient for treatment in a hospital, everything is handled digitally with the help of a patient tracking system. The following strategies are the ones which have made this challenge doable:
D3.1. 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
Figure D5 Testing Labs in Ahmedabad City Source: https://ahmedabadcity.gov.in/portal/jsp/Static_pages/corp_department.j Figure D6 COVID Case status in Ahmedabad City Source: https://ahmedabadcity.gov.in/portal/jsp/Static_pages/corp_department.j
Figure D7 104 Emergency vehicle in Ahmedabad City Source: https://ahmedabadcity.gov.in/portal/jsp/Static_pages/corp_department.j
Figure D8 Kiosk for Rapid antigen testing at CG Road, Ahmedabad, Gujarat Source: https://english.sakshi.com/photos/
quarantining, treatment and finally discharging. On 15th May 2020, a medical van converted into miniclinic for rapid testing was launched by Ahmedabad Municipal Corporation called Dhanvantri Rath. It also provided non-COVID patients with the essential healthcare services to the doorsteps of the people in the city. Monsoon season at its edge, immediate care of symptoms, reference to UHC, with tests of malaria and dengue, was another motive for which this mobile testing van was launched (Corporation, 2020). If the patient is found COVID19 positive, he or she is made to fill up an online form. The van stays at a place for 2 hours at a spot, catering citizens living in the vicinity of up to 1 km radius. Oximeter are provided to the patient free of cost if home quarantined (Grewal & Jain, 2020). A team of AYUSH Doctor, paramedic and nursing staff along with local Medical Officer from Urban Health Centre of AMC are present in a Dhanvantri Rath van to provide necessary assistance to citizens. The civic authorities have also launched a Special helpline number – 155303 for senior citizens (Age > 60 years) to avail essential goods and can also complain about lack of services or improper civic work. Another initiative was 104 Helpline number which is a 24x7 helpline for people who feel like they want to get tested for COVID19. Antigen test helps in contact tracing. Test results in 15 minutes. The next step in identifying a patient about COVID19 symptoms after Rapid testing is a RT-PCR test (Reverse Transcription Polymerase Chain Reaction). Ahmedabad has 25 test labs where the testing process takes place. Out of these 25 labs, 16 are private labs and 9 are Government labs(as shown in Figure D5). For scaling up the testing numbers, kiosks (as shown in Figure D8) have been set up in 116 locations where anyone can come in and take a rapid antigen test free of cost. This has helped to ease off pressure of contact tracing.
D3.2. Treatment Strategies:
According to Ahmedabad Municipal Corporation, there is a guideline to provide separate medical facilities available to citizens in every zone (Division), 2020). Urban Health Centres (UHC) were the first point of contact for any medical assistance. A total of 77 UHC also know as COVID Health Centres now (DCHC)were converted into quarantine facilities. Apart from this, private hotels and malls were converted into quarantine centres in aid to help AMC provide the patients with isolation bed at the earliest. 17 COVID care centres(CCC) were made available for patients facing mild symptoms. 39 Dedicated COVID Hospitals (DCH) with a capacity of 1773 beds are available in the city.
Every day a list of available beds is issued in the newspaper and also updated on the Ahmedabad COVID dashboard at 11:00 AM to navigate the incoming patients. At CCC, the Municipal corporation employees along with Sanjeevni workers assist the quarantined patients and also monitor their vitals and provide them with essential needs. At DCHC the paramedical staff along with AYUSH and MBBS students look after the quarantined patients (Welfare, 2020). At both CCC and DCHC, Medical officers visit every 2 days to every patient to do regular checkups in which body temperature, oxygen levels are the 2 prime areas of focus. At hospitals, a patient is first monitored in the triage area for a few days, and if the medical condition of a patient requires special assistance, separate ICU wards are there for it. These ICU wards have ventilator facility. At the quarantine centres the staff has put barricades and checkposts around the campus and within the facility so that
exposure is kept at a minimum for those managing the facility and taking care of the patients. There are about three medical teams who work in shifts and each team consists of one doctor and one paramedic. A section of the facility has been cordoned off for health care professionals so that they can live within the facility. The medical team will also be tested every 14 days to ensure they haven’t contacted the infection. The facility is equipped with a yoga centre, an indoor game facility, free WiFi and a library that comprises over 1000+ books and magazines. Once a patient enters the facility, they are each provided with kits consisting of a bucket with soap and a toothbrush. The food for the patients is specially planned and prepared by the Nutrition department. It contains nutritious items like juices, khichri, dal, soup, vegetables, rotis among others.
Figure D9 Containment zone barricading Source: https://www.youtube.com/watch?v=LHKjfYH2kDU Figure D10 Relaxing zone in one of the Quarantine Centres in Ahmedabad Source: https://www.youtube.com/watch?v=LHKjfYH2kDU Figure D11 Robotic drone being used in walled city area of Ahmedabad Source: Source: https://ahmedabadcity.gov.in/portal
D3.3. Monitoring and Surveillance Strategies:
Even after providing all top-notch medical infrastructure, there was a subsequent rise in the deceased cases. In initial days, the family of the patients were not allowed near the patient but with the help of technology, AMC is helping contain the spread of the virus as well as maintain social distancing. The first step taken towards this was ensuring Home quarantine patients are following the guideline. Sanjeevni Rath (CORONA Ghar Seva) were introduced for surveillance over home quarantine patients. Doctor and paramedic staff go and check every 3rd day to check social distancing and other guidelines (Grewal & Jain, 2020). The Integrated Command and Control Centre (ICCC) has played a crucial role in the proper patient monitoring system using a drone for sanitizing in walled city and surveillance over citizens to ensure Social distancing (as shown in Figure D11) . Another initiative has been taken by the authorities was ‘Vegetable-on-wheels’ to supply vegetables to the people at their doorstep. E-rickshaws are being used for the execution of the plan wherein the rickshaw visits the localities so that people do not need to get out of their houses and go to mandis. FlytNow
Figure D12 Chalaans being issued for not wearing masks Source: Source: https://ahmedabadcity.gov.in/portal
developed drones which police authorities used to carry out live, remote drone operations to monitor the overall social situation through an operatorfriendly dashboard and take measures to monitor crowds and maintain public safety. Ahmedabad Police employed 200 local drone operators, to help authorities to identify crowded areas and intimating the police control rooms in real-time in order to take necessary action.
This enabled the police to stream live multi-video feeds from multiple drones to their control room, thus providing situational awareness and enabling them to respond quickly to emergencies. The drones actually helped to control the havoc at a time without putting human helpers at risk of contracting the coronavirus. These drones also had loudspeakers, and sirens, serving as a public safety aid, sending a warning to people about the need to stay indoors, as well as potentially spraying disinfectants and the platform, can help the corona warriors do this safely from their homes. A silent campaign which turned out to be a failure though was MASK CAMPAIGN. Till chemist department were involved in the operation (World, 2020).
date, about 10,000 people are fined for not wearing a mask and authorities have collected about 1 Crore. Another initiative which was taken at a very early stage was Public place disinfectant drive on March 23rd 2020. For the execution of this plan, 18 vehicles were deployed. The department utilised 40,000 Litre sodium hypochlorite creating 4,00,00,000 Litre mist. The authorities made sure that they covered an area of about 100 sq km. For this BRTS corridor and bus stations, public places, 1000 buses, Riverfront was chosen, where the majority of the citizens usually use the public spaces. Fire health, engineer and A team from Municipal Corporation thoroughly sprayed disinfectant in every nook and corner of the house. They also inform DO’s and DON’T’s about the containment area (as shown in Figure D14).
Figure D13 Area sanitized by fire department team during sanitization operation Source: Primary
Figure D14 Sanitisation done in Public and private spaces by dedicated teams Source: https://ahmedabadcity.gov.in/portal Figure D14 Advertisement promoting usage of mask Source: https://twitter.com/AmdavadAMCjsp
Table D1 Containment zones in Ahmedabad (zonewise data) Source: Source: https://ahmedabadcity.gov.in/portal
B4. COVID19 Management Process Analysis B4.1. SWIMLANE Diagram
Inferences: As shown in figure swimlane diagram, it was observed that the testing process has been divided into 2 levels just to make the patient sure about his or her condition. As soon as the a patient is declared as COVID positive the contact tracing team tries to get in touch with those people who have been in contact
Patient
Symptoms (fever, cough, shortness of breath)
On call consultation
Call the helpline number
Medical Staff
Doctor prescribes COVID19 test
Municipal Corporation
Laboratory
T
SWAB collection COVID19 negative confirmed
COVID -ve COVID -ve
COVID +ve
RT PCR HRCT scan test COVID19 positive intervied
COVID19 positive confirmed
Rapid Antigent test COVID +ve Patient identifies contacts Contact located for testing
Timeline
Day 1 10 minutes
Day 1 30 minutes
Day 1 30 minutes
Day 3 24 hours
Figure D15 Dhanvantri Rath Source: https://www.youtube.com/watch?v=LHKjfYH2kDU Figure D16 Contact Tracing Team Source: https://www.youtube.com/watch?v=LHKjfYH2kDU Figure D17 Swab Collection Source: https://www.youtube.com/watch?v=LHKjfYH2kDU
with the patient. On the other hand, same information is reported to ICCC where all the COVID19 related decisions take place. ICCC decides how to manage the requests of the testing process and send adequate workforce to different places. Marking and demarking of containment zones help with the help of ITIHAS application which is supporting the back end of Arogya Setu App.
Content notified
T
B
Contact assigned
Send Dhanvantri Rath
Swab Collection Covid 19 negative confirmed
COVID-VE
Rapid Antigen Test Result COVID-VE
Quarantine centre
Input from ICCC
Day-3 Day-3 (24 hours )
Figure D18 ICCC Source: https://www.youtube.com/watch?v=LHKjfYH2kDU Figure D19 People waiting in line for Rapid Antigen Test Source: https://www.youtube.com/watch?v=LHKjfYH2kDU Figure D20 Paramedical Staff Source: https://www.youtube.com/watch?v=LHKjfYH2kDU
After is patient is confirmed as Positive, on the basis of conidition of the patient and availability of beds a patient’s quarantine location is decided. Home quarantine is for self isolating a person at home. DCHC(Dedicated COVID Healthcare Centres), CCC (COVID Care Centre) and DCH (Dedicated COVID Hospital) are the 3 instituitional quarantine facilities available in Ahmedabad.
Sanitize residence and seal the floor Follow home quarantine instruction for 14 days
Moderate symptom
Sent to DCHC Provide essentials to patient and monitor condition Discharged with certificate and suggested precautions
Covid-ve
Regular checkup every 3 days Retest Sent to DCH
Covid+ve
A
Covid-19 positive confirmed
Yes
Home quarantine available
No
Symptomatic
Asymptomatic Check symptom type Mild
symptom
Severe symptoms
Sent to CCC
Day 4 Day 5 (30 minutes to 1 hour) Day 6
Figure D21 COVID CARE CENTRE Source: https://www.youtube.com/watch?v=LHKjfYH2kDU Figure D22 Sanitizing activity outside a house Source: https://www.youtube.com/watch?v=LHKjfYH2kDU Figure D23 Marking Home Quarantine Source: https://www.youtube.com/watch?v=LHKjfYH2kDU
Monitored by sanjeevni workers.
Day 20
Inferences: After understanding the process with the help of swimlane, the COVID19 management in Ahmedabad City can be categorised into three processes; Identification & Testing, Treatment and Monitoring & Surveillance (as sh. Key Process Area: COVID19 management services Trigger Event Process Name Person facing symptoms Identifying & Testing of COVID19 and getting himself tested. According to the grade Treatment of symptoms, the patient is allotted a quarantine facility. Sanitization of patient’s Monitoring & house and instructing Surveillance self-isolation rules.
Table D2 Process identification worksheet
D4.3. Process Profile Worksheets
This tool helps in listing down the trigger events, stakeholders, service risks, key controls and measures of success of different processes.
D4.3.1. Identification and Testing
Inferences: The process profile worksheet for Identification focuses on identifying the 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. Positive feedback was success measure. Process Name
Process Owner Identification and Testing Ahmedabad Municipal Corporation Description Identifying the positive cases in the city from various places. Triggers
Event beginning The person falls sick and experience symptoms such as fever, soar throat, body pain, etc.
Event ending
Confirming the RT-PCR Test result positive Additional events Informing the doctor, receiving the medication, contact tracing and surveillance, Taking testing sample 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 (AYUSH Doctor) Process Units Process Unit Owners Informing about symptoms to a Doctor Suspect Assistance in taking antigen test COVID Control Room Supervisor Diagnosing the symptoms and providing medication & Conducting the test ANM/ASHA worker/ Anganwadi workers/ NCC cadets
Service Objective(s)
To identify the maximum number of people in the city with utmost accuracy
Key Controls Doctor’s contact details, Training protocol, Back up Inventory , SOPs for testing Service Risks Unavailability of the medical staff, Inadequate PPE kits, Mishandled samples, Report errors, Error with the Report Measure of Success Outreach(Reaching out to max. people) Number of samples collected and tested. Recommendations Positive feedback
Process Name
Process Owner Treatment Ahmedabad Municipal Corporation Description The patient asked to home quarantine or admitted to COVID Care Centre, or Dedicated COVID Health Centre based on symptoms.
Event beginning Triggers
The person tested positive with mild or moderate symptoms
Event ending
Patient recovery Additional events Updating patient status, monitoring the patient’s vitals, Notifying for a retest post 14 days, coordinating with COVID19 war room Inputs – Items and Sources Call(Patient), Quarantine Facility (Medical officer), Call (ICCC Employee) Outputs – Items and Customers
Recovery(Patient) Process Units
Process Unit Owners Updating patient status Medical Officer Quarantining at institutional Facility AMC worker/Medical officer Monitoring patient’s health status Sanjeevni worker/Medical officer Service Objective(s) Service Risks
To inform the patient and provide with the further medical assistance till the person is recovered from COVID19 symptoms. Quality & Quantity of food served, Resistance from Patients, Faulty documentation Degraded Food Quality Patient avoiding getting retested Error with the new report
Food quality checkpoints, SOPs for Sanjeevni workers, SOP for testing Recovered patient Positive feedback/ Rating received for the institutional facility
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. Measure of success of the profile were recovery of patient Positive feedback for the institutional facility.
Figure D24 Quarantine Facility in Ahmedabad City Source: https://ahmedabadcity.gov.in/portal/web?requestType=ApplicationRH& actionVal=loadCoronaRelatedDtls&queryType=Select&screenId=114#
Process Name – Number
Process Owner Monitoring & Surveillance Ahmedabad Municipal Corporation Description Prohibiting further spread of the symptoms in the area due to a COVID positive tested patient Triggers
Event beginning Patient tested positive and mandatorily asked to quarantine
Event ending
No cases suspected twice. Additional events Demarcating the house, Sanitizing the perimeter, Restricting the movement outside the house, Barricading in pink containment zones Inputs – Items and Sources Sticker outside patient’s house, Sanitization (AMC) , Barricading (Police officer) Outputs – Items and Customers Abridgement of the symptoms (Government ) Process Units Process Unit Owners Demarcating property & apprising the public AMC employee Sanitizing the house and the surrounding Police officer Barricading the area Fire department Service Objective(s) Service Risks
To prevent spread of the COVID19 Virus
Unavailability of the sanitizing vehicle/ equipment , Breakdown of the vehicle, Wrong address details, Social distancing defaulters 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
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. Measure of success was the number of patients recovered.
Figure D25 COVID Hospital Facility in Ahmedabad city Source: https://ahmedabadcity.gov.in/portal/web?requestType=ApplicationRH& actionVal=loadCoronaRelatedDtls&queryType=Select&screenId=114#
Process Name Patient Municipal Corporation
Identification & Testing R A
Treatment I R Medical Staff Laboratory staff
C I
C A Police ICCC
I I
I I
Monitoring and Surveilance I R A A C
Table D6 RACI Chart depicting Roles and Responsibilities of all the Stakeholders Where R- Responsible A- Accountable C- Consulted I- Informed
Inference: The RACI Diagram shows the various stakeholders, i.e., the patient, municipal corporation, medical staff, laboratory staff, police and ICCC who are Responsible, accountable, consulted and informed respectively in all the processes that are followed in the COVID-19 management in the city(as shown in Table D6).
D4.5. SERVQUAL Analysis
Servqual Tool helps in digging into the depth of an issue by supporting it with the help of customer’s opinion. For the city of Ahmedabad, a questionnaire was floated which had total 25 questions based on all the 3 parameters; Identifying & Testing (9), Treatment(9) and Monitorig & Surveillance(7). The questionnaire was sent to COVID positive patients who got in touch with Ahmedabad Municipal corporation and received various services according to the type of symptom they had. The survey was floated from 14th 18th October 2020 and 30 responses were received. Out of the 30 responses, 19 were of male respondants and 11 were female. Majority of the responsants were in the age group of 20-30 years. 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. The analysis are as follows:
Figure D26 Age group of respondants Source: Primary Figure D27 P-E gap for Identification and Testing Source: Primary
Figure D28 P-E gap for Treatment Source: Primary
Figure D29 P-E gap for Monitoring & Surveillance Source: Primary
In the testing process the reliability in finding a testing facility had the highest gap (-0.40) and assurance of testing being conducted in a gentle manner had the lowest gap (-0.06). In the treatment process the responsiveness to conduct scheduled check-ups had the highest gap ( -0.43) and empathy of the staff to stay patient to answer all the queries had lowest gap (-0.21). In the monitoring and surveillance process the Assurance of sanitization happening thoughout the house had the highest gap (-0.93) and the tangibility of the frontline workers to wear in PPE kit before entering patient’s premises is the lowest gap (-0.5). According to Composite rater analysis states that monitoring and surveillance has the maximum gap(as shown in D30).
Figure D30 Composite Rater Analysis Source: Primary
Figure D31 Composite Process Analysis Source: Primary Sanitation throughout the perimeter
Handling service requests for sanitizations
Unsatisfactory sanitization
Using new kit for Swab collection
Approachable medical staff whenever required
Politeness of medical staff to answer to patient’s queries.
4.5.2 Good Points:
The FMEA (Failure Mode and Effect Analysis) Tool helps in root cause analysis of an issue. RPN (Risk Priority Number) defines the most critical aspect of the parameter. FMEA is used to identify the potential effects of failure and it’s causes. Higher th RPN value, higher is the risk. For the city of Ahmedabad, FMEA was performed highest 2 gap in each process: 1. Locating a testing facility 2. Difficulty in finding access to the helpline number 3.Difficulty in interacting with the Sanjeevni workers 4. Frontline workers not wearing PPE 5. Inefficient Sanitization 6. Delayed sanitization activities
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 we can understand that identification & testing had 2 potential failures. First one was locating a testing facility, potential effect to this mode was delay in identification of suspect and the potential cause leading to the failure was the travelling distance from a patient’s residence. Use of capturing patient’s GPS location while registering the complaint can be a recommended action for this which will significantly help in making the testing numbers better (as shown in Table D7). The second failure mode is difficulty in finding access to helpline number, to which the potential effect of failure is delay in reporting and testing
of a case. This failure is being cause due to lack of awareness among people. If AMC can conduct some IEC programs regarding COVID19 virus then significatly testing process will become smooth. In the treatment process difficulty in interacting with sanjeevni workers was a failure mode. Due to rapid increase in COVID positive cases from 2nd to 6th month, Sanjeevni workers were not well trained enough to support the patient and respond in such a pandemic situation. This lead to a lot of discomfort to the patients. AMC needs to set up a proper complaint redressal system with trained staff to supervise as well as train the Sanjeevni workers based on the feedback received by the patients. At times there were few cases in which Sanjeevni workers went to conduct scheduled checkups without wearing the PPE kit. In this situation AMC can impose some sort of penalization on the Sanjeevni works in order to ensure containment. GPS based Oxymeters can provided to home quarantined patients at nominal fee just for immediate help. In Monitoring & Sanitization the major failure modes were insufficient sanitization and delayed response of sanitization service provider. AMC can hire private sanitizing companies or make dedicated task force with the exisitng staff to sanitize houses of COVID positive patient within 24 hours of being declared. These recommendations can certainly affect the performance of the monitoring and surveillance teams which currently are not meeting their objectives due to lack of workforce and simultaneous increase in location to cater.
Table D7 FMEA Analysis Source: Primary
D5. Service Concept
Organization: Ahmedabad Municipal Corporation Organizing Idea: To instantly cater the people of the city, while minimalizing their movement, providing services to look after their health nurturing their needs during the pandemic. Service Concept: Targeting on creating an secure environment that serves to the needs of its citizens by providing healthcare, food, shelter under one roof. It also focuses on spreading public awareness about the steps taken to prevent COVID19 Virus 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 • Shelter homes for migrant workers • Relaxation in paying bills/taxes • NGO’s for providing food to the poor • IEC to create awareness •Defining SOP’s for functioning of public amenities • Online App integrating essential services
Service Received:
Quality and timely treatment Regular and responsible monitoring On call services through helpline numbers Food for everyone Provision of safety gears • Provision of safety gears • Sanitized and safe surroundings • Free Testing • Integrated platform for all services
Figure D32 Advertisement promoting Do’s in COVID times Source: https://twitter.com/AmdavadAMC
Figure D33 Advertisement promoting benefits of mask Source: https://twitter.com/AmdavadAMC Figure D34 Advertisement for behavior change Source: https://twitter.com/AmdavadAMC
Figure D35 Advertisement for behavior change Source: https://twitter.com/AmdavadAMC
Figure D36 Service Audit Profile Source: Primary
Inferences: In the Service Audit profile, we can see the reflection of recommended action on the right. and towards the left is the existing scenario. The ratings received on the Serv Qual has been plotted on the service audit profile to understand each parameter and its efficiency(as shown in Figure D36) . The root cause analysis gave issues mentioned above and derived from that are the recomendations which are mentioned on the right side of the service audit profile. The dotted line on plot area shows the improvement in the overall rating after the recommneded actions are implemented. The inbetween area represents the service gap between the existing service delivery and the desired recomended service delivery.
D7. Conclusion
After using 6 managemnt tools to elaborate the existing scenario of COVID Management in the Ahmedabad city and also by analysing benchamarks of the cities across the country, it can be conlcuded that Ahmedabad has both good services and few areas of improvements. AMC has ramped up the very first step by taking over the control to the citizens themselves by making rapid antigen tests readily available free of cost. This has significatly reduced the workload of contact tracing domain in which various departments were integrated. But the fact cannot be denied that Ahmedabad is still facing the challenge in containing citizen at their homes, that too when the second wave of spread is just around the corner. Sanitization team needs to have a proper framework to monitor the hot spots as well as provide the same service to the people who have been quarantine on regular basis for better recovery rate. To cope up with the COVID times, citizens themselves need to get involved and join hands with AMC at every step to ensure the quality of services.
Figure D37 Advertisement discouraging spitting in public spaces. Source: https://twitter.com/AmdavadAMC
Figure D38 Advertisement for COVID friendly greeting styles Source: https://twitter.com/AmdavadAMC Figure D39 Advertisement for CORONA SANTVANA(Mental Helpline Number) Source: https://twitter.com/AmdavadAMC
Figure D40 Poster for mask awareness Source: https://twitter.com/AmdavadAMC
