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City Learning
1. City Case Analysis
In the figure 9 cities are compared with respect to overall performance of the city in controlling number of cases. From figure 9, it can be seen that Navi Mumbai has the highest number of cases per lakh population. The reason for the same was the footfall in the APMC (Agricultural Produce Market Cooperative). It was a part of essential services due to which lockdown was not applicable there. Hence, the affected traders coming down from various parts of the state stood responsible for the spread of the virus. In the same parameter, Hapur was the least affected city among the others, the reason being the wide-ranging perimeters of the containment zones helped them contain the virus effectively. In the case of deaths per thousand cases, Ahmedabad’s position is unsettling due to less number of treatment facilities, whereas, Faridabad was doing well as the Faridabad Municipal Corporation are hospitalizing all the patients aged above 60, showing any sign or symptom. Lastly, the Positivity rate of the tests conducted per thousand tests, Ahmedabad was lowest as compared to other cities, the reason being setting up of rapid antigen testing booths. Whereas on the other side, Navi Mumbai is performing relatively well as high numbers oh rapid tests conducted in in the containment zones. Hence, from the above observations, it can be noticed that some cities are getting more affected in some parameters that can be looked into else practices of the other cities performing well can be adopted.
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2. Process wise service analysis
As in the above study, the processes identified are identification, treatment and monitoring and surveillance. RATER analysis of these processes is done, to see which city is most affected and which city is doing well in the said processes. According to the graph in figure 10, monitoring and surveillance is the process in which all the cities are lacking. According to the RATER, the cities that have the scope of improving their service in terms of identification are, Vasai Virar with a maximum difference of perception and expectation, followed by Gulbarga and Faridabad. Similarly, in the case of treatment Faridabad, Gulbarga and Vasai Virar are the cities need improvement. In the case of monitoring and surveillance, Faridabad is the city demanding maximum attention followed by Gulbarga and Vasai Virar respectively. The cities doing comparatively well, in all the three processes are Lucknow, Hapur and Ahmedabad respectively.
Figure 10. Process wise RATER analysis Source: Primary
RATER analysis of City’s COVID Management services. The difference between perception and expectation helps to understand which RATER parameter is the city doing well in and where is the improvement required in the city. The city RATER gives an overall idea that how are the services perceived in that city with respect to others. From figure 11, it is seen that reliability is the factor that is going low for all the cities i.e. the health care services lack everywhere in the listed city. Further if observed closely, the city performing well in terms of reliability is Lucknow whereas Faridabad is showing the lowest P-E difference indicating the need for improvement in the parameter. In the case of assurance, Navi Mumbai is the city performing well whereas Gulbarga needs improvement. Lucknow is again doing well in the case of tangibility whereas Hapur needs improvement. Empathy is the factor that determines the behavior of the staff. Hence, if we look at the graph in figure 4, Lucknow is performing the best whereas Gulbarga needs improvement. Lastly, responsiveness is good in Lucknow whereas in Faridabad it needs to be improved. In the next section, it is looked into detail, that what common parameters in the cities are resulting in the particular factor to rise up or down in the graph.
4. RATER Analysis of various services
Various services taking place in the cities in order to combat the virus, are identified with the help of the difference between perception and expectation as marked by the people. The services marked yellow in the table1 are a few of the services that might be the reasons for affecting the city. It might be in terms of process or the service quality provided by the particular municipal corporation. The dark red colour in the table shows, the service risk according to the perception of the citizens of that city. Whereas the white shows that the service is satisfactory. 1. Sanitization Service in various cities. Sanitization is a part of the monitoring and surveillance process and lies in reliability. The service is marked as the highest P-E difference in Faridabad and Gulbarga. The major contributing factor fot the low rating identified, in Faridabad there is a lack of communication channels within the government institutions responsible for implementing the service while in the case of Gulbarga, there was a lack of Human Resources with respect to the number of cases to cater to. Ahmedabad and Lucknow are the cities that are
Figure 11. RATER Analysis of city’s COVID Management Services Source: Primary
Table 1. RATER Analysis of various services carried out in the city as a part of COVID management Source: Primary
close to white and are taking good measures in order to make the service quality better. In Ahmedabad, the Integrated fire department services to sanitize the public spaces and a dedicated sanitization team appointed to conduct and coordinate door to door sanitization activity helped the Municipal Corporation to achieve the satisfaction of the citizens. 2. Frontline workers wearing PPE Kits This service is part of tangibility and falls in the identification process. Hapur and Gulbarga are the cities that need to encourage their workers to wear the kits whereas Vasai Virar is doing comparatively well in this aspect. The reason being, in Gulbarga PPE kits, were not given to the ASHA workers whereas, in the case of Vasai Virar, the PPE kits were locally manufactured. 3. Waiting area at the testing center. This service falls under tangibility in the RATER and is part of the identification process. Hapur is the city ranging to red due to lack of space and furniture at the testing centers whereas, in the case of Vasai Virar, the makeshift Fever clinics were created in
government schools, wherein common open to sky areas are used as waiting spaces. Hence, the service is marked satisfactory. 4. Constant follow-ups in case of home quarantine. The service falls in Responsiveness and is part of the treatment process. Vasai Virar and Gulbarga are folling in red range in this parameter. Reasons being GNM worker having too many responsibilities and lack of human resource
5. Unique Features in the Cities
The figure 12 shows the unique features of the cities in containing the COVID. 1. Faridabad - Senior citizens with any symptoms/ infection mandatorily asked to
as ASHA workers have boycotted work as PPE kits were not given respectively. In this service, Ahmedabad and Navi Mumbai are noticed doing well comparatively. Reasons being, Sanjeevni Rath – dedicated mobile van used for monitoring and follow-ups and A WhatsApp group being made by the Medical Officer, were in the patients are supposed to send the photos of the said parameters. If anything wrong is
Figure 12 Unique features of the cities. Source: Primary
quarantine/ hospitalized. Pupose - To immediately treat high risk patients and reduce number of deaths. 2. HAPUR: Neighbourhood surveys Purpose: Identify symptomatic patients early and tracing contacts 3. LUCKNOW: DSO portal for updating all data record and maintenance. Integrated COVID Control Centre Purpose - An integrated system for collection and provision of all data 4. AHMEDABAD: Kiosks for free rapid antigen testing Purpose - Make contact tracing easier. 5. VASAI VIRAR: Voluntary service provided by General Physicians at fever clinics Purpose - To mobilize resources immediately 6. GULBARGA : Corona Watch App Purpose - Monitor patients activity and condition remotely during home quarantine; helps in contact tracing 7. NAVI MUMBAI: A WhatsApp group of home quarantined patients to track their health condition Purpose - Monitor patients condition in a particular ward remotely by the Medical Officer
6. Other Services
1. Dead body Management. The last rites of the COVID positive person is the responsibility of the Municipal Corporations. The rites are done following the religious norms of the patient. The patient is packed in a black cover and is taken to the respective crematorium with in an ambulance. The roads are at times blocked for a while when the infected body is carried. The family members are informed, and only 5 members from the family are allowed in the crematorium. 2. Bio - Medical Waste Management According to the news report published by NDTV on 18th September 2020, a report has been filed by Central Pollution Control Board (CPCB) in the National Green Tribunal in July stating that India generates about 101 Metric Tonnes per day (MT/day) of COVID-19 related bio-medical waste, in addition to the regular bio-medical waste generation of about 609 MT per day. According to the CPCB report, the inceneration capacity of the of COVID-19 biomedical waste in the country is about 840 MT. (Ahuja, Aastha ; Bhaskar, Sonia ;2020) According to the Guidelines for Quarantine Facility COVID-19 issued by the Ministry of Housing and Urban Affairs, used personal protective equipment (PPE), gloves, shoe covers, head covers, disposable bed sheets, and PPE with spill is to be discarded in the yellow bin which are then incinerated or buried in deep pits. CPCB has also released a few set of guidelines, stating isolation wards in hospitals need to keep up discrete shading coded canisters for the isolation of waste. A dedicated bin marked “ COVID 19” to be kept in a separate space, handled by approved staff only. The board has also requested to record the generation of the this kind of waste. For the patients in home quarantine the CPCB has asked them to dispose the waste in yellow pack, and handover them to approved authorities. (Ramteke & Sahu, 2020) The news report clearly claims that Maharastra is highest bio - medical generating state. But, the state is coping up with the situation by making stand by arrangements with Treatment, Storage and Disposal Facilities (TSDF) to avoid spread of disease through waste route. (Ahuja, Aastha ; Bhaskar, Sonia ;2020)
Figure 13 Process of COVID waste management Guidelines. Source: (Ramteke & Sahu, 2020)
