‘Building a health care staff pool was Maharashtra’s biggest challenge’
Ajoy Mehta, Maharashtra’s principal advisor on Covid-19 from June 2020 to February 2021, speaks about how the state dealt with its greatest ever crisis
MUMBAI Soon after Maharashtra’s first two Covid-19 cases were detected on March 9, 2020, the state began surpassing others in both cumulative cases and deaths. By May 2020, it became evident that it would require a gargantuan effort from the state to put the brakes on what was described as the crisis of the century.
In May 2019, Ajoy Mehta, a 1984 batch IAS officer and former Mumbai municipal commissioner, was appointed the state’s chief secretary. In June 2020, Mehta was due to retire, but, by then, had earned enough trust with chief minister Uddhav Thackeray to be appointed his principal advisor on all matters Covid, a post he occupied until February 10 this year.
This month, Maharashtra observes its first Covid-case anniversary. Mehta candidly admits it was his toughest year as an administrator; even though, he says, the state’s bureaucratic and medical machinery looked indefatigable and was never short on motivation.
In an interview, Mehta, among other key issues, speaks how Mumbai needs to learn from this experience and create better housing and public transport facilities for its residents to ensure the next medical emergency is dealt with quickly and effectively.
How effectively did the state machinery handle the Covid-19 crisis?
It was handled with firmness and honesty. We were not shaken or unnerved, but yes, we were not certain of the direction it was heading. The infection was new. Nobody knew how it would behave. We were quick to learn as we went along. We took some bold decisions that other Indian states quickly followed.
What were those decisions?
Maharashtra was the first state to admit discrepancies in reporting Covid-19 deaths. We undertook a massive reconciliation exercise. We faced flak, but we stood by our decision. In all our meetings, the chief minister repeatedly said we should report the right numbers; otherwise, we will never find solutions to the crisis. We were also the first state to take control of 80% of the beds in private hospitals, in spite of stiff opposition from the sector. We took over private premises and set up jumbo facilities. We offered a universal scheme through the Mahatma Jyotiba Phule Jan Arogya Yojana (a state-sponsored health insurance scheme). Maharashtra instituted a medical task force comprising private and government healthcare experts to create a treatment protocol. We were the first to set up a death audit committee. We decided to give personal protective equipment (PPE) kits to small clinics as many were shut causing stress to non-Covid patients. During the migrant workers crisis, we had housed more than half a million citizens in our camps where we served them three meals a day. To serve 1.5 million meals a day is no small task.
What were the challenges in building healthcare facilities in Mumbai and the rest of the state?
The biggest challenge was to build a pool of experienced healthcare staff. Here, the medical workforce should be given a lot of credit. They forgot their eight-hour shifts. They left their families and stayed in makeshift arrangements. They really came forward. Our next challenge was to set up physical infrastructure – beds, ventilators and oxygen facilities. We created anywhere between 100,000 and 150,000 oxygen beds in a short span. We did not have an adequate number of ambulances in Mumbai, so we converted BEST buses into ambulances. Dialysis for kidney patients had become a parallel crisis, so we set up a new protocol and opened a chain of dialysis centres.
The administration had to change its way of working since physical meetings were not possible. How was that challenge met, given the scale of the crisis?
Maharashtra’s bureaucracy has been responsive during disasters. Whether it be the earthquake in Latur (1993), the floods (2005 and 2019), or the drought (an ongoing crisis), we have handled it. But these were known adversities. We knew how to deal with them. This (Covid-19) was a disaster we knew nothing about, and the very people who treat others were exposed to danger. Motivation, however, was never a challenge; it was about giving direction. In fact, many IAS officers went beyond their call of duty. The CM also decided that each officer should handle a vertical – data management, camps for migrant workers, train movement, NGO assistance, stocking up on essentials, everyone was handling a key part.
Since you mention IAS officers, you received flak for replacing the Mumbai municipal commissioner (Praveen Pardeshi was replaced by IS Chahal in May 2020) at a crucial juncture. You also replaced the municipal commissioners in the Mumbai metropolitan region. Your comment?
Just when the state was hitting a peak in the middle of 2020, there was a point when low availability of beds and ventilators had become a major issue. How did the state tackle it?
Several hospitals did not accept Covid patients, even if there were beds. Patients were moved from one hospital to another and, unfortunately, some even died in the ambulances. We came down heavily on this by passing an order stating no patient can be denied treatment if he or she arrives at a hospital. We sent auditors to every hospital to check bed availability. Owing to the caseload in Mumbai, we also asked IAS officers to handle hospitals. The jumbo facilities helped a lot in solving these issues.
Cases in both Mumbai and the rest of Maharashtra are increasing again. Why do you think this is happening? Do we need restrictions again?
It will not be correct for me to say what the government should be doing now (Mehta is currently the chairman of Maharera, the state’s real estate regulator). However, having worked with this government, I can tell you that the decision-making is prudent and accurate. The state reports cases honestly and that should continue.
What do you think is the reason for increasing number of cases?
It’s not just Maharashtra. If you look globally, at some point countries such as the UK, Israel, just about everyone said it’s over. Everything opened up. However, it’s back to square one now. The very nature of the virus is that it comes in surges. The only thing I would say is please be cautious, don’t do away with your masks, continue to wash your hands frequently and maintain social distancing.
You have been the municipal commissioner of Mumbai. What are the lessons to be learned from an urban planning point of view?
Mumbai needs to sort its housing issue. We need good quality housing with hygienic facilities. We have to also improve our public transport. With Covid, public transport became a super-spreader. We had to shut trains and buses, which knocked off Mumbai. We need to sort this (transport).
What do you think are the major vaccination challenges?
Most challenges seem to have been sorted. Initially, there was vaccine hesitancy. It seems to have gone now, and the software concerns (of the Co-WIN app) have been resolved. Even the issues of cold chain facilities in rural areas seem to be have been sorted.