The Pulse | Society | South Asia

Comparing Pandemic Responses in Bangladesh and Kerala

Bangladesh’s COVID-19 response shows the need for increased state capacity in meeting challenges and shocks.

By M Niaz Asadullah and Antonio Savoia for
Comparing Pandemic Responses in Bangladesh and Kerala

Life in the slums by the railway tracks in Tejgaon, Bangladesh.

Credit: Flickr/Stars Foundation

South Asia has been hit the hardest among all developing regions by the COVID-19 pandemic. Available evidence suggests that as many as 400 million in the region will be pushed into poverty. One exception to the regionwide trend in infection and fatality rates is the Indian state of Kerala. But this is no accident. Within India, Kerala has also stood out in terms of social gains during the United Nations Millennium Development Goals (MDGs) campaign despite a modest income level. Kerala’s past developmental legacy has paid off during the coronavirus crisis. It is now widely acknowledged as a success story for tackling the pandemic.

However, the opposite is true for Bangladesh, also a South Asian MDGs success story. With a death toll over 4,500 compared to under 500 in Kerala, Bangladesh is facing a catastrophic crisis. The total number of confirmed infections in Bangladesh has surpassed 330,000.

In the past, Bangladesh made global headlines for its fight against water borne diseases, like diarrhea and cholera. A nationwide nongovernmental organization (NGO) network innovated and scaled up solutions to dramatically bring down child mortality rates. The country’s high population density and close proximity of human settlements have been leveraged by NGOs and government agencies to run awareness campaigns and bring about lasting behavioral changes against harmful social and personal practices.

What led to this divergence between Kerala and Bangladesh in managing the pandemic and what are the main policy lessons?

Following decades of steady growth, Bangladesh’s economy is richer than before. But this income rise has not been accompanied by increased investment in social sectors and meaningful governance reforms. It has, instead, seen the country sliding toward authoritarianism. With the weakening of political institutions providing effective accountability mechanisms, the political elites may have weaker incentives to invest in state institutions and infrastructures that could manage the pandemic. By the end of the MDGs era, Bangladesh had the worst ranking within South Asia in terms of public spending on health. Decades of underinvestment in health infrastructures combined with weak state institutions to cause the lockdown, and the associated relief program, to fail. The state capacity deficit in terms of enforcing national public health policies was laid bare during the pandemic.

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In the fight against the coronavirus, the country’s high population density has turned into a major hurdle, making it extremely hard to contain the spread of infection. Existing social customs of communal gathering and socialization patterns further limit the citizen’s ability to coordinate self-isolation efforts at an individual level. Physical distancing for most poor Bangladeshis is not an option. This calls for state intervention, in terms of ability to diagnose problems, enforce rules and coordinate activities. But given years of underinvestment in state institutions and insufficient democratic accountability, state response has been inadequate.

Fearing backlash from Islamic leaders, the government allowed mass prayers during the pandemic, the type of events that lead to major outbreaks. Testing is inadequate and infrequent in Bangladesh, and its administration lacks clarity and purpose. There is no systematic assessment of the prevalence rate of COVID-19. In basic health administration capacities such as index case isolation and speedy contact tracing, Bangladesh lags. And unlike Bangladesh, in Kerala, the government took a tough stance on those defying state orders against public prayers.

The government announcement of lockdown in Bangladesh was described as a “general holiday.” In some instances, partial reopening of the economy followed rushed decisions to impose movement order controls. The mismanagement of public communication was evident when some ready-made garment factories re-opened production units during the lockdown, adding to further spread of the virus.

In Kerala, the state government has set up 18 committees to coordinate contamination and mitigation efforts. All committees met daily, held evening meetings to evaluate the situation, update the public through media releases about progress in quarantine, test, and recovery efforts. In Bangladesh, numerous committees were also formed, but some never met for a single day. The head of the national committee on coronavirus publicly complained about lack of coordination within the government. Other capacity deficits include the absence of a central socioeconomic registry of beneficiaries and an effective safety net system that ensures resilience against future shocks.

Given large-scale administrative failure, the Bangladeshi government has insisted on voluntary compliance and pro-social choices to coordinate individual behavior. However, the government’s own communication campaigns promoting home quarantines of foreign workers have not been effective and credible. Hundreds of returnee migrants from overseas were allowed to reunite with their families without any state oversight. Directives for social distancing and self-isolation remained mostly overlooked.

The Bangladesh model shows that human development progress is necessary but not sufficient to develop resilience against shocks and crisis. Such “investment in people” model of development cannot be sustained without strengthening state institutions and political accountability mechanisms. Investment in state capacity would restore confidence in key developmental actors, such as the traditionally influential NGOs in Bangladesh, as well as in the general public.

On the other hand, the Kerala model reminds us that political accountability and state effectiveness are the missing links. In support of this, in a recently published study, we present evidence that Sustainable Development Goals (SDGs) gains from simultaneous improvement in state capacity and public expenditure in South Asia would be significant. If government spending on education and health were to be raised alongside improvements in state capacity to levels witnessed in other developing regions (such as East Asia), South Asian countries like Bangladesh would make significant progress in achieving the SDGs. Kerala has the highest per capita spending on health in India, government health spending accounts for 1.5 per cent of its GDP; in Bangladesh, the figure is less than 1 per cent.

The main lesson therefore is the need to increase public spending along with improvements in state capacity. But without improvement in the latter, South Asian countries like Bangladesh may remain trapped in a low capacity, low spending equilibrium.

M Niaz Asadullah is a professor of development economics at the University of Malaya and Southeast Asia lead of the Global Labor Organization. Follow him on Twitter @Niaz_Asadullah

Antonio Savoia is a senior lecturer in development economics at the University of Manchester. Follow him on Twitter @AntoniSavoia