A man walks with his bicycle in front of the BMC building and the Chhatrapati Shivaji Maharaj Terminus (CSMT) during a weekend lockdown to limit the spread of COVID-19 in Mumbai, Maharashtra on April 10, 2021. (Image: Reuters/Francis Mascarenhas)
Among the first actions that Iqbal Singh Chahal took as Mumbai’s newly-appointed Municipal Commissioner on May 8, 2020 was to review the civic body’s COVID-19 war room set up two months earlier. Chahal all but dismantled it except for a tiny hub through which he would keep daily tabs. Experienced officers in the Brihanmumbai Municipal Corporation (BMC), Mumbai’s chatterati, and Maharashtra’s politicians thought he was going for broke.
A year later, as the brutal COVID-19 second wave tapers off in India’s economic capital, it’s clear that Chahal was playing to a plan like CEOs of multi-billion dollar enterprises do. The ‘Mumbai Model’ is now lauded by sceptics, the Supreme Court of India, the Bharatiya Janata Party (BJP)’s leaders otherwise hostile to Maharashtra, corporate India, and the international media. Importantly, it is adopted in other cities and studied for COVID-19 crisis management that prevented a catastrophe.
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At the core of the ‘Mumbai Model’ are classic managerial concepts such as foresight, planning, decentralisation and delegation, marshalling scarce resources, and leadership. However, its strength lay in putting the public sector at the heart of the COVID-19 response mechanism. The BMC was firmly in command through its network of primary health centres, civic hospitals and special jumbo COVID-19 centres, backed by private hospitals whose beds were mandated for public use.
Foresight lay in anticipating the second wave, creating the hospital infrastructure and liquid medical oxygen tanks; planning drew from regular reports of the special task force set up in 2020.
Decentralisation was the key to making this model work. Chahal’s decision to replace the central control room with 24 war rooms in each municipal ward of Mumbai gave relative autonomy to the assistant municipal commissioner of a ward. This meant that the nearly 10,000 RT-PCR reports which trickled in every evening through March-April did not overwhelm one central facility. Instead, each war room dealt with roughly 415 reports, which given the average positivity rate of 20 percent in April, meant not more than 84 patients a day. Data was not depressed or fudged, at Chief Minister Uddhav Thackeray’s insistence, which meant the BMC knew the level of response and resources called for.
Each war room was equipped with multiple phone lines publicised in all media, each had a 24x7 team of doctors and trained staff who would diligently triage cases allotting ICU or oxygen beds only to serious patients, each had a dashboard of hospital beds and network of ambulances run on Uber’s software.
Expertise from IIT-Bombay was roped in to create and manage a dashboard for the city's crematoria to avoid queues of corpses. When oxygen supply ran dangerously low, Chahal worked with the Centre and Reliance Industries to fill the gap. Every jumbo centre offered walk-in testing and quarantine for Mumbaikars. All testing labs had to deliver reports to the BMC, not individual patients, which meant thousands of patients did not access scarce resources on lottery or through personal networks.
Despite the occasional rush for private hospital beds, Mumbai did not see heart-wrenching scenes of desperate patients struggling for ICU beds or oxygen cylinders even when active cases topped 80,000 a day, as would happen in Delhi later. It is testimony that Chahal’s ‘Mumbai Model’ of hub-and-spokes worked, even in an emergency when 168 patients were successfully moved from private hospitals to BMC’s COVID-19 centres one April night as hospitals ran out of oxygen.
The high incidence of infection in the second wave in the middle and well-to-do clusters could have overwhelmed the private healthcare system, created panic and subsequent black marketing of oxygen or medicines. Mumbai’s public health system, though resilient, is woefully inadequate for its nearly 20 million residents and dismissed by well-off residents. The Mumbai Model’s ingenuity lay in working within the limits of the public structure, marshalling private resources to segue into this, ramping up temporary facilities, and matching these scarce resources to demand on a dynamic basis.
Smart City, the buzz phrase from 2015 which emphasised a tech-driven exclusivist approach to urban infrastructure, did not get off the ground in India’s maximum city where resources are super-stressed by a crush-load density of 20,000 people per square kilometre. Instead, a smart systems-driven approach helped prevent a COVID-19 catastrophe. This, unfortunately, did not save nearly 3,000 people who died since the second wave began in March but it ensured that fatalities would not be three-four times that, as happened in the national capital.
The ‘Mumbai Model’ will be tested again in the anticipated third wave. Chahal and his team have begun scaling up resources. Mumbai’s COVID-19 management model could be adapted to natural emergencies such as floods and cyclones that the city faces, and may well be studied alongside its famous Six Sigma Dabbawala Model.