This paper presents an analysis of the role of decentralised institutions to understand the learning and challenges of the grass-roots-led pandemic response of Kerala.
The study is based on interviews with experts and frontline workers to ensure the representation of all stakeholders dealing with the outbreak, from the state level to the household level, and a review of published government orders, health guidelines, and news articles. The outcome of the study shows that along with the decentralised system of governance, the strong grass-roots-level network of Accredited Social Health Activists (ASHA) workers, volunteer groups, and Kudumbashree members played a pivotal role in pandemic management in the state. The efficient functioning of local bodies in the state, experience gained from successive disasters, and the Nipah outbreak naturally aided grass-roots-level actions. The lessons others can draw from Kerala are the importance of public expenditure on health, investment for building social capital, and developing the local self-delivery system.