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. 2025 Feb 6;40(2):153-164.
doi: 10.1093/heapol/czae096.

Capacity and crisis: examining the state-level policy response to COVID-19 in Tamil Nadu, India

Veena Sriram  1   2 , Girija Vaidyanathan  3 , G S Adithyan  3 , Shambo Basu Thakur  3 , Simran Kaur  2 , Hari Narayanan Gl  2 , Sabah Haque  2 , V R Muraleedharan  3
Affiliations

Capacity and crisis: examining the state-level policy response to COVID-19 in Tamil Nadu, India

Veena Sriram et al. Health Policy Plan. .

Erratum in

Abstract

The capacity of government agencies to develop effective policy responses to external shocks is an important area of focus for health policy processes, as illustrated by the coronavirus (COVID-19) pandemic. However, few empirical studies exploring the subnational capacity of governments and the influence of institutional, organizational and political factors in shaping the policy response to complex emergencies have been conducted. The purpose of this study is to examine the governance capacity to develop and implement a policy response to a major health emergency-COVID-19-in Tamil Nadu, India, and to understand the factors shaping governance capacity during the first and second waves (2020-21). Tamil Nadu offers a useful case for exploring governance capacity due to its long-standing public health institutions and previous experiences with disaster and outbreak response. We utilized three sources of data: (1) a review of key policy documents (n = 164); (2) a review of English-language media articles in the Indian press (n = 336); and (3) in-depth interviews with senior decision makers, technical experts and other stakeholders (n = 10). We present four key findings from this analysis. Firstly, Tamil Nadu's institutional framework enabled state-level governance capacity during an emergency of massive complexity, allowing for flexibility and nimbleness to adapt to evolving dynamics of centralization and decentralization over the course of the pandemic. Secondly, the ability to integrate public health expertise was circumscribed at important phases. Thirdly, while coordination with external experts was utilized extensively, engagement with civil society groups was perceived as limited. Fourthly, the electoral cycle was perceived by some to have constrained governance capacity at a critical point in the pandemic. By analysing the dynamics of state-level capacity in Tamil Nadu during a complex emergency, this study provides important learnings for other contexts globally regarding the drivers shaping capacity to develop and implement policy responses to crises.

Keywords: COVID-19; Governance; Tamil Nadu; capacity; crisis; policy.

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Conflict of interest statement

A.G.S. served as a consultant in the National Health Mission in Tamil Nadu from 2017 to 2022. G.V. was a civil servant in the Government of Tamil Nadu until 2019.

Figures

Figure 1.
Figure 1.
Organizations involved in COVID-19 governance in Tamil Nadu (non-exhaustive and illustrative)
Figure 2.
Figure 2.
Key milestones in COVID-19 policy response in Tamil Nadu (2020) (weekly mean cases per 100)
Figure 3.
Figure 3.
Key milestones in COVID-19 policy response in Tamil Nadu (2021) (weekly mean cases per 100)
See this image and copyright information in PMC

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