Strengthening public health capacities in disasters

HEALTH/ ECONOMY/ DISASTER MANAGEMENT

Topic: General Studies 2,3:

• Issues relating to Health and disaster management
• Indian Economy and issues relating to planning, mobilization, of resources, growth, development and employment. 

Strengthening public health capacities in disasters

Context: Much of Europe is witnessing a menacing second wave of COVID-19, which is seemingly worse than the first.

Second Wave and Challenges 

• Desensitised Public: Living with the pandemic for months together has had a desensitising effect on the collective psyche.
• Reduced Urgency: Owing to such ‘desensitisation’, disasters that are not sudden and striking – like the second wave of COVID-19 pandemic- tend to be minimised. 
• Impacting Disaster Management Framework: Unfortunately, the above two has characterised and thus weakened India’s disaster management framework in dealing with many pressing public health issues.

India’s Disaster Management Framework

• In 2005, India enacted the Disaster Management Act(DMA), which laid an institutional framework for managing disasters across the country 
• What hitherto comprised largely of reactive, ad hoc measures applied in the event of a disaster, was to be replaced under the Act with a systematic scheme for prevention, mitigation, and responding to disasters of all kinds. 
• Disaster management considerations were to be incorporated into every aspect of development and the activities of different sectors, including health. 
• The Disaster Management Act is one of the few laws invoked since the early days of COVID-19 to further a range of measures — from imposing lockdowns to price control of masks and medical services.
• Concerns w.r.t Disaster Management Framework: While some headway has indeed been achieved with the enactment of Act, the approach continues to be largely reactive, under-emphasizing of Public Health concern and presence of significant gaps in terms of medical preparedness for disasters.

Experience of using DMA during Pandemic and lessons learnt

1. Drawbacks in private sector

• Health services and their continuing development are oblivious to the possibility of disaster-imposed pressures.
• Non-dependability of Private Sector during Crisis times: Since the capping of treatment prices in private hospitals in May, many instances of overcharging by hospitals in India have surfaced, in some cases even leading to suspension of licences. 
• Private Sector Significance in future road map of Public Health Policy: Dependability of private sector is important since the future development of hospital care services is being envisaged chiefly under publicly financed health insurance, which would very likely be private-sector led
• Structural Weakness in Private Sector:  A large majority of private hospitals in the country are small enterprises which cannot meet the inclusion criteria for insurance. Many of these small hospitals are also unsuitable for meeting disaster-related care needs. 
• Incompatibility between Disaster Preparedness and Profit: Disaster preparedness does not make a strong “business case” for hospitals, which prefer to invest in more profitable areas
• Lesson Learnt: Strong public sector capacities are therefore imperative for dealing with disasters. There is a strong case for introducing a legal mandate to strengthen public sector capacities via disaster legislation

2. Weakness in DMA

• DMA fails to identify progressive events (which nevertheless cause substantial damage, often more than sudden catastrophes) as disasters, thus neglecting pressing public health issues such as tuberculosis and recurrent dengue outbreaks
• Had they been identified as disasters, they would have attracted stronger action in terms of prevention, preparedness, and response

• Inadequate Integration with primary care: Primary care stands for things such as multisectoral action, community engagement, disease surveillance, and essential health-care provision, all of which are central to disaster management. This area of disaster management, especially relevant for low-income setting, has been overlooked.

• Lesson Learnt: Making primary health care central to disaster management can be a significant step towards building health system and community resilience to disasters. Also, synergies with the National Health Mission with the Disaster Management Act in 2005, could be worth exploring.

Conclusion

• While the novel coronavirus pandemic has waned both in objective severity and subjective seriousness, valuable messages and lessons lie scattered around. It is for us to not lose sight and pick them up.