Context: Living with the pandemic for months together has had a desensitising effect on the collective psyche. Owing to such ‘desensitisation’, disasters that are not sudden and striking tend to be minimised. India’s disaster management framework also suffers from ‘desensitisation’.
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- In 2005, India enacted the Disaster Management Act (DM Act), which laid an institutional framework for managing disasters across the country.
- 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.
Provisions in the DM act
- The law laid down a legal framework for disaster response at the national, state, and district levels.
- The Act paved the way for establishing Disaster Management Authorities at the national, state, and district levels .
- It also provided for setting up the National Disaster Response and Mitigation Funds, and the formation of the National Disaster Response Force (NDRF).
- The National Disaster Management Authority is chaired by the Prime Minister.
Concerns during medical disasters
More a reactive approach
- Critics have indicated that the Disaster Management Act fails to identify progressive events 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.
- While the Disaster Management Act does require States and hospitals to have emergency plans, medical preparedness is inadequate.
Drawbacks in private sector
- Weak regulations: The Indian private sector is characterised by weak regulation and poor organisation.
- It is incapable for mounting a strong and coordinated response to disasters.
- A large majority of private hospitals in the country are small enterprises which cannot meet the inclusion criteria for insurance.
- Overcharging by hospitals: It illustrates how requisitioning of private sector services during disasters can hardly be a dependable option in the Indian context.
- This 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.
- Business interests: They are generally averse to infectious diseases and critical cases with unpredictable profiles.
- Disaster preparedness does not make a strong “business case” for hospitals, which prefer to invest in more profitable areas.
- Medical preparedness for disasters: Two important lessons emerge-
- Health services and their development cannot be oblivious to the possibility of disaster-imposed pressures;
- The legal framework for disaster management must push a legal mandate for strengthening the public health system.
- 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, including relevant facets such as capacity-building of staff.
- Integration of disaster management 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.
- Evidence supports the significance of robust primary care during disasters, and this is particularly relevant for low-income settings.
- Synergies with the National Health Mission: The flagship primary-care programme which began as the ‘National Rural Health Mission’ concurrently with the Disaster Management Act in 2005, could be worth exploring.
- The National Health Mission espouses a greater role for the community and local bodies, the lack of which has been a major criticism of the Disaster Management Act.
- Making primary health care central to disaster management can be a significant step towards building a health system and community resilience to disasters.