strengthening-public-health-capacities-in-disasters

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’.

More on news:

  • 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.

Way forward:

  • 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.

Image source: https://homelandprepnews.com/stories/44679-senate-bill-would-create-a-permanent-fund-to-respond-to-public-health-emergencies/