IAS Gyan

Daily News Analysis

Strengthening public health capacities in disasters

11th November, 2020 Editorial

Context: Disaster legislation can help in this as private sector services are not a dependable option in the Indian context.

  • Much of Europe today is witnessing a menacing second wave of COVID-19, which is seemingly worse than the first.
  • Neither is a second wave necessarily less dangerous nor is a vaccine freely available, but 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.
  • Unfortunately, the same has characterised India’s disaster management framework in writing off many pressing public health issues.

More a reactive approach

  • In 2005, India enacted the Disaster Management Act, 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.
  • While some headway has indeed been achieved, the approach continues to be largely reactive, and significant gaps remain particularly in terms of medical preparedness for disasters.
  • 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.
  • The common theme is that the public health angle in disasters and disaster management has been under-emphasised.
  • Two important lessons emerge, which will be discussed:
    • first, health services and their continuing development cannot be oblivious to the possibility of disaster-imposed pressures; and
    • second, the legal framework for disaster management must push a legal mandate for strengthening the public health system.

Drawbacks in private sector

  • Since the capping of treatment prices in private hospitals in May, many instances of overcharging by hospitals in Maharashtra have surfaced, in some cases even leading to suspension of licences.
  • It illustrates how requisitioning of private sector services during disasters can hardly be a dependable option in the Indian context.
  • Health systems with large private sectors do not necessarily flounder during disasters.
  • But the Indian private sector landscape, characterised by weak regulation and poor organisation, is particularly infelicitous for mounting a strong and coordinated response to disasters.
  • During disasters, the limited regulatory ability could be further compromised.
  • While publicly financed insurance could be a medium to introduce some order into this picture, 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 and punitive action against non-compliant hospitals becomes tricky during disasters since health services are already inadequate.
  • Private hospitals are known to prefer lucrative and high-end ‘cold’ cases, especially under insurance, and are generally averse to infectious diseases and critical cases with unpredictable profiles.
  • Strong public sector capacities are therefore imperative for dealing with disasters.
  • While the Disaster Management Act does require States and hospitals to have emergency plans, medical preparedness is de facto a matter of policy, and, therefore, gaps are pervasive.
  • 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 with primary care

  • 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.
  • Again here, a legal mandate can contribute to strengthening the public health system at the grass-roots level.
  • There is also scope for greater 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.
  • 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 health system and community resilience to disasters.
  • 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.