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12th November – Strengthening Public Healthcare

Strengthening public health capacities in disasters

In 2005, India enacted the Disaster Management Act, which laid an institutional framework for managing disasters across the country. 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.

Disaster Management during COVID-19 –

  • 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: first, that health services and their continuing development cannot be oblivious to the possibility of disaster-imposed pressures; and second, that the legal framework for disaster management must push a legal mandate for strengthening the public health system.

Why private sector healthcare is unreliable during disasters?

  • 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.
  • Many of these small hospitals are also unsuitable for meeting disaster-related care needs. And while requisitioning can be done under law, 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.

What should be done?

  • 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. A desirable corollary will be that it will also serve us well during normal times.
  • 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. Interestingly, 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.

Conclusion –

Making primary health care central to disaster management can be a significant step towards building health system and community resilience to disasters.

SourceThe Hindu

QUESTION – Is there a need to introduce a separate legal mandate to strengthen public sector capacities via disaster legislation. Comment.

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