Strengthening public health capacities in disasters
Disaster legislation can help in this as private sector services are not a dependable option in the Indian context
Soham D. Bhaduri
M
uch of Europe today is wit-
nessing a menacing se-
cond wave of COVID-19,
which is seemingly worse than the
first. Infections have waned in In-
dia, although some are anticipat-
ing another wave around winter.
While appearing unlikely, it is im-
possible to guarantee that a se-
cond wave will not be worse for In-
dia as well. However, one does not
get to witness the sharp reaction
today that the early days of the dis-
aster evoked, albeit except for the
fresh round of lockdowns imposed
in parts of Europe. Neither is a se-
cond wave necessarily less danger-
ous nor is a vaccine freely availa-
ble, but living with the pandemic
for months together has had a de-
sensitising effect on the collective
psyche. Owing to such ‘desensiti-
sation’, disasters that are not sud-
den and striking tend to be mini-
mised. Unfortunately, the same
has characterised India’s disaster
management framework in writ-
ing off many pressing public
health issues.
More a reactive approach
In 2005, India enacted the Disas-
ter Management Act, which laid an
institutional framework for ma-
naging disasters across the coun-
try (https://bit.ly/3eKDG9N). What
hitherto comprised largely of reac-
tive, ad hoc measures applied in dy inadequate. ger action in terms of prevention,
the event of a disaster, was to be Also, development of certain preparedness, and response.
replaced under the Act with a sys- services and competencies that Again here, a legal mandate can
tematic scheme for prevention, are crucial for disaster response contribute to strengthening the
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mitigation, and responding to dis- could lag behind. Private hospitals public health system at the grass-
asters of all kinds. Disaster man- are known to prefer lucrative and roots level.
agement considerations were to high-end ‘cold’ cases, especially There is also scope for greater
be incorporated into every aspect under insurance, and are general- integration of disaster manage-
of development and the activities ly averse to infectious diseases and ment with primary care. Primary
of different sectors, including critical cases with unpredictable care stands for things such as mul-
health. While some headway has profiles. Eric Toner (2017), under tisectoral action, community en-
indeed been achieved, the ap- the “parking lot conundrum” gagement, disease surveillance,
proach continues to be largely ate sector services during disas- (https://bit.ly/3eJdwUI), describes and essential health-care provi-
reactive, and significant gaps re- ters can hardly be a dependable how disaster preparedness does sion, all of which are central to dis-
main particularly in terms of med- option in the Indian context. This not make a strong “business case” aster management. Evidence sup-
ical preparedness for disasters. is particularly important since the for hospitals, which prefer to in- ports the significance of robust
The Disaster Management Act is future development of hospital vest in more profitable areas. primary care during disasters, and
one of the few laws invoked since care services is being envisaged Strong public sector capacities this is particularly relevant for low-
the early days of COVID-19 to chiefly under publicly financed are therefore imperative for deal- income settings. Synergies with
further a range of measures — health insurance, which would ve- ing with disasters. While the Disas- the National Health Mission, the
from imposing lockdowns to price ry likely be private-sector led. ter Management Act does require flagship primary-care programme
control of masks and medical Health systems with large priv- States and hospitals to have emer- which began as the ‘National Rural
services. ate sectors do not necessarily gency plans, medical prepared- Health Mission’ concurrently with
The common theme is that the flounder during disasters. But the ness is de facto a matter of policy, the Disaster Management Act in
public health angle in disasters Indian private sector landscape, and, therefore, gaps are pervasive. 2005, could be worth exploring.
and disaster management has characterised by weak regulation There is a strong case for introduc- Interestingly, the National Health
been under-emphasised. Two im- and poor organisation, is particu- ing a legal mandate to strengthen Mission espouses a greater role for
portant lessons emerge, which larly infelicitous for mounting a public sector capacities via disas- the community and local bodies,
will be discussed: first, that health strong and coordinated response ter legislation, including relevant the lack of which has been a major
services and their continuing de- to disasters. During disasters, the facets such as capacity-building of criticism of the Disaster Manage-
velopment cannot be oblivious to limited regulatory ability could be staff. A desirable corollary will be ment Act. Making primary health
the possibility of disaster-imposed further compromised. While pu- that it will also serve us well during care central to disaster manage-
pressures; and second, that the le- blicly financed insurance could be normal times. ment can be a significant step to-
gal framework for disaster man- a medium to introduce some or- wards building health system and
agement must push a legal man- der into this picture, a large major- Integration with primary care community resilience to disasters.
date for strengthening the public ity of private hospitals in the coun- Critics have indicated that the Dis- While the novel coronavirus
health system. try are small enterprises which aster Management Act fails to pandemic has waned both in ob-
cannot meet the inclusion criteria identify progressive events (which jective severity and subjective se-
Drawbacks in private sector for insurance. Many of these small nevertheless cause substantial riousness, valuable messages and
Since the capping of treatment hospitals are also unsuitable for damage, often more than sudden lessons lie scattered around. It is
prices in private hospitals in May, meeting disaster-related care catastrophes) as disasters, thus ne- for us to not lose sight and pick
many instances of overcharging by needs. And while requisitioning glecting pressing public health is- them up.
hospitals in Maharashtra have sur- can be done under law, punitive sues such as tuberculosis and re-
faced, in some cases even leading action against non-compliant hos- current dengue outbreaks. Had Dr. Soham D. Bhaduri is a Mumbai-based
to suspension of licences. It illus- pitals becomes tricky during disas- they been identified as disasters, physician, public health commentator,
trates how requisitioning of priv- ters since health services are alrea- they would have attracted stron- and editor of ‘The Indian Practitioner’