Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Strengthening the public health capacities in disasters

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Disaster Management Act 2005

Mains level : Paper 2- Making healthcare disaster prepared

The article highlights the importance of the robust public healthcare system for the disaster preparedness and suggests linking it with the primary healthcare.

Reactive approach to disasters

  • In 2005, India enacted the Disaster Management Act, which laid an institutional framework for managing disasters across the country.
  • Under the Act, reactive, ad hoc measures applied in the event of a disaster, was to be replaced 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.
  • Significant gaps remain particularly in terms of medical preparedness for disasters.

Medical preparedness for disasters

  • Two important lessons emerge:-
  • First, health services and their continuing development cannot be oblivious to the possibility of disaster-imposed pressures.
  • Second, the legal framework for disaster management must push a legal mandate for strengthening the public health system.

Role of private health sector during disaster

  • Instances of overcharging during Covid illustrates how requisitioning of private sector services during disasters can hardly be a dependable option in the Indian context.
  • This is particularly 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.
  • The Indian private sector landscape, characterised by weak regulation and poor organisation, is incapable 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.
  • Punitive action against non-compliant requisitioned 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.

Need for strong public sector capacities

  • Due to the above-cited limitations of the private sector, strong public sector capacities are imperative for dealing with disasters.
  • While the Disaster Management Act does require States and hospitals to have emergency plans, medical preparedness is 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.
  • 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.

Way forward

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

Consider the question “Robust public healthcare system is indispensable for the disaster preparedness which could be achieved through making the primary healthcare central to the disaster management. Comment.

Conclusion

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.

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