Building India’s disaster health systems: A lot to be accomplished

Natural disasters hit the Indian sub-continent on a regular basis. Disaster strikes at a time we do not expect, and it overwhelms health systems. More than 58.6 per cent of the landmass is prone to earthquakes, over 40 million hectares of land carry the risk of flooding and river erosion, 68 per cent of the land that is available for cultivation in India is prone to droughts and 5,700 kilometres of the 7,516 kilometres long coastline is prone to tsunamis and cyclones. Health systems get deeply affected during disasters leading to disproportionate illness and injury, and worsen those with chronic pre-existing diseases. 

Health workers till date are ill-equipped to face disasters. The most important priority post-disaster is safeguarding life and livelihood. 

Medical education teaches a doctor-in-training to inspect, palpate, percuss and auscultate a human body, but the same medical education does not teach them to be disaster prepared. Important discussions on creating field hospitals, identifying dead bodies, reproductive and child health, addressing logistical challenges, handling mass emergencies, and the concept of incident command never really form discussions at medical colleges and corporate hospitals. Global policy frameworks have emerged in the form of Sendai Framework, Paris Agreement on Climate Change and Sustainable Development Goals, but the case in point is to create a value proposition at local levels of governance and functioning. 

What India needs is a dedicated cadre of doctors in every health setting who can be trained to address disasters. Public health experts working with civil society organisations involved in disaster response and mitigation strategies must get appropriate government support to carry out epidemiological surveillance and disease control activities. 

Temporary re-settlements create problems of overcrowding, sanitation, and spread of air-borne infections. Health systems need to work with local municipalities to implement a proper mechanism to address these issues, which would vary for different geographical locations. These systems must be equipped to provide curative treatment, give psycho-social rehabilitation, and engage in vector control measures. With India facing a triple burden of disease threat in the form of infectious, non-communicable and re-emerging diseases, it will have to step up its health system to address national disaster resilience. The Union Health ministry’s draft public health bill 2017, which also attempts to incorporate disaster management as one of its priorities, lacks depth. 

To begin building India’s health systems will require strengthening of State Disaster Management Authority and District Disaster Management Authority. It would require holding the District Health and Family Welfare officer accountable for any public health lapse in disaster at the district level. This component could be brought in by introducing a Public Health Law of Disaster Resilience which could regulate this institutional and legal framework. 
Competency and capacity building in disaster response should be optimised, and this gap must be bridged with financial support through appropriate line ministries as disaster risk reduction remains a multi-sector problem. 
In 2013, the Abe administration in Japan passed a landmark Basic Law of National Resilience to protect the people of Japan. Drawing inspiration from Japanese leadership, Indian parliamentarians need to take moral responsibility for the lives of the people from their region and deliberate on the need for the law. 

Dr Edmond Fernandes is CEO, CHD Group based in Mangaluru and Member-Health Task Force, DDMA, Government of Karnataka. He can be reached on www.edmond.in