IASbhai Daily Editorial Hunt | 11th Nov 2020

Year from now you may wish you had started today.– Karen Lamb

Dear Aspirants
IASbhai Editorial Hunt is an initiative to dilute major Editorials of leading Newspapers in India which are most relevant to UPSC preparation –‘THE HINDU, LIVEMINT , INDIAN EXPRESS’ and help millions of readers who find difficulty in answer writing and making notes everyday. Here we choose two editorials on daily basis and analyse them with respect to UPSC MAINS 2020-21.

EDITORIAL HUNT #235 :“Disaster Management and Primary Health Care | UPSC

Disaster Management and Primary Health Care | UPSC

Dr. Soham D. Bhaduri
Disaster Management and Primary Health Care | UPSC

Dr. Soham D. Bhaduri is a Mumbai-based physician, public health commentator, and editor of ‘The Indian Practitioner’

      HEADLINES:

Strengthening public health capacities in disasters

      CENTRAL THEME:

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

SYLLABUS COVERED: GS 3 : Disaster management

      MAINS QUESTION:

Integration of Primary health care services with disaster management can build robust primary care solutions . Comment -(GS 3)

      LEARNING: 

  • The second wave and responses
  • Reactive Approaches
  • Drawbacks in private sector
  • Integration with Primary Health Care

      INTRODUCTION: 

  • THE SECOND WAVE : Much of Europe today is witnessing a menacing second wave of COVID-19, which is seemingly worse than the first.

Infections have waned in India, although some are anticipating another wave around winter.

  • A LOSS OF LIFE : It is impossible to guarantee that a second wave will not be worse for India as well.
  • SHARP REACTIONS : One does not get to witness the sharp reaction today that the early days of the disaster evoked ; lockdowns imposed in parts of Europe.
  • PSYCHOLOGICAL IMPACT : Living with the pandemic for months together has had a desensitising effect on the collective psyche.
  • EMERGING TRENDS : Owing to such ‘desensitisation’, disasters that are not sudden and striking tend to be minimised.
  • IMPROPER FRAMEWORK : Unfortunately, the same has characterised India’s disaster management framework in writing off many pressing public health issues.

      BODY: 

MORE A REACTIVE APPROACH

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

It comprised largely of ad hoc measures applied in the event of a disaster. 

  • SYSTEMIC IMPLEMENTATION : This was to be implemented as systematic scheme for prevention, mitigation, and responding to disasters of all kinds.
  • MULTI FUNCTIONAL ACT : Disaster management considerations were to be incorporated into every aspect of development and the activities of different sectors, including health.
  • TACKLING TECHNIQUE : The approach continues to be largely reactive, and significant gaps remain particularly in terms of medical preparedness for disasters.
  • INVOKED TO MAXIMS : The Disaster Management Act is one of the few laws invoked since the early days of COVID-19 to further a range of measures.

Disaster management Act was invoked from imposing lockdowns to price control of masks and medical services.

  • UNDERMINING PUBLIC HEALTH : The common theme is that the public health angle in disasters and disaster management has been under-emphasised.

TWO IMPORTANT LESSONS

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

DRAWBACKS IN PRIVATE SECTOR

  • CAPPING THE BILLS : Since the capping of treatment prices in private hospitals in May, many instances of overcharging by hospitals in Maharashtra have surfaced
  • PUNITIVE MEASURES : 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 INSURANCE AND PRIVATE SECTOR : Future development of hospital care services is being envisaged chiefly under publicly financed health insurance, which would very likely be private-sector led.
  • PRIVATE HEALTH SECTOR BOOM : Health systems with large private sectors do not necessarily flounder during disasters.
  • INDIAN PRIVATE SECTOR LANDSCAPE : It is 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.

  • INSURANCE : INCLUSION CRITERIA : A large majority of private hospitals in the country are small enterprises which cannot meet the inclusion criteria for insurance.
  • INFRASTRUCTURAL NEEDS : Many of these small hospitals are also unsuitable for meeting disaster-related care needs.

Punitive action against non-compliant hospitals becomes tricky during disasters since health services are already inadequate.

  • SNAIL PACE DEVELOPMENT : Also, development of certain services and competencies that are crucial for disaster response could lag behind.
  • LUCRATIVE CASES : Private hospitals are known to prefer lucrative and high-end ‘cold’ cases, especially under insurance.
  • INDISPENSABLE MEASURE : Strong public sector capacities are therefore imperative for dealing with disasters.
  • MEDICAL PREPAREDNESS : 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.
  • CAPACITY BUILDING : 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.

      IASbhai Windup: 

INTEGRATION WITH PRIMARY CARE

  • NEGLECTING LOCAL OUTBREAKS : Disaster Management Act fails to identify progressive events as disasters, thus neglecting pressing public health issues such as tuberculosis , dengue outbreaks.
  • STRINGENT MEASURES : Had they been identified as disasters, they would have attracted stronger action in terms of prevention, preparedness, and response.
  • LEGAL MANDATE : A legal mandate can contribute to strengthening the public health system at the grass-roots level.

MUCH NEEDED INTEGRATION

  • SCOPE OF INTEGRATION : There is also scope for greater integration of disaster management with primary care.
  • 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.

  • ROBUST PRIMARY CARE CENTES : Evidence supports the significance of robust primary care during disasters, and this is particularly relevant for low-income settings.
  • SYNCHRONISATION : Synergies with ‘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.
 

  • BUILDING COMMUNITY RESILIENCE : Making primary health care central to disaster management can be a significant step towards building health system and community resilience to disasters.
  • AWARENESS : 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 the lies up.

SUGGESTED READING : PSYCHO-SOCIAL IMPACT OF COVID-19 
       SOURCES:   THE HINDU EDITORIAL HUNT | Disaster Management and Primary Health Care | UPSC

 

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