Interventions in Health for Tsunami Victims in India

1
Interventions in Health for Tsunami Victims in
India

• C. Kumar
• Tsunami Response Program
• CARE India, Chennai

2
The Tsunami Context

• CARE one of many agencies to respond to Tsunami
  quite sooner
• Severely hit districts covered 4 in AP, 3 in
  Tamil Nadu, and 1 in Pondicherry, and Andaman
  Nicobar Islands
• Identified gaps in relief extended and filled in
  gaps non-food items, temporary shelter,
  drinking water, sanitation, medicines supply etc.
  
• Subsequently implemented community micro projects
  to help communities recover and reestablish
  productive assets, community infrastructure and
  lost linkages to markets and services.
• Initiated long term interventions for rebuilding
  livelihood systems about ten sub-sectors
  identified
• Other interventions included shelter, water and
  sanitation, psychosocial care, community based
  disaster preparedness
• Launched a large scale micro insurance program in
  tsunami hit districts in Andhra Pradesh and
  subsequently in Tamil Nadu Pondicherry in 2006
  as part of long term strategy to strengthen
  community resilience

3
Approach to program designing

• Health interventions integral component of
  disaster response programs complements
  designing and implementation of other
  interventions such as shelter, livelihoods etc
• Complement the initiatives by the governments and
  other aid agencies
• Focus on the poor and most vulnerable- especially
  the women and children
• Increase awareness, enhance access to and
  availability of resources, eventually increase
  communitys resilience for disasters
• CAREs perspective on humanitarian response to
  link programs of relief, recovery and
  rehabilitation to measures for disaster
  preparedness and risk reduction.

4
Interventions in Health

• Spanning all three phases of disaster response -
  relief, rehabilitation and rebuilding
• Relief provisions of hygiene kits, medicines,
  halogen tablets, floor mats, safe drinking water,
  sanitation facilities, and psychosocial care
• Recovery and Rehabilitation
• Psychosocial care,
• water and sanitation and
• micro health insurance

5
Psychosocial care

• Relief phase Emotional first aid to victims,
  sensitization in the government and
  non-government sectors (trained VHNs, Anganwadi
  teachers, school teachers, health functionaries,
  NGO functionaries, volunteers from the community)
• Rehabilitation phase building capacities on
  technical content, process skills and motivation,
  integrating with primary health care centers, and
  other government departments, strengthening
  referral systems
• Rebuilding phase building capacities at the
  community level, life skills education to
  children, integrating with disaster preparedness
• Resulted in increased psychosocial awareness,
  volunteerism, mental health literacy, increased
  capabilities, realization on the need for
  spectrum of care and disaster preparedness

6
Water and Sanitation

• Ensured safe drinking water and sanitation
  facilities in relief camps and temporary shelters
• Cleaned up and desalinated wells and other
  drinking water sources like ponds
• Improved access to safe drinking water facilities
  to about 20,000 families provision of new hand
  pumps with platform and soak pits, provision of
  filter points, reverse osmosis plants, storage
  arrangements etc
• Upgraded sanitation technology using available
  low cost alternatives eco-san toilets
• Construction of community sanitary complexes
• Sensitized and built awareness in the community
  for behaviour change
• Integrated with ICDS Program for mainstreaming
  initiatives to focus on women and children
• Promoted school hygiene and sanitation programs
• Strengthen the network of NGOs and CBOs

7
Micro Health Insurance

• Protection against health risks accorded first
  priority by the communities
• There were experiences of epidemics like
  chickengunia in the post tsunami context
• A free micro health insurance introduced by the
  government in select villages, but was limited in
  out reach with apprehensions about continuity
• CARE introduced micro insurance as a risk coping
  mechanism layered over livelihoods rehabilitation
  initiatives to take care of repeat disasters of
  varying scale
• Community Based Disaster Preparedness program
  helps in risk reduction and protection, but needs
  to be complemented by appropriate risk mitigation
  mechanisms
• Micro health insurance piloted in one district as
  a community mutual with private insurance company
  offering co-insurance support a unique model in
  the country - program extended to other districts
  now

8
Micro Health insurance Product features

• Health Insurance for low income community from
  commercial insurance companies is rare, therefore
  introduced
• As community mutual to keep premiums low, take
  advantage of existing solidarity, to reduce
  administrative expenses and keep the moral hazard
  at bay
• Risks shared with insurance company through
  co-insurance option (3664)
• Age cover 3 months to 70 years
• Cover for the entire family and frequently
  occurring illnesses
• Cover for epidemics
• Cover for surgical care, medical care and day
  care

9
Overall Learning

• Need to design interventions so as to complement
  the government support initiatives
• Map communities needs and priorities and work in
  tandem with other aid and development agencies
• Effective coordination mechanisms required at all
  levels
• Never compromise on standards and programming
  principles promote empowerment, work with
  partners, ensure accountability and promote
  responsibility, address discrimination, promote
  non-violent resolution of conflicts
• Even in a disaster context, program interventions
  to in-build mechanisms for sustainability the
  investments made in the communities, public and
  private systems are to result in increasing
  impact and synergies
• Institutionalize systems and processes and build
  local capacities for management and governance
• Turn disasters into opportunities for the
  communities

10

• Thank You