Interventions in Health for Tsunami
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Victims in India
C. Kumar
Tsunami Response Program
CARE India, Chennai
The Tsunami Context
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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
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Approach to program
designing
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Health interventions – integral component of disaster response
programs – complements designing and implementation of other
interventions such as shelter, livelihoods etc
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Complement the initiatives by the governments and other aid
agencies
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Focus on the poor and most vulnerable- especially the women and
children
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Increase awareness, enhance access to and availability of resources,
eventually increase community’s resilience for disasters
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CARE’s perspective on humanitarian response – to link programs of
relief, recovery and rehabilitation to measures for disaster
preparedness and risk reduction.
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Interventions
in Health
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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 –
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Psychosocial care,
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water and sanitation and
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micro health insurance
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Psychosocial
care
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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
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Water and
Sanitation
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Ensured safe drinking water and sanitation facilities in relief camps and temporary
shelters
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Cleaned up and desalinated wells and other drinking water sources like ponds
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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
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Upgraded sanitation technology using available low cost alternatives – eco-san
toilets
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Construction of community sanitary complexes
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Sensitized and built awareness in the community for behaviour change
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Integrated with ICDS Program for mainstreaming initiatives to focus on women
and children
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Promoted school hygiene and sanitation programs
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Strengthen the network of NGOs and CBOs
TitleInsurance
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Micro Health
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Protection against health risks accorded first priority by the communities
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There were experiences of epidemics like ‘chickengunia’ in the post tsunami
context
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A free micro health insurance introduced by the government in select villages,
but was limited in out reach with apprehensions about continuity
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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
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Micro Health insurance
– Product
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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 (36%:64%)
• 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
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Overall
Learning
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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
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Thank You