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 community’s resilience for disasters • CARE’s 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 (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

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