Lack of proper commitment by state government towards decentralization. Political Decentralization.( Control of Local Politicians on Non-Teaching Hospitals). Indian Medical Association Against Political Decentralization.

1. EXISTING
DISASTER
MANAGEMENT
STRUCTURE
Disaster Management Act,
2005.
National Institute of Disaster
Management.
National Disaster Response
Force.
National Disaster Mitigation
Resource Center.
National Disaster
CHALLENGES IN DISASTER
PREPAREDNESS
Need for comprehensive Public Health Strategy to
meet all expected needs through enhanced
relationship and communication with private Health
•Lack of proper commitment by state government towards decentralization.
•Political Decentralization.( Control of Local Politicians on Non-Teaching
Hospitals).
•Indian Medical Association Against Political Decentralization.
•Health administrators and
bureaucrats are protected .
•State Protection of Regional
Employees.
•Limited transfer of power.
•District Collector Chairman of
Selection Committee Instead of Zilla
Parishad Chairman (Against 73rd Act)
PROBLEMS IN DECENTRALISATION OF
HEALTH CARE IN AP, INDIA.
PROBLEMS IN HEALTH
SERVICE DELIVERY
 Non-availability of staff during duty
hours
Lack of funds
National Disaster
Management Authority.
National Crisis Management
Committee.
National Exec. Committee.
State Disaster
Management
Authority
(SDMA)
District
Disaster Response
Force.(NDRF)
Calamity
Relief
Fund.
Emergenc
y Medical
Relief
Division of
DGHS in
MOHFW.
CONCLUSIONS
No Political decentralization.
Positive and Negative effects of Aarogya shri on
Decentralization and Disaster Preparedness.
Failure of State Government in conducting training
workshops and Periodic Drills of all stake holders in
the preparation and implementation of Disaster
Preparedness Plan.
relationship and communication with private Health
sectors for improving Psychological Preparedness
help in event of disaster crisis.
 Need interventions for Hospital staff Training on
use of Multi-user System for Emergency Response.
(MUSTER) at semi-urban and Rural Levels.
Need for development of Community Mental
Health Services in rural areas.
Need for Gold Standards on Humanitarian Health
Interventions.
•Lack of accountability .
•Improper implementation of
Decentralization as District Mayor
not included in the committee.
(against 74th Amendment Act)
•Corruption
•Impact of Aarogya
shri on
Decentralization.
•Delay in payments
• Local Institutions
Depend on State
government for funding
Non-utilization of
funds and Budget by
Local Government due
to limited budget
spending Facility.
•Deficiency in efficiency and
Leadership of Chairmanship and
composition of Hospital Development
Society (HDS) In conducting regular
Meetings to address issues Health care
improvements.
EXAMPLE OF MUMBAI TERROR ATTACKS ON 27 NOV, 2008.
Lack of funds
Corruption
Quality of spending
Lack of accountability
Lack of proper incentives
Shortage of medicines
Inadequate supervision
Lack of proper infrastructure
INTRODUCTION
Indian Planning Commission opted for
Decentralisation to overcome the problems
in public health care delivery.
To increase the accountability of health
care providers.
To improve the health outcomes.
Preparedness Plan.
No focus on Psycho-social Interventions.
Delay in Payment by Central Government & State
government & Non-utilization of funds for appro-
priate Decentralization of Health care & Disaster
Preparedness.
REFERENCES
Mazzaferro C. & Zanardi A. (2008): Centralization versus Decentralization of public policies: Does the
Heterogeneity of Individual Preferences Matter? Fiscal studies, 29(1), pp-35-73.
Mooji (2003): Smart Governance ? Politics in the policy process in Andhra Pradesh , India; Working Paper
228; Overseas Development Institute, London
Mosca (2006): Is decentralization the real solution? A Three country study. Health Policy .vol.77, pp 113-120
Rondinelli D.A., Nelis J.R., & Cheema.G.S (1983): Decentralization in developing countries, Staff Working
Paper 581. Washington, DC, World Bank.
Singh, N (2008) Decentralization and Public Delivery of Health Care Services in India Munich Personal
RePEc Archive. Available Online at http://mpra.ub.uni-muenchen.de/7869/ [Accessed on Nov 14 2009]
http://www.searo.who.int/linkfiles/EHA_cp_India.pdf. (Accessed on Nov 14, 2009)
RECOMMENDATIONS
Increase in resources, Marked improvement of
Public Health infrastructure, medical and Para-medical
staff availability, involvement of key stake holders &
also community will help state government in proper
implementation of Decentralization & Disaster
Preparedness.
Training and orientation programs for Disaster
Preparedness.
Quick approval of New Disaster Management policy
& Training Module on Mass causality Management.My sincere thanks to J Agustín Ozamiz, Program Director of the EMSRHS and deep appreciation to my family, friends & colleagues.