Embed Size (px)
Citation preview
Public health system response
to flood: A study on public health workers
in Kendrapara district of Odisha, India
Dr Saumya Ranjan Mishra
Dissertation submitted in partial fulfillment of the requirement for
the award of the degree of Master of Public Health
Achutha Menon Centre for Health Science Studies
Sree Chitra Tirunal Institute for Medical Sciences and Technology
Thiruvananthapuram, Kerala, India
October 2012
Declaration
I hereby declare that this dissertation titled ‘Public health system response
to flood: A study on public health workers in Kendrapara district of
Odisha, India’ is an original work of mine and it has not been submitted to
any other university or institution.
Dr Saumya Ranjan Mishra
Achutha Menon Centre for Health Science Studies
Sree Chitra Tirunal Institute for Medical Sciences and Technology
Thiruvananthapuram, Kerala, India
October 2012
Certificate
I hereby certify that the work embodied in this dissertation titled ‘Public
health system response to flood: A study on public health workers in
Kendrapara district of Odisha, India’ is a bonafide record of original
research work undertaken by Dr Saumya Ranjan Mishra, in partial
fulfillment of the requirements for the award of the degree of Master of
Public Health, under my guidance and supervision.
Dr Kannan Srinivasan
Associate Professor
Achutha Menon Centre for Health Science Studies
Sree Chitra Tirunal Institute for Medical Sciences and Technology
Thiruvananthapuram, Kerala, India
October 2012
Acknowledgements
I am grateful to the study participants who participated or declined to participate in the study,
without whom, I would not have been able to accomplish this piece of work.
This work would not have been possible without the support of district health administration,
Kendrapara and block health administrations of Marshaghai and Rajnagar block. I offer my
special thanks to the CDMO, Kendrapara for permitting me to conduct this study.
I extend my heartfelt thanks to Mr. Ranjit Kumar Sahoo and Mr. Soubhagya Ranjan Mishra
for supporting me during my field work.
I would like to express my gratitude to Dr. Lipika Patra and Dr. Arup Abhishek for helping
me in translating interview guidelines and consent form.
Collective and individual acknowledgements are also owed to all members of AMCHSS
family, especially Mr. Sanjeev Kumar Singh and Dr. Apurvadan Ratnu for their help and
constant encouragement.
I would like to thank all the faculties at AMCHSS: Dr. K R Thankappan, Dr. V Raman
Kutty, Dr. P S Sarma, Dr. T K Sundari Ravindran, Dr. Mala Ramanathan, Dr. Biju Soman,
Dr. Ravi Prasad Varma, Dr. Manju R Nair, and Ms. Jissa V T for providing their valuable
suggestions to improve the study.
I would like to express my sincere gratitude to my guide Dr. K Srinivasan, Associate
Professor, AMCHSS for his supervision and guidance throughout the study.
I thank my family members for their unconditional love and support.
Thank God for divine presence around me.
Dedicated to my father
Table of contents
Abstract
Chapter 1: Introduction Page No
1.1 Introduction…………………………………………………………… ……... 1
1.2 Disaster………………………………………………………………………. 2
1.2.1 Disaster management………………………………………………….. 2
1.2.2 Relative frequency and effects of disasters …………………………... 4
1.3 Flood…………………………………………………………………………. 4
1.3.1 Flood in India. ……………………………………………………....... 4
1.3.2 Flood in Odisha………………………………………………………... 5
1.3.3 Flood in Kendrapara…………………………………………………... 5
1.3.4 Health effects of flood………………………………………………… 6
1.4 Public health system and flood………………………………………………. 7
1.4.1 Problems………………………………………………………………. 7
1.4.2 Preparedness ………………………………………………………….. 8
1.4.3 Community……………………………………………………………. 8
1.4.4 Public health workers…………………………………………………. 9
1.5 Public health system in Odisha………………………………………………. 10
1.5.1 Public health system response to flood in Odisha…………………….. 11
1.6 Rationale for the study……………………………………………………… 11
1.7 Objectives of the study …………………………………………………….. 12
Chapter 2: Methodology
2.1 Study design ………………………………………………………………………... 13
2.2 Study setting………………………………………………………………………… 13
2.3 Study population……………………………………………………………………. 13
2.3.1Inclusion criteria……………………………………………………………… 13
2.3.2 Exclusion criteria…………………………………………………………….. 13
2.4 Number of respondents…………………………………………………………....... 14
2.5 Respondent selection procedure…………………………………………………….. 14
2.6 Data collection tools ………………………………………………………………... 15
2.7 Data collection process ……………………………………………………………...16
2.7.1 Secondary data collection …………………………………………………….16
2.8 Data entry and analysis……………………………………………........................... 17
2.9 Ethical consideration ……………………………………………………………….. 17
2.10 Operational definitions…………………………………………………................. 18
Chapter 3: Results
3.1 Health system in the study district…………………………………………………...19
3.2 Respondent characteristics ……………………………………………………......... 20
3.3 Services delivery …………………………………………………………………….22
3.4 Service provided during flood…………………………………………………........ 23
3.5 Problems faced by public health workers ………………………………………….. 23
3.5.1 Lack of personal safety………………………………………………………. 24
3.5.2 Irregular supply of medicines and disinfectants……………………………... 25
3.5.3 Poor transportation ………………………………………………….……….. 26
3.5.4 Poor communication ………………………………………………………… 27
3.5.5 Difficulties in achieving targets…………………………………….……….. 27
3.6 Preparedness ……………………………………………………………………….. 29
3.6.1 Vulnerability assessment……………………………………………………… 30
3.6.2 Planning……………………………………………………………………….. 30
3.6.3 Information and communication……………………………………………… 31
3.6.3.1 Health communication…………………………………………….. 31
3.6.3.1.1 IEC material distribution………………………………….31
3.6.3.1.2 Awareness campaign…………………………………….. 32
3.6.4 Resources…………………………………………………………………….. 32
3.6.4.1 Financial resources ………………………………………………… 32
3.6.4.3 Human resources…………………………………………………… 33
3.6.5 Implementation ………………………………………………………………. 33
3.6.5.1 Establishment of medical relief center…………………………….. 33
3.6.5.2 Organizing mobile health team……………………………………. 34
3.6.5.3 Streamlining the supply of essential drugs………………………… 34
3.6.5.4 Transportation arrangements ……………………………………… 35
3.6.6 Coordination………………………………………………………………….. 35
3.6.6.1 Coordination within health system………………………………… 35
3.6.6.2 Coordination with other sectors……………………………………. 36
3.6.7 Monitoring…………………………………………………………………….. 39
3.6.7.1 Establishment of control room…………………………………….. 39
3.6.7.2 Reporting procedures……………………………………………… 40
3.6.8 Evaluation ……………………………………………………………………. 40
3.6.8.1 Organizing meeting………………………………………………… 40
3.6.8.2 Documentation and research ……………………………………… 41
3.7 Capacity gap……………………………………………………………………….. 41
3.7.1 Lack of infrastructure…………………………………………………………. 42
3.7.2 Human resources shortage……………………………………………………. .42
3.7.2.1 Contractual appointment…………………………………………… 43
3.7.3 Training needs………………………………………………………………… 44
3.7.3.1 Induction training…………………………………………………... 44
3.7.3.2 Training in disaster management…………………………………... 44
3.7.3.3 Training in flood management…………………………………….. 45
3.7.3.4 Training in epidemic investigation and surveillance………………. 45
3.7.3.5 Training material…………………………………………………… 46
3.7.4 Administrative lapses ………………………………………………………… 46
3.7.4.1 Poor leadership…………………………………………………….. 46
3.7.4.2 Poor supervision…………………………………………………… 46
3.7.5 Information gap……………………………………………………………….. 47
Chapter 4: Discussion and conclusion
4.1 Discussion…………………………………………………………………………... 48
4.2 Conclusion…………………………………………………………………….……. 52
4.3 Recommendations………………………………………………………………….. 52
4.4 Strengths of the study………………………………………………………………. 53
4.5 Limitations of the study…………………………………………………………….. 54
References
Annexures
Annexure 1: Health system in Odisha
Annexure 2: Map of Kendrapara
Annexure 3: Consent form
Annexure 4: And they also stated
Annexure 5a-5f: Interview guideline for health worker female, health worker male,
supervisor female, supervisor male, hospital support staff and medical officer
List of Tables
Table Page No
Table 1.1 Top 10 Natural Disasters in India during 1900-2012 in terms of
numbers of people affected…………………………………………………………1
Table 1.2 Top 10 Natural Disasters in India during 1900-2012 in terms of
economic damage …………………………………………………………………...1
Table 1.3 Government health care infrastructure in Odisha……………………… 11
Table 3.1 Respondent characteristics…………………………………………….. 21
Table 3.2 Total duration of service of respondents………………………………. 21
Table 3.3 Duration of service of respondents at current place…………………...... 21
Table 3.4 Nature of service of respondents………………………………………. 44
Table 3.5 Training of public health workers……………………………………… 45
Abbreviations
ADMO- Assistant District Medical Officer
AHRCC- Acharya Harihar Regional Cancer Center
ASHA- Accredited Social Health Activist
ASV- Anti Snake Venom
AWW- Angan Wadi Worker
AYUSH- Ayurvedic Yoga Unani Sidhha and Homeopathy
BDO- Block Development Officer
BP- Blood Pressure
CBO- Community Based Organization
CDMO- Chief District Medical officer
CGHS- Central Government Health Scheme
CHC- Community Health Center
CRED- Centre for Research on Epidemiology of Disasters
CUG- Common User Group
ESIC- Employees’ State Insurance Corporation
GKS- Gaon Kalyan Samiti
HR- Human Resource
IDNDR- International Decade for National Disaster Reduction
IDSP- Integrated Disease Surveillance Project
IEC- Institutional Ethics Committee
IEC material- Information Education and Communication material
ILR- Ice Lined Refrigerator
IPD- In Patient Department
IPHS- Indian Public Health Standard
ISM- Indian System of Medicine
LHV- Lady Health Visitor
MBBS- Bachelor of Medicine and Bachelor of Surgery
MO- Medical Officer
MO I/C- Medical Officer In-Charge
MRC- Medical Relief Center/Camp
NDMA- National Disaster Management Authority
NGO- Non Government Organization
NRHM- National Rural Health Mission
OPD- Out Patient Department
ORS- Oral Rehydration Salt
OSACS- Odisha State AIDS Control Society
OSDMA- Odisha State Disaster Management Authority
PH- Public Health
PHC- Primary Health Center
PRI- Panchayat Raj Institution
RKS- Rogi Kalyan Samiti
RSS- Rastriya Swayamsevak Sangh
SC- Sub Center
SHG- Self Help Group
SI- Sanitary Inspector
SIHFW- State Institute of Health and Family Welfare
SIM- Subscriber Identity Module
TAC- Technical Advisory Committee
TB- Tuberculosis
UGPHC- Up-Graded Primary Health Center
ULB- Urban Local Body
UNDP- United Nations Development Programme
UNICEF- United Nations Children’s Fund
USA- United States of America
VHND- Village Health Nutrition Day
Abstract
Background: Flood is a perennial problem in Kendrapara district of Odisha, India.
Although district health administration tries to provide uninterrupted services during
flood, it is often not possible due to various reasons. This study aimed to study the major
problems encountered by public health workers in delivering the services after flood, their
preparedness for flood and the capacity gaps in dealing with flood situation.
Methodology: The study was conducted in two blocks (Marshaghai and Rajnagar) of
Kendrapara district. Fifty public health workers were interviewed by using interview
guidelines. The interviews were transcribed, coded into different themes and then
analysed. Official documents of health department on flood management in the district
were also collected and analysed.
Results: Public health workers were facing problems in service delivery due to non
availability of boats, non availability of required medicines and disinfectants when they
were in need and communication gap. They were not provided with life jackets.
Abysmal condition of health infrastructure and human resource shortage add to these
problems. There was lack of coordination among stakeholders. Planning process for
preparedness was haphazard and was not coordinated at various levels. Only few senior
staffs (16 out of 50) were trained in disaster management many years back.
Conclusion: There are major gaps in flood preparedness. Health services delivery
during flood is also affected by many factors. District health administration should take
these factors into account and should remain prepared. Measures to reduce the
infrastructure and human resource gap should be given due priority.
1
Chapter-1
Introduction
1.1 Introduction
According to India disaster report 2011, fourteen States and one Union Territory of India
had experienced at least one disaster during the year 2011. The damage occurred in terms
of number of human lives lost was 1432 and number of cattle perished was 6266. In total
6,84,901 houses were damaged and 16.28 lakh hectares of cropped area were affected. 1
Table1.1 Top 10 Natural Disasters in India during 1900-2012 in terms of numbers of
people affected
Rank Disaster Year of occurrence Total number of people affected
1 Drought 1987 300,000,000
2 Drought 2002 300,000,000
3 Drought 1972 200,000,000
4 Flood 1993 128,000,000
5 Drought 1965 100,000,000
6 Drought 1982 100,000,000
7 Drought 2000 50,000,000
8 Flood 2002 42,000,000
9 Flood 1975 34,000,000
10 Flood 1982 33,500,000
Source- EM-DAT: The OFDA/CRED International Disaster Database www.em-dat.net - Université Catholique de Louvain - Brussels - Belgium
Table1.2 Top 10 Natural Disasters in India during 1900-2012 in terms of economic
damage Rank Disaster Year of occurrence Damage (000 US$)
1 Flood 1993 7,000,000
2 Flood 2006 3,390,000
3 Flood 2005 3,330,000
4 Earthquake 2001 2,623,000
5 Storm 1999 2,500,000
6 Flood 2004 2,500,000
7 Flood 2005 2,300,000
8 Storm 1990 2,200,000
9 Flood 2009 2,150,000
10 Flood 2010 1,680,000
Source- EM-DAT: The OFDA/CRED International Disaster Database www.em-dat.net - Université Catholique de Louvain - Brussels - Belgium
2
Droughts and floods were the disasters which affected maximum number of people in
India. Table1.1 shows the top 10 natural disasters in India in terms of total number of
people affected during 1900-2012. In terms of economic damage it was again the floods
which had caused huge economic losses to India. Table1.2 shows the top 10 natural
disasters in India in terms of economic damage during 1900-2012.
1.2 Disaster
So what is a disaster? Let’s discuss about it. Disaster is defined as occurrence of
catastrophe in any area which may be due to natural or manmade causes. It can occur as
an accident or due to negligence and may result in loss of human life and/or cattle life
and/or damage to property. It may also lead to degradation of environment. Community
of the affected area usually don’t have the capacity to cope with the situation without
external support. 2
Disasters can be classified into two broad types: natural disasters and manmade disasters.
The High Power Committee on disaster management in India, constituted in 1999, has
identified 31 different disasters which can be categorized into five major groups. 3
i. Water and climate related disasters
ii. Geological disasters
iii. Chemical, industrial and nuclear disasters
iv. Accident related disasters
v. Biological disasters
1.2.1 Disaster management
Disaster management is necessary not only for prompt response during disaster but for
prevention of it and for reduction of risk and severity of any disaster. It is a continuous
3
and integrated process of planning, organising, coordinating and implementing different
activities and measures. It includes preparedness, assessment of magnitude of effects,
prompt response such as evacuation, rescue and relief. It also includes rehabilitation and
reconstruction.2 A typical disaster management cycle has six elements; the pre-disaster
phase comprises of prevention, mitigation and preparedness while the post-disaster phase
comprises of response, rehabilitation, reconstruction and recovery. 4
Traditionally, management of any disaster worldwide, focussed on immediate rescue and
relief operation, so as in India. After the Great Famine of 1876-1878 in India, the Famine
Commission was constituted in 1880. The Famine Relief Code was also adopted. 5
Relief departments were set up under British rule for emergencies during disasters. After
independence, disaster management in each state was looked after by Relief
Commissioners, under Central Relief Commissioner. Their role were limited to
distribution of relief material in the affected areas. 3
Consequent upon proclamation of the decade 1990-2000 as International Decade for
Natural Disaster Reduction (IDNDR) by the general assembly of the United Nations 6 and
the world conference on natural disasters reduction at Yokohama, Japan in 1994,
Government of India constituted a High Powered Committee in August, 1999. 7 The High
Power Committee gave its recommendations in October 2001 including a draft of the
disaster management bill and suggested for the establishment of National Disaster
Management Authority. 3, 5
After Odisha Super Cyclone (1999) and Gujarat Earthquake (2001), India changed its
disaster management approach from reactive to proactive. 8
After the super cyclone, the
Government of Odisha established the Odisha State Disaster Management Authority
(OSDMA). 5
4
1.2.2 Relative frequency and effects of disasters
World meteorological organization statistics shows that damage caused by natural
disasters during 1963-2002 was worst for floods (Flood-32%, Tropical cyclone-30%,
Droughts-22%, Earthquakes-10%and other disasters-6%). 3
78.4% of all disaster events
worldwide occur due to hydro-meteorological causes and 47.94% of all disaster deaths
worldwide are due to hydro-meteorological disasters from 1900 to 2009. 3
Children and
women are the most vulnerable group as 85% of the deaths during disasters are of women
and children. 3
1.3 Flood
Flood is defined as ‘the condition that occurs when water overflows the natural or
artificial confines of a stream, river, or other body of water, or accumulates by drainage
over low-lying areas’. 9 Flood can occur in a small localized area due to heavy rainfall
over a sustained period of time and the consequent drainage problem. Flash flooding
occurs when it rains too quickly, generally for less than six hours. But river floods are
usually of longer duration as it may last a week or more and in some cases for months
together causing more harm to human lives and livestock. Coastal floods are caused by
tsunami, heavy costal rainfall and tidal action.10
River floods are expected in some geographical areas. People generally welcome floods
as they provide rich soil for cultivation and water for various purposes. But flood at an
unexpected scale and with excessive frequency causes damage to lives, livestock and the
environment. Matter of concern is that, there is increase in the frequency and intensity of
floods in many regions of the world including India due to current climate change.11
1.3.1 Flood in India
The Indian sub-continent is highly vulnerable to various types of natural disasters like
droughts, floods, cyclones, earthquakes, and landslides etc. India is one of the ten worst
5
disaster prone countries of the world. 3
Among all these natural disasters that occur in
the country, river floods are the most frequent and often the most devastating. In India, 40
million hectares of land which is almost one-eighth of the total area of the country is
prone to floods. Flood occurs in 23 out of total 35 states and union territories in the
country. 3
To control flood in the country, The National Flood Control Program was
launched in India in 1954. 3
1.3.2 Flood in Odisha
Odisha state which is situated in the east coast of India is one of the most vulnerable
Indian states to climate change.12
It is located between 170 48’ N and 22
0 35’ N latitudes,
and 810 47’ E and 87
0 32’ E longitudes.
1 The main rivers of Odisha are Mahanadi,
Brahmani, Baitarani, Budhabalanga, Subarnarekha, Rushikulya etc. These rivers are
perennial with sluggish flow throughout the dry season. With the onset of monsoon they
swell menacingly and flood large areas. 1
Odisha experiences severe floods in almost
every two years. 13
1.3.3 Flood in Kendrapara district of Odisha
Kendrapara district is one of the coastal districts of Odisha. After separation from Cuttack
district as a separate district in 1993, Kendrapara has faced severe floods in 1994, 1995,
1997, 1999, 2001, 2003, 2006, 2007, 2008, 2009 13
and recently in 2011.14
According to India disaster report 2011, Kendrapara district was badly hit by flood in
2011. All the nine development blocks in the district were affected. 473 villages of 116
Gram Panchayats and two Urban Local Bodies (ULBs) were affected. Total number of
population affected were 507145 (Third highest after 625897 in Puri district and 526923
in Cuttack district) with 13 human casualties (Highest in the state). 27000 houses were
damaged (Second highest after Puri district) including kuchha and pucca houses. 1
6
1.3.4 Health effects of flood
Floods are often considered the most frequent and costly of all natural disasters in terms
of human suffering and economic loss.15
Health impacts of flood vary between
populations and these depend on the physical vulnerability of population, individual as
well as community preparedness and the type and duration of flood event.
The immediate health effects of flood can be drowning, injury, acute asthma, skin rashes,
gastroenteritis, and respiratory infections. The mid-term effects of flood are infected
wounds, poisoning, communicable diseases, and starvation. The long-term health effects
of flood can be disability, poor mental health and malnutrition. 16
Approximately two-
thirds of the flood deaths can be attributed to drowning. This implies that other one-third
fatalities are due to causes other than drowning, such as physical trauma, heart attack,
fire, carbon monoxide poisoning and electrocution.17
In flood situations, there are always increased chance of transmission of diseases like
cholera, cryptosporidiosis, poliomyelitis, rotavirus, typhoid and paratyphoid, especially in
areas if the community does not have access to safe drinking water and sanitation.18
Common mental disorders like anxiety, depression and posttraumatic stress disorder are
common after a stressful event of an exceptionally threatening nature like severe flood. 18
These may manifest with symptoms like disturbing memories, avoidance of
circumstances associated with the stressor, sleep disturbances, irritability and lack of
concentration.18
Loss of treasured possessions in flood can have much more impact than
financial losses. 19
One study found a four times increase in illnesses among people whose homes were
flooded compared with those whose homes were not flooded.20
Referrals to hospitals
were more than double from the flooded households than non flooded households for the
years following the floods in Europe. 21
7
One community level study in rural Odisha, India shows that exposure to floods is
associated with long-term malnutrition. Children who are exposed to floods during their
first year of life show higher levels of chronic malnutrition compared to the children who
are not exposed to flood during their infancy.22
1.4 Public health system and flood
Public health system should remain prepared to provide emergency services to the
community as the demand may increase suddenly when flood strikes the community. 23
but public health systems face lots of problems in managing the flood situation.
1.4.1 Problems
Flood can have impact on the public health care systems in two ways. The direct impact
is due to structural damage to health facilities and the secondary impact is through other
management problems. 24
Scarcity of resources reduces the ability of the health system to
respond effectively. 25
Public health systems also face problems in delivering services due to population
displacement and power failure. Population displacement leads to crowding and
sanitation problem around the temporary settlements. This may lead to outbreak of
diseases. 26
Water treatment plants may stop working due to power failure problem during
floods. This increases the risk for waterborne diseases. Power failure problem also affects
proper functioning of health facilities such as maintenance of cold chain. 26
Disease surveillance in affected areas is important to understand the impact of flood on
diseases. But getting accurate and timely information during flood is frequently
challenging. 26
Healthcare immediately after flood is often delivered by many agencies
and organizations. Coordination among them at that time becomes a challenge. 26
8
1.4.2 Preparedness
In general flood preparedness measures include construction of dams, land use
planning, watershed management, flood forecasting and warning system, flood
contingency planning and preparedness of community for self-protection activity and
capacity building programmes. 11
Public and the public authorities always focus on
structural interventions that modify and control the speed and the force of flood.10
Primary health centres under public health system are the main health care institutions in
rural areas to deal with health impacts of disasters. 27, 28
Poor people are more likely to be
affected than the wealthier, when public health institutions are affected. 29
To reduce the health impacts on a population significantly, health system should have
information on impending flood. 30
Flood preparedness planning for public health system
should be an ongoing process. It should encompass all stakeholders so that the collective
wisdom can be utilised to reduce the impact of flood, to take necessary action during the
flood event and to take up proper rehabilitation and recovery activities. 31
but it is a
common fact that public health planning processes in most of the countries including
India are based on assumptions and speculations rather than evidence. 27
1.4.3 Community
National Disaster Management Authority (NDMA) has advised the Ministry of
Panchayati Raj and Rural Development to address the concerns of disaster management
in the training of representatives of the Panchayati Raj Institutions and local bodies.
Women Self Help Groups (SHGs), Anganwadi workers and women volunteers are
playing a lead role in disaster management preparedness. Accredited Social Health
Activist (ASHA) workers are also facilitating first aid and search and rescue training for
large number of people. 8
9
So community should be aware about their vulnerability and strength. They are
themselves the first responders to any type of disasters. Education and training of the
general community in first aid and resuscitation definitely helps in saving many lives
before formal medical aid reaches the disaster site. Evaluations of training programs on
first aid and resuscitation have shown good results. Contingency plans and mitigation
plans for flood become successful only when the planning process involves all the
community members and it take into account the existing social structures and
dynamics.32
It has been estimated that, 80-90 percent of health care demands in the first 24 hours after
flood strikes the community can be managed by trained volunteers from the community
itself. This also reduces the work burden on the public health system. 33
1.4.4 Public health workers
Recruiting and retaining human resources in public health system is an all time challenge.
There is acute shortage of human resources in rural areas and it is felt clearly during
disasters like flood. 34
But Training of available human resource in flood management can
reduce the service gap during flood substantially. 35
Training and capacity building of health personnel is one of the most important elements
of disaster preparedness plan of public health system. Trained manpower shows
confidence in handling emergency situations. Evaluation of training and capacity building
activities are usually done by comparing pre-tests and post-tests36
but the actual
evaluation of competency and effectiveness occurs as the hazard strikes the community.
Training also helps to discover insufficiencies in skills, decision taking practice and
information systems. 37
Training should have theory sessions based on success stories elsewhere in the world and
mock sessions providing skills to deal with the practical problem. The most important
10
thing is that there should be refresher trainings regularly with regular updating of
knowledge. 38
There should be more capacity building activities for community level
health workers as they are the first contact points for the community in emergency
situations like flood. These activities should be based on accepted scientific approaches
but adapted to the local culture.39
1.5 Public health system in Odisha
Commissioner-cum-secretary of department of health is the administrative head of the
department and reports to the health minister. Nine directors and the drug controller of
Odisha report directly to the commissioner-cum-secretary. These directors are Mission
Director, National Rural Health Mission(NRHM); Project Director, Odisha State AIDS
Control Society (OSACS) ; Director, Medical Education and Training; Director, Acharya
Harihar Regional Cancer Centre(AHRCC) ; Director, Family Welfare ; Director, Health
Services; Director, Public Health ; Director, State Institute of Health and Family
Welfare(SIHFW); Director, Indian System of Medicine(ISM) and Homeopathy.
Commissioner-cum-secretary is also helped by secretaries at various levels such as
special secretary, additional secretary, joint secretary, deputy secretary and under
secretary. (Annexure-1)
District health administration is headed by chief district medical officer. Public health
system below district level has been described in the section 3.1 (Health system in the
study district) of result chapter.
Table1.3 gives an idea about the number of public health care institutions in Odisha
which provide services to total population of 41,947,358 (Rural 34,951,234 and Urban
6,996,124) in Odisha.40
11
Table1.3 Government health care infrastructure in Odisha
Public Health Facility Numbers
Medical College and Hospitals 3
District Hospitals (30 districts +
Capital Hospital, Bhubaneswar & Rourkela General
Hospital)
32
Sub-Divisional Hospitals 26
Community Health Centres 377
Other Hospitals 79
Primary Health Centres 1228
Sub-Centres 6688
Ayurvedic Hospitals 2
Ayurvedic College & Hospitals
3
Ayurvedic Dispensaries 619
Homoeopathic College & Hospitals 4
Homoeopathic Dispensaries 561
Unani Dispensaries 9
Source- Annual Activity Report 2011-12, Health and Family Welfare Department,
Government of Odisha.
1.5.1 Public health system response to flood in Odisha
Directorate of Public Health in Odisha has been created by a resolution of Department of
Health & Family Welfare in 2009. Disaster management is one of the main activities of
the directorate. 14
The State unit of Integrated Disease Surveillance Project (IDSP)
becomes the state control room during flood. During 2011 flood, 135 medical relief teams
were deployed and 482 Medical Relief Centers were opened in the flood affected
districts.14
1,73,374 packets of ORS and 52,74,613 Halogen tablets were distributed. 1
1.6 Rationale for the study
Successful management of health impacts of flood depends on the coordination of various
departments and agencies with the health department, cooperation from the community
12
and leadership of the health department. This can only be achieved by improving the
understanding of health risks in local settings and of the social and cultural modifiers of
those risks.17
Research on flood risks and response has largely focused on economics, livelihood and
agriculture. Very few researches have given attention to health dimension of flood. 41
A survey of primary health centers in Jagatsinghpur district of Odisha, bordering district
of Kendrapara was done immediately after 2008 flood. The objectives were to assess the
preparedness and functional capacity of primary health centers in the district for flood
response. Pretested questionnaire was used to interview medical officers only. Health
workers and other supporting staffs were not interviewed. 42
No references of study conducted in Kendrapara district which tries to understand the
health risks of community and health staffs, inter and intra health department work
dynamics, expectation and cooperation of community and community based
organizations in flood situations were found.
This study is an attempt to understand these local health system dynamics which can be
utilized to change the policy for better preparedness of health system to manage and
mitigate the adverse health impacts of flood in Kendrapara district.
1.7 Objectives of the study
Major objectives
• To study the major problems encountered by public health workers in delivering
the services after flood
Minor objectives
• To study the preparedness of public health workers for managing flood situation
• To find out the capacity gaps of public health workers in dealing with flood
situation
13
Chapter-2
Methodology
2.1 Study design
In this study, data were collected by interviewing the study participants using interview
guidelines. Qualitative approach was used to avoid premature focus on few known
aspects. 43
This also facilitated secondary data collection. Analysis of documents related
to flood response and management in the district was also done.
2.2 Study setting
The study was conducted in two blocks (Marshaghai and Rajnagar) of Kendrapara
district, Odisha, India.(Annexure-2)
2.3 Study population
All the public health workers of the district including health workers (female and male),
health supervisors(female and male), medical officers and supporting staffs like nurses,
laboratory technicians and pharmacists etc working in the state health department and
providing services constituted the study population. Contractual employees under state
health department and National Rural Health Mission were also included in the study
population.
2.3.1Inclusion criteria
Only the public health workers who had worked for more than 1 year at their current duty
stations (who had experienced the last year flood in 2011) were included.
2.3.2 Exclusion criteria
Ayurvedic, Yoga, Unani, Sidhha and Homeopathy(AYUSH) health care providers under
directorate of Indian System of Medicine(ISM), Govt. of Odisha, Central Government
14
Health Scheme (CGHS) and Employees State Insurance Corporation (ESIC) health care
providers working in the district were excluded from the study population.
2.4 Number of respondents
Initially it was decided to interview total 54 respondents (27 respondents from each
block). But the actual number of respondents interviewed were 50 (33 from Marshaghai
block and 17 from Rajnagar block).This is thought to be sufficient for adequately
answering the research questions.
2.5 Respondent selection procedure
Each block in the district has either a Community Health Centres (CHC) or Up-Graded
Primary Health Centres (UGPHC). Under each CHC or UGPHC, there are some Primary
Health Centres (PHC) and under each PHC there are some sub-centres. Health workers
female and health workers male work in the sub-centres. Health Supervisor Female and
Health Supervisor Male supervise their work respectively.
Two block level health institutions; Marshaghai CHC and Rajnagar CHC were selected
randomly from the nine block level health institutions (six CHCs and three UGPHCs) in
the district. All the nine blocks were affected by flood in 2011.
List of all the health workers working in the flood affected areas in each block was
obtained from the office of the medical officer in charge of two respective CHCs.
Initially it was proposed to select the respondents randomly but after visiting the study
blocks, every public health worker from the list was contacted for interview.
There were six categories of respondents; Health worker female, Health worker male,
Health supervisor female, Health supervisor male, Hospital support staff and Medical
officer.
15
2.6 Data collection tools
Interview guidelines for each category of respondents were prepared keeping duty station
and work responsibilities in mind. Guidelines were first prepared in English and then
translated into Odia with the help of two public health professionals who had reasonable
knowledge and understanding of both the language.
Interview guideline for each category of participant was divided into 10 thematic areas
such as General information, Health problems during flood, Status of usual services
delivery during flood, Special practices during and after flood, Damage to health centre
due to flood, Personal protection, Institutional preparedness for flood response,
Community preparedness, Coordination, Training and capacity building. There were
questions under each thematic area and some of the questions had further probing
questions.
Some general information about the respondent and nature of service were collected by
asking the questions under general information. These introductory questions also helped
to build rapport with the respondents. Questions on health problems during flood were
prelude to the specific questions further. Questions on status of usual services delivery
during flood were asked to find out the problems during services delivery. Questions on
special practices during and after flood specifically seek information on emergency
management, assessment of health situation, health information system and medical
relief camps. Questions on damage to health centre due to flood and personal protection
were straight forward. Questions on institutional preparedness assessed the health system
preparedness for impending flood and questions on community preparedness assessed the
health system role in community preparedness especially in health communication.
Questions on coordination tried to find out details of intra-departmental and inter-
departmental meetings and the process of cooperation from community members, private
16
service providers and NGOs and CBOs. Questions on training and capacity building were
to assess the training status of public health workers in flood management.
2.7 Data collection process
Participants were contacted before the interviews. The interviews began after taking
consent from the participants. In-depth interviews were conducted among the study
participants by using interview guideline. Participants were interviewed at their work
places or residences whichever was convenient to them. Principal investigator
interviewed the participants and a research assistant recorded the interview proceedings.
2.7.1 Secondary data collection
Official documents related to flood response and management which were available with
the study participants, office of the medical officer in charge CHC and office of the Chief
District Medical Officer (CDMO) were collected. For this purpose, photocopies of these
documents were done with prior permission.
The documents collected were as follows
District action plan
Block action plans-Rajnagar block and Marshaghai block
Letter from The Director, Public Health to CDMO with template for action plan
Letter from the Medical Officer in charge CHC to CDMO regarding opening of control
room
Letter from The Director, State Institute of Health and Family Welfare (SIHFW) to
Block Development Officers (BDO)
Training booklet
Reporting format
17
2.8 Data entry and analysis
End of each day the interviews were transcribed. If there were any clarification needed,
respondents were contacted. After transcription they were coded and recoded. Codes
were then grouped and regrouped to get common patterns. Analysis was done manually
and no software was used for analysis.
2.9 Ethical consideration
The study had obtained clearance from the Technical Advisory Committee (TAC) and
Institutional Ethics Committee (IEC) of Sree Chitra Tirunal Institute for Medical
Sciences and Technology, Thiruvananthapuram, Kerala. Permission for data collection
was also taken from the Chief District Medical Officer (CDMO) of Kendrapara district of
Odisha. This study complied with the basic ethical principles of research. Written
informed consent (Annexure-3) for participating in the study was taken from the study
participants. Consent form also had information about the study and contact details of the
principal investigator. It was prepared in English and later translated into local language
(Odia). One copy of the signed informed consent was handed over to the participants.
Participants had full freedom of either accepting or refusing to participate, and to opt out
temporarily or permanently at any time of the study without any explanation and
consequences. Participants were informed regarding the voluntary nature of participation,
study objectives and the potential benefits and risks of participation. They were also
given chance to ask any question, query or doubt related to the study. Proper care was
taken not to cause any distress to the respondents during interview. Utmost care was
taken to protect the privacy and confidentiality of the participants. Personal information
of the participants was not shared with anyone not involved in the study. A unique
identification number with block, category of respondent and respondent code was
18
assigned to each respondent to maintain the privacy and confidentiality. All hard copies
of interview notes and consent forms are kept under custody of principal investigator.
2.10 Operational definitions
Public health workers- An employee of the health department whose duties may
include either surveillance, case management, or some combination of these activities.
(http://www.cdc.gov/tb/education/ssmodules/glos%206-9.htm). Synonymously used as
health worker or health staff or service provider.
Public health system- Synonymously used as health system or health department or
health administration.
Public health system response- includes professional activities during preparedness,
response and recovery phase of emergency management. It excludes activities during
mitigation phase.
Mitigation- attempts to prevent hazards from developing into disasters
Preparedness-attempts to limit the impact of disasters on the population
Response- mobilisation and functioning of emergency services in disaster areas
Recovery- activities such as repair work and epidemic prevention that lead to restore the
previous situation
19
Chapter-3
Results
This chapter discusses the findings of the present study. It begins with the description of
health system in Kendrapara district, characteristics of respondents, services provided by
public health workers during flood and the rest of the year. Later part discusses the
problems of public health workers during flood, flood preparedness and capacity gap in
health system.
3.1 Health system in the study district
Health administration in Kendrapara had four tier structures. At the apex level, it was the
district head quarter hospital headed by the chief district medical officer (CDMO) who
was assisted by three assistant district medical officers (ADMO). Three ADMOs were
managing three major wings of health services: medical, public health and family
welfare. CDMO was also supported by district level medical officers such as district
malaria officer, district TB officer etc for managing national programmes.
According to Indian Public Health Standard (IPHS), the next level below district head
quarter hospital is the community health centre (CHC). It is a 30 bed hospital covering a
population of 100,000. It serves as the first referral unit. 44
Kendrapara district is divided
into nine development blocks. Each of the blocks had either of the following major
health institution; community health center (CHC) or upgraded primary health center
(UGPHC). There were six CHCs and three UGPHCs in the district. There was also an
area hospital at block level in Rajkanika block. 45
According to Indian Public Health Standard (IPHS), the next level below CHC is the
primary health centre (PHC). It covers a population of 30,000. At this level integrated
services are delivered to the community. Both out-patient and in-patient services are
20
available at the PHC level.46
In Kendrapara, under six CHCs and three UGPHCs in the
district, there were 44 PHCs delivering services.45
CHCs and UGPHCs were divided into
sectors manned by supervisory staffs such as lady health visitor (LHV) and sanitary
inspector (SI) for supervision of sub-centre staffs.
As per IPHS, at the lowest level there are sub-centres. Each PHC has 4-5 sub-centres and
each sub-centre covers a population of 5,000. Sub-centres are expected to provide out-
patient services only.47
In total there were 227 sub-centers at the grass root level in the
district.45
The work force at sub-center level consisted of female and male health
workers.
From the six CHCs and three UGPHCs, two CHCs had been selected for study as
described in methodology chapter. These were Marshaghai CHC and Rajnagar CHC.
Under Marshaghai CHC there were five PHCs and 22 sub-centers.45
These 22 sub-
centers were grouped into three sectors. Similarly under Rajnagar CHC there were five
PHCs and 25 sub-centers.45
These 25 sub-centers were grouped into four sectors.
3.2 Respondent characteristics
Fifty public health workers were interviewed of which 33 were from Marshaghai block
and 17 were from Rajnagar block. The details of respondents are given in Table 3.1.
Out of 50 respondents, twenty five (50%) of respondents were female. In Marshaghai
block sixteen (48.48%) respondents were female while in Rajnagar block nine (52.94%)
respondents were female. Out of total respondents, twenty (40%) were health worker
female where as 11(22%) were health worker male and six (12%) were supervisory staff.
All of hospital support staffs and medical officers were male except one female staff
nurse. Out of five medical officers interviewed, only one had qualification in modern
medicine (MBBS) and the rest were AYUSH doctors.
21
Table 3.1 Respondent characteristics
Respondent Category Marshaghai Rajnagar Number of respondent
Health worker female 13 7 20
Health worker male 8 3 11
Health supervisor female 2 2 4
Health supervisor male 1 1 2
Hospital support staff 5( male=4) 3( male=3) 8
Medical officer 4(male=4) 1(male=1) 5
Total 33 17 50
Table 3.2 presents total duration of service of respondents and Table 3.3 presents
duration of service of respondents at current place.
Table 3.2 Total duration of service of respondents
Total duration of
service
Marshaghai block Rajnagar block Number of respondent
1-5 11 3 14
6-10 5 4 9
11-20 5 5 10
21-30 10 4 14
More than 30 2 1 3
Table 3.3 Duration of service of respondents at current place
Service duration at
current place
Marshaghai
block
Rajnagar
block
Total
1 5 0 5
2-5 15 8 23
6-10 5 6 11
11-20 7 3 10
More than 20 1 0 1
22
14 (28%) out of total 50 respondents had completed less than six years of service. During
last seven years which coincide with the introduction of National Rural Health Mission
(NRHM) in the state in 2005, 48
new appointments were continuously given. Out of total
50 respondents, 22(44%) have completed more than five years of services at the current
place of posting.
3.3 Service delivery
Health worker females reported that they were providing following services:
immunization, antenatal and post natal check up, conducting delivery, family planning
services, iron folic acid tablet distribution, birth and death registration, blood smear
preparation and collection, home visits, attending Gaon Kalyan Samiti (GKS) meetings,
attending Accredited Social Health Activist(ASHA) meetings, participating in village
health and nutrition day(VHND), participating in school health programme and
organizing Mamata diwas. Health worker female attached to PHCs had some special
duties like ice lined refrigerator (ILR) maintenance, vaccine packing and distribution and
maintaining vaccine carrier.
The main jobs of health workers male were blood smear collection, epidemic control,
birth and death report, immunization, family planning services such as condom
distribution and participating in school health programme and VHND and attending
sector meeting.
Supervisor female were engaged in supervision of field staff, family planning,
immunization and ILR maintenance where as supervisors male were mainly engaged in
staff supervision, attending sector meetings and monthly meetings.
PHC support staffs were providing services such as managing OPD and IPD, drug
distribution, conducting delivery, maintaining stock and store where as main job of
23
medical officers were AYUSH unit management, OPD and IPD management,
conducting delivery, managing Rogi Kalyan Samiti(RKS) activities, supervising field
staffs, immunization, attending meetings and supervising VHND.
All public health workers said that they were only providing the first aid services
although the meaning of first aid was not same for all. When asked about the life saving
procedures performed, PHC staffs including doctors mentioned that it was not possible as
the oxygen cylinders and ambu bags etc were not available. Only thing they were
performing was administering injections and intravenous drip if required or referring the
patient to CHC or district head quarter hospital directly. Health worker males and health
worker females were only handling minor injuries.
3.4 Services provided during flood
It is important to state that usual public health services delivery is affected for about six
months in a year due to flood and flood related activities. Preparedness for flood starts
from May of each year and public health workers have to remain alert till October as
flood usually occurs during June to September. Specific services provided during this
period include Distribution of disinfectants like bleaching powder and halazone tablets,
Disinfection of drinking water source, Conducting medical relief camps, Taking sanitary
measures at temporary settlements and Control of epidemic if any.
3.5 Problems faced by public health workers
Public health workers face various problems while delivering services. These are related
to personal safety, supply of essential medicines and disinfectants, transportation and
communication. They also face problem in locating beneficiaries due to temporary
displacements during flood.
24
3.5.1 Lack of personal safety
Public health workers face number of problems related to personal safety as they are
posted in flood affected areas. In general they are not equipped with safety equipments to
safeguard themselves from any untoward events. For example many of them were not
provided with life jackets and means to reach flood hit areas. Boat services at many
places terminated away from the actual service areas. Public health workers had to walk
through flood water for delivering services. This at times leads to risk as they were
exposed to threat of some water animals especially crocodile in Rajnagar block. Many
sub-centers and PHCs are also uninhabitable in nature. They have not been repaired in
spite of reminding many times to higher authorities. Public health workers mentioned
‘There should be insurance of health staffs providing services during flood. There is risk
to life.’ (Interview 4)
‘Nothing serious has happened. But I fear to walk through the water. Crocodiles are
there.’ (Interview7)
‘Health system should give priority to the protection of field staffs during service
delivery. Special package can be announced at that time.’ (Interview 48)
‘Two doctors of our team fell down in the water. We rescued them by throwing tyres at
them. After that incident no doctor came in the medical team.’ (Interview 31)
‘Last year Water current drove me away. I could manage to save myself because I know
swimming and the water flow was not so forceful. But I lost my bag and shoe. I don’t
know how to demand and say in the department for my lost things.’ (Interview 33)
‘It is your own risk if you are going by boat. There is no compensation for the risk.’
(Interview 13)
25
‘We face different types of snakes on the fences besides the road.......... Jackets should be
provided to all health workers. They should be insured.’ (Interview 28)
3.5.2 Irregular supply of medicines and disinfectants
Another problem faced by health workers was irregular supply of medicines and
disinfectants. In many instances health workers reported unavailability of medicines and
disinfectants in sufficient quantities when they were in need. They had to bring these
from CHC on daily basis. Medicines for most of the chronic conditions like hypertension
and joint pain were not generally available. At times even essential medicines such as
anti snake venom and intra venous fluid were not available. There were demands for
disinfectants like bleaching powder this year but were not supplied due to non
availability at CHCs, PHCs and sub-centers. A public health worker said
‘We indent according to the requirements. But the supply is erratic generally. Supplies
don’t follow the local need. …….They ultimately ended up in purchasing the drugs which
were not required and not purchasing the drugs which were required. Halogen tablets
are not required in such huge quantity but it is available plenty. In 2006 saline bottles
were purchased in huge quantity only after the disease subsided and we were forced to
use it up to 2008 although many had crossed expiry date. The non official instruction
was to show the use in whatever way we can.’ (Interview 42)
Another health worker also said
‘Last year, water remained for 15-20 days. ……We including ASHAs had to collect
medicines from PHC every day.’ (Interview 23)
A health worker on the proactive approach to this problem said
‘We become alert at that time. Whatever is required we take before flood strikes. We get
some, some are replenished in between.’ (Interview 12)
26
3.5.3 Poor transportation
All public health workers shared the transportation related problems in flood affected
areas. The study areas were submerged during flood for weeks and inaccessible on road.
People had to depend on other mode of transport such as boats for transportation. For
conducting medical relief camps and reaching beneficiaries public health workers
required boats. Medical officer in charge of CHC sent requisition long before flood to the
Block Development Officer (BDO) of the concerned block for allotting boats to the
health department. But usually the number of boats allotted was very less than requested.
All respondents said that boats were not available as required. They usually went by
adjusting with other boats like relief boats, boats carrying media persons and private
boats. When requested sometimes panchayat members and sarapanch arranged boats for
them. They were not sure about the return once they went to distance places for service
delivery. While referring to this problem one public health worker mentioned
‘Department don’t give any boat. We have to adjust in other department boat or media
boat or personal boat. If you go to one place for service delivery it’s not sure whether
you will come back in time. This hampers the quality of service.’ (Interview 33)
Another public health worker said
‘We use boats to reach people but numbers of boats are not sufficient usually. We face
lots of problem to get boats. Health department don’t have any provision for hiring or
buying of boats.’ (Interview 42)
There was no provision by the health department for bringing the patients to the health
institutions in the block and referral of patients to higher health institutions. People had
to arrange for their own transport. They either used their own boats or hired boats. The
public health workers had stated
‘Department has no responsibility to arrange transport for the patients.’ (Interview 39)
27
‘Janani express carries patients. But they have to reach at Janani express by boat.
People arrange their own transport.’ (Interview 20)
When explaining the above problem a health worker said
‘The private boat owners take Rs 200 for transferring one pregnant woman from one
side to the other side of the river.’ (Interview 3)
3.5.4 Poor communication
Each one of the public health workers were provided with common user group (CUG)
mobile Subscriber Identity Module (SIM) cards excluding hospital support staffs. This
facilitated the process of getting instruction from supervisors and sending daily reports.
Sometimes communications got interrupted due to poor signal. In addition they also
faced problem in recharging the mobile phones as the electricity failure was a common
problem during flood sometimes for weeks together. Field staffs did not have any other
mode of communication such as land phone. On this problem one health worker
mentioned
‘Instruction from supervisor comes through mobile phone. Sometimes mobile towers
don’t function properly. This creates problem.’(Interview 18)
Another health worker mentioned
‘Once electricity supply stops, it resumes again after one month. It also stops in-between.
No there is no emergency provision for electricity and telecommunication.’ (Interview
24)
3.5.5 Difficulties in achieving targets
In India, the target free approach in delivery of family planning services was taken way
back in 1996.49
But still targets are used as a means to access the performance of public
health workers. This adds stress to public health workers while delivering services during
flood. People were shifted to safe places during flood and public health workers had to
28
locate them and provide services. In addition to targets of national programmes, they
were also expected to achieve targets related to flood including home visits, disinfection
of drinking water sources, distribution of disinfectants and conducting medical relief
camps. Problems related to personal safety, supply, transportation and communication
acted as barriers in achieving targets. On this issue a public health worker mentioned
‘Out of 4 immunization points, immunization in 3 points totally stopped. It is done only in
one point.’ (Interview 6)
Another health worker mentioned
‘Water flows with speed. Roads are submerged. After flood subsides and water level
comes down work starts again. …. At that time there was no holiday. There was no time
table for work. One cannot eat properly at that time.’ (Interview 34)
Due to crowding, sanitation around the temporary shelters becomes horrendous.
Maintaining sanitation around temporary shelters becomes headache for the public health
workers to curb the outbreak of diarrheal diseases. The number of days MRCs organized
depends on the flood duration and epidemic situation. Pointing out the difficulty a public
health worker said
‘MRCs are conducted for about a month. If epidemic starts it continues for about another
month.’(Interview 44)
When enquired about the functional status of various national programmes, all public
health workers said that these were hampered in one way or other. People found it
difficult to reach service providers and service providers also found it difficult to reach
beneficiaries. Work hampered for weeks or months together. One public health worker
said
29
‘National programmes like TB programme and malaria programme are hampered for
some time because slides and sputum specimens cannot be checked in time. This hampers
treatment.’ (Interview 42)
Due to constant power failure in PHCs all vaccines from PHCs were shifted to CHCs
where power supply was better. As a preventive measure this is usually done before
flood sets in. Referring to the common practice during flood one public health worker
spoke
‘Electricity supply stops. Immunization sessions are cancelled. It stops for about one
month. Vaccines are sent to CHC. Immunization sessions start again after vaccines come
from CHC.’ (Interview 24)
In a nutshell public health workers were facing four major problems in service delivery
during flood. They were also stressed due to targets given to them. In spite of these
problems they have mentioned some of the positive aspects (Annexure-4) which make
them confident and satisfied to provide continued services.
3.6 Preparedness
In this section we discuss about the flood preparedness of the health system. To avoid the
problems encountered by the public health workers during service delivery and to
provide uninterrupted services to the people in flood situation, health system has to
remain prepared. Preparedness minimizes the adverse effects of a hazard through
effective precautionary actions, rapid response, rehabilitation and quick recovery.
According to training module of disaster management training programme, United
Nations Development Programme (UNDP), disaster preparedness framework consists of
vulnerability assessment, planning, institutional framework, information systems,
resource base, warning system, response mechanism, public education and training and
30
rehearsals. 50
Let us discuss the framework followed to study the preparedness of public
health system in Kendrapara district under following steps
Vulnerability assessment
Planning
Information and communication
Resources
Implementation
Coordination
Monitoring
Evaluation
3.6.1 Vulnerability assessment
State guideline directed districts to list the flood affected areas based on the past
experience. According to district action plan all the blocks were included in flood prone
areas. All the nine blocks were divided into two zones for better delivery of flood related
services. Block plans of two study blocks had village and panchayat wise list of
population affected and number of wells and tube wells affected.
3.6.2 Planning
Planning is considered to be the backbone of preparedness. A typical planning process
has six steps: situational analysis, setting objectives, resource allocation, implementation,
monitoring and evaluation. 51
Action plan documents for the study district and two study blocks for the year 2012 were
available. As per the letter of Director of public health, preparedness activity starts in the
month of May each year considering flood during June to October.
State guideline for making action plan had clear objectives for flood response. These
were establishment of control rooms at block and district level, contingency plan for
31
medical relief centers, plan for mobile health team and deployment of staffs, supply of
medicines and disinfectants, ambulance services, disinfection of drinking water sources,
functioning of disease surveillance system, health education, personal safety measures,
and inter-sectoral coordination.
3.6.3 Information and communication
Information system is the blood line for preparedness. It is vital to an organization for
monitoring and evaluation. The information system includes meetings, reporting system,
health communication and so on. Let’s discuss about the health communication.
3.6.3.1 Health communication
One important activity of health system is to provide information on health and hygiene
during flood as there is threat of food and drinking water being contaminated. It can be
done through IEC material distribution in the community or awareness campaigns.
3.6.3.1.1 IEC material distribution
Many public health workers had said that leaflets were distributed during last year (2011)
flood. These were mainly distributed by the ASHAs. No such materials had been
distributed this year till data collection was over. No public health worker could provide
single copy of IEC material which was distributed last year. They mentioned
‘Leaflets were distributed in 2011. This year it has not started yet.’ (Interview 37)
‘Last year, (2011) there were cases of Dengue. I have personally visited village to village
and counselled the villagers about Dengue. No IEC materials have been distributed.’
(Interview 48)
‘We don’t have any such material. There is no supply from the department.’ (Interview 2)
‘Leaflets were distributed for vector borne diseases and water borne diseases.’
(Interview 36)
32
3.6.3.1.2 Awareness campaign
This year (2012) a fortnight long campaign was conducted for prevention of malaria,
dengue and diarrhea from 1st to 15
th August across the state. Block administrations were
requested to take lead role in this campaign. But less than one week period was given to
block administration for preparation.
3.6.4 Resources
For effective flood response the health system requires financial resources and human
resources. This was also envisaged in the state guideline by stating that all the processes
should be institutionalized with the existing health structure to enable immediate
response.
3.6.4.1 Financial resources
Although district and blocks had action plans, none of them reflected any specific budget
for any flood management activities. These activities were regarded as extension of usual
activities of the department. A public health worker said
‘Food and other expenses have to be met from our own pocket. Only later they are
reimbursed which is a tedious process.’ (Interview 17)
Another health worker mentioned
‘People always tell about untied fund but how much money is there? We have a balance
of Rs 500 only. They are saying that money will not come further.’ (Interview 3)
This clearly shows that there was no priority for flood management in terms of financial
resources.
Even the lowest level health institutions like sub-center and GKS have been provided
with untied funds by NRHM. Guidelines for expenditure of these funds were circulated
by NRHM. Form the interview it came out that either the public health workers didn’t
33
know about the guideline for expenditure during emergency or the guideline was not
clear in this matter. Health workers mentioned
‘I can utilize untied fund but the guideline is not clear about the expenditure during
flood. Some of the registers were damaged. I replaced it by purchasing the new ones. I
purchased it from the untied fund.’ (Interview 7)
‘I cannot purchase without RKS approval. There is no guideline for calamity fund. It
should be included.’ (Interview 47)
‘They have said that at the time of emergency you can spend any amount of money. I
think I can go up to 10-15 thousand at the time of emergency.’ (Interview 48)
‘There is an emergency fund. I can utilize less than Rs 1000 at a time in case of
emergency.’ (Interview 17)
3.6.4.2 Human resources
It seems that state remained ready to deploy extra human resource both medical doctors
and paramedical staffs from the unaffected districts and medical colleges on request of
district health administration. District action plan clearly mentioned that 53 medical
officers and 32 paramedical workers were deputed during 2011 flood to the district.
3.6.5 Implementation
As per the guideline provided by the state, district had been divided into two zones, each
under one district level health officer. Control rooms were also functioning at the district
level as well as block level. Number of medical relief camps at existing institutions and
additional camps at other places were clearly mentioned both in the district action plan
and block action plans.
3.6.5.1 Establishment of medical relief centers
It had been planned to conduct 45 medical relief camps at existing 44 PHCs and one area
hospital in the district. Forty nine additional medical relief camps were also planned for
34
the district. Block action plans clearly mentioned the number of medical relief camps to
be conducted along with health staffs responsible for conducting camps.
3.6.5.2 Organizing mobile health team
District action plan mentioned functioning of two mobile teams at district level and one
mobile team each at block level during flood.
3.6.5.3 Streamlining the supply of essential drugs
Disruption in road transportation during flood is an obvious reason for planning
uninterrupted supply of essential drugs to the public health workers working at the grass
root level well before flood strikes. The state guidelines prescribed that stock and store
were prepositioned sufficiently ahead in the areas likely to be marooned.
Mismatch between the requirements of medicines at block and district level was
inevitable, because the requirement list of medicines and disinfectants at the district level
were made well before the list from blocks reached at the district level. Health workers
mentioned
‘In 2008 flood there was no ASV and anti rabies injection available. I have seen doctors
giving paracetamol or distilled water injection to snakebite patients during flood when
ASV was not available. When I enquired, the doctor explained that we have to anyhow
create confidence in the mind of the patient before we refer them.’ (Interview 19)
‘There was no medicine for some disease especially for chronic diseases like colic pain
and rheumatism. Scabies lotion was very less than the requirement. One blood pressure
patient came. We checked his BP but BP medicine was not available.’ (Interview 9)
‘There are cases of diarrhoea now. I don’t have bleaching powder, halogen and ORS. I
will get nothing until flood situation is declared officially by the department.’ (Interview
29)
35
3.6.5.4 Transportation arrangements
Health department had to depend on the block administration for getting boats. Rajnagar
CHC had placed requisition to block development officer, Rajnagar for six motorboats,
in case needed for conduction of medical relief camps this year (2012). The investigator
could not get the copy of letter to block development officer for Marshaghai block.
During interviews all the public health workers mentioned about non availability/
difficulty in getting boats for conducting medical relief camps. The district action plan
validated this finding as it says
‘In the context of the bitter experience in the last flood the district administration is
requested to supply separately 2 powder boat to each affected block in the disposal of the
I/C medical officer.’
3.6.6 Coordination
Efforts of various organizations to restore normalcy after a disaster like flood should be
in tandem as the resources become scarcer during disaster situation. Health system have
to work in coordination with other agencies both public and private, for activities like
search and rescue, supply of relief, supplementary nutrition, awareness creation because
all these activities during flood are intimately related to health of the people. Health
system also gets benefits by smoothing the process of health services delivery with the
help of these agencies.
3.6.6.1 Coordination within health system
Coordination is most important within the health system itself for rapid response to
flood. All the public health workers said that they extended maximum cooperation to the
medical relief teams which comes from other parts of block or district or from other
36
districts or medical colleges. Without the help of local public health workers these teams
would find it difficult to operate. A health worker female mentioned
‘Doctors come from Cuttack. I prepare food for them. They eat here and do the flood
duty.’ (Interview 3)
3.6.6.2 Coordination with other sectors
Although monthly coordination meetings were done regularly, there was hardly any
coordination seen between other stakeholders. Due to lack of coordination at the higher
level, this couldn’t be institutionalized and propagated to the lower levels. Coordination
at the grass root level was possible only through personal relations of public health
workers. In many instances public health workers were getting cooperation from other
stakeholders where as in many instances interaction with other stakeholders hampered
the service delivery. Public health workers spoke about some of the stakeholders.
Angan Wadi Workers(AWW)
Angan wadi workers are the village level workers of department of women and child
development. They work in close collaboration with health department. But they were
not instructed specifically to help health workers during flood. A health worker female
pointed out
‘AWWs don’t come for help during flood. This is because they don’t get any instruction
from the higher authority.’ (Interview 5)
Another health worker female said
‘AWWs also help but sometimes after request.’ (Interview 7)
Another health worker female pointed out that they also remained busy doing their own
job.
‘They become busy in community kitchens. At that time they don’t receive our words.’
(Interview 4)
37
Community and community based organizations
Many people in the village were also interested in helping health workers during flood.
Members of many community based organizations also help health workers. A health
worker mentioned
‘There are people in villages who are capable and ready to distribute medicines to
villagers. They are given some medicines to distribute to villages in case of need.’
(Interview 5)
Referring to community based organization another health worker said
‘Village club and RSS members help us in many aspects.’ (Interview 6)
School
Every health worker mentioned about the school health programme but very few health
workers mentioned about the flood related health communication during these
programmes. A health worker male stated
‘Students are taught about the possible flood situation and how to behave in that time in
school health programme.’ (Interview 8)
Most of the health workers were skeptical about the school health programme. Pointing
out the problem a health worker said
‘In school health programme one teacher has to be paid Rs100. That money has not
reached yet even if the programme was conducted 6 month ago.’ (Interview 29)
Local Non Government Organization(NGO)
Public health workers pointed out that there was no formal collaboration with any NGO
working in these two flood affected blocks for providing services during flood. Pointing
out this, a medical officer mentioned
38
‘No NGO work here in health sector. Even if anybody is working we don’t have any
relation with them.’ (Interview 48)
A health worker said
‘Some of them work but not in health sector. Department has no such relation with
them.’(Interview 39)
But pointing out the collaboration with an external NGO, a health worker expressed
‘Last year they had taken our help. They provided relief materials as well as medicines.
We also gave some medicines from our side.’ (Interview 13)
Private service providers
All the health workers reported that there was no effort from the health department to
collaborate with the local private service providers. Some health workers were also
indifferent to them. A health worker mentioned
‘They are also providing services. Some people are getting benefits. We don’t have any
connection with them.’ (Interview 26)
Another health worker mentioned
‘They are on their way, we are on our way.’ (Interview 8)
Political leaders/ Panchayat members
While political leaders/panchayat members help during flood mainly by arranging boats
and medical relief camps, in few instances they also interfere in service provision. A
health worker pointed out
‘They cooperate with us whenever we ask for any help. They mainly help us in arranging
boats. Some people also fight with us in MRC. They come after drinking alcohol.’
(Interview 9)
Another health worker said
39
‘These people create lots of problem. They want more bleaching powder to sprinkle in
their cow shed and latrine.’ (Interview 36)
Media
Due to lack of official press release by the health department, public health workers were
facing embarrassing situations in few instances. Referring to it, a public health worker
said
‘Last year there was a case of diarrhoea. Someone reported to the CHC saying there was
an epidemic. I had to give explanation to so many officials so many times. Actually there
was no epidemic. Everything was in control.’ (Interview 48)
3.6.7 Monitoring
Flood response activities such as medical relief camps done, number of minor ailments
treated, disinfection of water sources etc were monitored through daily reports in a
prescribed format. The format also collected information about details of areas affected,
stock and store position along with details of specific disease conditions like diarrhea and
snake bite. Reports were compiled in the control room.
3.6.7.1 Establishment of control room
Control room at the office of the CDMO and at block levels were already in function.
Names of control room in charge along with staffs allotted were mentioned along with
their mobile numbers. But specific duties in the control room were not mentioned.
Control room in district and both the study blocks operated from 8 am to 8 pm in two
shifts. District control room had separate staffs who didn’t have control room duty for
report collection and compilation.
40
3.6.7.2 Reporting procedures
Public health workers had to report daily to their supervisors. Hard copies of reports had
to be sent daily but most of the time it was impossible. So initial reports are sent over
phone. A public health worker mentioned
‘Due to network failure sometimes it is not possible to contact the supervisor
immediately. We report to them after we return from the day’s work.’ (Interview 31)
Another public health worker also said
‘Daily report is to be given at the time of flood. I sent report over phone followed by
written report when ever feasible.’ (Interview 27)
When inquired about the reporting format which they were using to send report to higher
authority everybody said that a new reporting format was used at the time of flood. It
included number of new cases and deaths for diseases. Daily report also included number
of village affected by flood and number of villages attended by health staffs along with
total number of MRCs conducted. Public health workers said
‘At that time daily reporting is done. Snake bite, diarrhoea case report is added.’
(Interview 8)
‘A new format was developed in 2008. It was also used in 2011.’ (Interview 39)
3.6.8 Evaluation
There was no mention of evaluation of flood response activities in the guideline supplied
by the state. Accordingly there was no mechanism of evaluation at the district level and
block level. The only means of evaluation of flood related activities were the regular
departmental meetings.
3.6.8.1 Organizing meeting
To make the coordination during flood response effective, meetings of different
departments at various levels are necessary. Regular meetings were conducted every
41
Saturday at sector level and every month in the first week at CHC and district level. But
no public health workers have mentioned that meetings specifically for flood have been
arranged at any level. Discussions regarding all flood related activities were done during
these regular meetings. Regarding meetings, public health workers said
‘Everything is discussed in Saturday sector meetings and monthly meetings at CHC. At
that time we bring whatever we require from the CHC.’ (Interview 12)
‘No separate meetings have occurred for flood response. But we discuss about the flood
situation before and during flood. All discussions are written in a meeting register.’
(Interview 2)
Monthly meeting register of one block from April 2012 to September 2012 was studied.
In the meeting agenda, there was no mention of flood situation anywhere although
epidemic situation was mentioned every month. Meeting proceedings were not
documented for any month. Monthly meeting register of other block and the district
could not be studied. But informal discussion with the respective functionaries confirmed
the same pattern of documentation of the proceedings of the meetings.
3.6.8.2 Documentation and research
To get insight into the gaps in management, documentation and research is necessary.
Action plan at district level and at block level for the 2 blocks didn’t have any mention
about the documentation and research activities except for the reporting of morbidity and
mortality for different diseases. Many public health workers expressed thanks to the
investigator in the hope that this dissertation will carry their voices to higher authority in
some way or other and will enable the system to manage flood situation in better way.
3.7 Capacity gaps
Any organization/institution which delivers standard services during normal time is also
expected to deliver during emergencies. It depends on the capacity of the
42
organization/institution to sustain the pressure of delivering services during emergencies.
Capacity gap in the public health system is studied in the following aspects: Lack of
infrastructure, Human resource shortage, Training needs, Administration lapses and
Information gap.
3.7.1 Lack of infrastructure
Most of the sub-centers didn’t have own building. These sub-centers were operating from
the rented house. Two PHCs visited for interview in Rajnagar block were not flooded
because these were situated on the other side of the road which was at high level. But the
connecting road to one of the PHC was in such a bad condition that it was difficult to go
to the PHC after a shower of rain. All four PHCs visited for interview in Marshaghai
block were flooded during 2011 flood. Karilopatana PHC operated from the first floor as
the ground floor was totally submerged. Health workers also complained about the
uninhabitable condition of older buildings of PHCs. Many of them were soaking wet
during rainy season. Public health workers said
‘One sub-centre is being captured by the public and it has not been transferred by the
contractor to the health department.’ (Interview 47)
‘PHC was flooded in 2008&2011. After that it has not been repaired.’ (Interview 46)
‘Out of 25 sub-centers only 5-7 have own buildings.’ (Interview 11)
‘Roof is leaking if there is continuous rain.’ (Interview 43)
‘There is an old asbestos house for sub center. People are using it for their own purpose.
We keep registers with us.’ (Interview 10)
3.7.2 Human resource shortage
Getting and retaining human resource is a challenge for any organization. Scarcity of
trained human resource in public health systems haunts all State Governments as well as
Government of India. The picture of human resource position in public health system in
43
Kendrapara district was not different from other parts of the country. CHC Rajnagar had
two specialist doctors only where as CHC Marshaghai had also only two specialist
doctors, one contractual MBBS doctor and one AYUSH doctor. Out of five PHCs in
Rajnagar block only one PHC had AYUSH doctor. Others didn’t have doctors at all.
These were run by pharmacists. All 5 PHCs of Marshaghai block had AYUSH doctors
where as two of them had one contractual MBBS doctor each. None of the PHCs in both
blocks was manned by laboratory technicians. Numbers of health workers male were
almost half the number of health workers female. So many health workers male were in
charge of two sub-centers.
Referring to manpower shortage a hospital support staff said
‘What steps health department will take? They even cannot appoint a doctor. I am
managing. Staff positions are vacant.’ (Interview 46)
3.7.2.1 Contractual appointment
Table 3.4 shows the nature of service of respondents. All five medical officers including
four AYUSH medical officers and one MBBS medical officer interviewed were on
contractual appointment. Out of 11 health worker male interviewed, 10 were on
contractual appointment where as all health worker females were having permanent job.
Contractual appointment reduces employee’s morale as they have less pay package and
other benefits. They don’t want to take risks especially in making financial decisions.
When enquired about the support from the department, one medical officer said
‘I should not tell about health department. I am a contractual staff.’ (Interview 49)
44
Table 3.4 Nature of service of respondents
Respondents Marshaghai Rajnagar
Permanent contractual permanent contractual
Health worker female 13 0 7 0
Health worker male 1 7 0 3
Health supervisor female 2 0 2 0
Health supervisor male 1 0 1 0
Hospital support staff 4 1 2 1
Medical officer 0 4 0 1
Total 21 12 12 5
3.7.3 Training needs
Manpower in any organization should be trained and tuned to any special requirement if
desirable outcomes are expected from them. Training public health workers of the district
in disaster management especially in flood management is imperative in this context.
Table 3.5 shows training status of public health workers.
3.7.3.1 Induction training
Only one health worker male in Marshaghai block out of 8 interviewed and one health
worker male in Rajnagar out of three interviewed were given induction training i.e.
health worker male training. All female health workers and supervisor male and
supervisor female were given induction training because it was a prerequisite condition
for recruitment. All five medical officers interviewed including one MBBS doctor were
not given any induction training although they were given disease and programme
specific trainings.
3.7.3.2 Training in disaster management
Total 16 public health workers out of 50 ( 12 out of 33 in Marshaghai block and four out
of 17 in Rajnagar block)interviewed were trained in disaster management. The training
45
programme was conducted at District Head Quarter, Kendrapara. Most of them said that
it was a two days training programme but no respondent could remember the year in
which the training was given. Some of them said that it was given many years back while
some said that it was given after 1999 super cyclone in Odisha. Only senior staffs were
trained in disaster management many years back but there was no refresher training or
training for freshly joined staffs after that.
One public health worker pointed out the lack of practical sessions in the training
programme and another public health worker pointed out the lack of academic rigor in
training programmes. Actually two days training programme ended after the first day.
3.7.3.3 Training in flood management
No special training was conducted for flood management. Many public health workers
felt that since they were local people and were facing flood year after year, they were
used to in managing the health situation of the community.
3.7.3.4 Training in epidemic investigation and disease surveillance
No public health worker was trained in epidemic investigation. Only four public health
workers (three health worker female and one AYUSH doctor) out of 50 interviewed were
trained in surveillance of disease.
Table 3.5 Training of public health workers
Block Number of public health workers trained in
Disaster management Flood management Disease surveillance
Marshaghai
N=33
12 ( mean total duration
of service=23 years)
0 1 ( health worker female
by an NGO)
Rajnagar
N=17
4 ( mean total duration of
service=19.5 years)
0 3 ( 1 AYUSH doctor and
3 health worker female
by health department)
46
3.7.3.5 Training material
Only one respondent out of 16, trained in disaster management could provide the training
material in Odia language “Durbipaaka prastuti ebam padakhepa- training booklet for
health workers”. Other respondents did not preserve the training materials although they
were also provided this training material during training sessions. The booklet was
jointly prepared by UNICEF and department of health and family welfare, government of
Odisha.
3.7.4 Administrative lapses
During interview few public health workers questioned the functioning of some of the
golden principle of administration such as leadership and supervision.
3.7.4.1 Poor leadership
A public health worker complained
‘During flood we have to give service without looking at our own health. Higher official
don’t enter into water but always complain about the non performance.’ (Interview 42)
Another health worker also said
‘Officers do not enter into water, rather they ask for the report.’ (Interview 22)
3.7.4.2 Poor supervision
Referring to unsupportive supervision a health worker female said
‘I had gone to PHC to collect medicines. As soon as I returned ADMO (PH) arrived and
asked me to show the register. Later they asked for an explanation. How can a person
act at 2 places at a time?’ (Interview 19)
Another health worker said
‘Supervisor called and scolded me for not contacting him for many days. I was going
inside the water at that time. But he presumed that I had not started work.’ (Interview
22)
47
3.7.5 Information gap
As already discussed in section 3.6.8 (Evaluation) and section 3.6.3.1(Health
communication) respectively, public health system in the district had major information
gap in collecting information through documentation and in disseminating information
through health awareness programmes.
48
Chapter-4
Discussion and Conclusion
The present study is one of the first studies in the Indian state of Odisha that studies the
health system response to flood with special reference to public health workers at the
grass root level.
4.1 Discussion
This study found that public health workers were facing four major problems in
delivering services during flood.
The first problem is related to personal safety. Life jackets are the key logistic
requirement for personal safety during flood. In spite of that almost all health workers
expressed their concern about the non availability of life jackets during flood. During the
study of documents it was found that state had already supplied life jackets to the district.
This contradiction shows major lapse in supply chain management.
The present study found that service providers were expected to provide continuous
services to the community even if they were themselves affected by flood. There were no
special arrangements or relief packages made available for them from health department.
As voiced by many, provision of group insurance and financial incentives were expected.
A study in USA also shows that health care workers were concerned about their personal
safety and health as well as of their families during disasters.52
The second problem faced by them was erratic supply of medicines and disinfectants.
Only after the epidemic alert, generous supply of medicines and disinfectants start
flowing. This was an example of reactive approach. This led to inadequate provision of
services to population in need. This sometimes resulted in wastage of medicines.
49
Literature also corroborates this finding of present study. It shows that in emergency
situation, need for care increases and supply may not follow the need. But the problem of
supply shortage can be solved by proactive approach.53
The third problem was related to transportation. Boat is an essential mode of
transportation during flood. Almost all health workers mentioned that there were no boat
facilities available for them during last flood (2011). Boats were not allotted to the health
department by block administration. This was due to lack of inter-departmental
coordination.
The fourth problem faced by public health workers was communication failure.
Communication plays a vital role during any emergency situation. Intact communication
channel is important for prompt response. 54, 55
But the present study shows that
transportation and power supply get interrupted during flood. This led to failure of
communication which in turn affected health information system.
The major component of preparedness is planning involving various stakeholders as
stated by many studies.56, 57, 31
The present study found that planning process was
haphazard, incremental, and did not allow participation of other stakeholders. This is not
in complied with previous studies. Situation analysis is the starting point for planning
process.23
The present study found that healthcare policy makers were aware about the
population vulnerable to flood. But situation analysis was not based on the experience of
previous flood management.
The present study found that there was ambiguity in fund management. Public health
workers were getting instructions for fund management from one authority while
instructions for specific activities during flood were given by a different authority.
50
Many studies reported that mobile health team,58
logistic supply, 58
coordination,26, 58
surveillance,26,58
and information system 30,58
are the major components of
implementation in any disaster preparedness pragramme.
The present study found major gaps in functioning of control room, coordination, supply
of logistics, health communication and transportation.
Timing of functioning of control rooms in district and few blocks were different. This
implied the lack of coordination between district control room and block control rooms.
Coordination mechanisms between control rooms of neighboring blocks and districts
were not outlined. But these are imperative in flood situation where mass displacements
are expected across administrative boundaries.
Due to lack of coordination at the higher level, public health workers were not getting
cooperation from field staffs of various departments during delivery of services. There
was no collaboration with local private service providers, community based organizations
and local NGOs for service delivery during flood.
Since the block plans were not consolidated to prepare district plan, the mismatch
between the requirement of medicine and the supply ought to happen. This led to
unavailability of required medicines in right quantity in right time.
For the awareness campaign against malaria, dengue and diarrhea Block Development
Officers were given a lead role. However, they were given only less than a week time for
preparation. This clearly suggests that there was lack of vision and interest in the higher
health officials for the fortnight long campaign across the state.
Health department should have authorized public release of facts and information during
flood to avoid panic in the community. 59, 60
But there was no such arrangement found in
51
the present study. Thus the present study finding was not in agreement with the
suggestions of previous literatures.
The present study also found that medical relief camps and mobile health teams were
operational during flood. The study also found disease surveillance and monitoring of
activities in prescribed format to be strong in the district. This is in contradiction with
many of the literatures. 55, 61
But documentation of management of flood situation was
not done. No separate meetings were conducted in the department to manage the flood
situation.
Adequate health infrastructure is crucial in reducing the vulnerability of the community to
deleterious effect of disasters. 56
This is not complied with the present study findings.
Most of the sub-centres didn’t have own building. Public health workers also complained
about the uninhabitable condition of older buildings. PHCs were not equipped with all
facilities to provide primary care. Many positions of public health workers were vacant.
Health workers male in most cases were working in two sub-centres. AYUSH medical
officers were managing PHCs due to unavailability of MBBS medical officers.
Training of community members is important because timely action can be taken in case
of emergency in the absence of service providers.33
But the present study found that
there was no capacity building activities for the community. This clearly shows
underestimation of the capability of community members during emergency. According
to annual report 2011-12 of health and family welfare department, government of Odisha,
some senior and mid level managers were given disaster management training at
Hyderabad, India. 14
But there was no training for public health workers who were
working at the community interface. Previous studies show that training of health workers
increase their knowledge level and build confidence. 62
52
4.2 Conclusion
The present study found that the health system in Kendrapara district had poor
infrastructure at the grass root level. Many sub- centers didn’t have own building. There
was shortage of manpower in the health system. Many male health workers were
working in two sub-centers. PHCs were not adequately equipped to provide
comprehensive primary care. Allopathic doctor positions were vacant. AYUSH doctors
were managing the PHCs. At few places even AYUSH doctors were not available. Few
senior public health workers were trained in disaster management. There was no refresher
training for them.
Public health workers were facing lots of problem in delivering services during flood.
They were concerned about their personal safety but the health department was not
providing life jackets to them. Due to unavailability of boats they were facing problem in
reaching the beneficiaries. Supply of drugs and disinfectants was erratic. These were not
available in time of need. They were also facing problem due to communication failure.
They were under stress to meet the targets of service provision.
Health communication was poor. Community was not trained in first aid or life saving
procedures. Flood preparedness planning was haphazard. Block plans were not
consolidated to prepare district plan. Collective participation of various stakeholders in
the planning process was absent. This led to lack of coordination during implementation
of flood response activities.
4.3 Recommendations
1. Flood preparedness planning process should involve various stakeholders. It should
ideally follow bottom up approach.
2. Research and documentation on flood should be promoted. Experience of success and
failure in managing previous flood situation should be incorporated in planning.
53
3. Because flood is a regular event in the district, action plan for flood may have separate
budget.
4. Coordination at all levels should be institutionalized and formal. Collaboration with
private agencies or organizations should be promoted.
5. Timely supply of medicines and disinfectants should be made based on the local need.
6. Life jackets should be provided to all public health workers in flood prone areas.
7. There should be provision of special package for health workers working in flood
affected areas.
8. Instead of depending on the block administration, health department can hire private
boats for the expected flood duration.
9. Supply of generator set with provision of adequate fuel may be a solution for power
failure problem and communication problem.
10. Community should be trained to protect themselves. School health programme can be
utilized for health communication.
11. Public health workers in flood prone areas should be trained in disaster management,
especially in flood management. They should also be given training on epidemic
investigation and management.
12. Health infrastructure should be strengthened. Vacant positions should be filled with
immediate effect.
13. In a place like Kendrapara where flood happens almost every two years, the health
system should adopt proactive approaches to handle flood situation.
4.4 Strengths of the study
• Interviews of the grass root level health workers who were actually responsible
for delivering services during flood were included
• Official documents related to flood management were studied
54
4.5 Limitations of the study
• Participant/non participant observation was not included as a method of data
collection. This would have contributed to some aspects of the study.
• Interviews of higher health officials and other stakeholders like beneficiaries,
Panchayat Raj Institution (PRI) members, and representatives of CBOs/NGOs
were not included. There is a scope for further study in this area.
References
1. National Institute of Disaster Management, India. India Disaster Report-2011. New
Delhi: National Institute of Disaster Management, 2012.
http://nidm.gov.in/PDF/India%20Disaster%20Report%202011.pdf (accessed 24 Oct
2012).
2. The gazette of India, Government of India. The disaster management act 2005.New
Delhi: Government of India, 2005.
http://www.ndmindia.nic.in/acts-rules/DisasterManagementAct2005.pdf (accessed 26
May 2012).
3. Ministry of Home Affairs, Government of India. Disaster Management in India. New
Delhi: Government of India, 2011.
http://www.ndmindia.nic.in/welcome.html (accessed 26 May 2012).
4. National Disaster Management Authority, Ministry of Home Affairs, Government of
India. National Policy on Disaster Management. New Delhi: National Disaster
Management Authority, 2009.
http://nidm.gov.in/PDF/policies/ndm_policy2009.pdf (accessed 26 May 2012).
5. Gupta K. Disaster management and India: Responding internally and simultaneously in
neighboring countries.
http://www.pddms.in/downloads/FEMA%20%20Disaster %20 Management%20and%20
India.pdf (accessed 26 May 2012).
6. National Disaster Management Division, Ministry of Home Affairs, Government of
India. Disaster Management in India -A Status Report. National Disaster Management
Division, 2004.
http://www.ndmindia.nic.in/EQProjects/Disaster Management in India-A Status Report-
August 2004.pdf (accessed 26 May 2012).
7. Orissa State Disaster Mitigation Authority, Government of Orissa. State Disaster
Management Policy. Orissa State Disaster Mitigation Authority, 2005.
http://v3.osdma.org/Download/DM Policy.pdf (accessed 26 May 2012).
8. National Disaster Management Division, Ministry of Home Affairs, Government of
India. Good Practices in Community Based Disaster Risk Management. National Disaster
Management Division.
http://www.preventionweb.net/files/11041_GdPracticesinCBDRM1.pdf (accessed 26
May 2012).
9. National Weather Service. Weather glossary.
http://www.erh.noaa.gov/er/rnk/glossary.html (accessed 07 Feb 2012).
10. Millennium Ecosystem Assessment. Flood and Storm Control. In: Ecosystems and
Human Well being- Policy Responses. 2005; pp 335-352.
http://www.maweb.org/documents/document.316.aspx.pdf (assessed 20 Jan 2012).
11. Kundzewicz ZW, Menzel L. Flood risk and vulnerability in the changing world.
International conference ‘Towards natural flood reduction strategies’, Warshaw, 6-13 Sep
2003.
http://levis.sggw.waw.pl/ecoflood/contents/articles/S6/html/6_2K.pdf (assessed 08 Feb
2012).
12. Brenkert AL, Malone EL. Modeling vulnerability and resilience to climate change: a
case study of India and Indian states. Clim Change 2005; 72: 57-102.
13. Department of water resources, Government of Odisha. Flood control and drainage:
major flood occurrences.
http://www.dowrorissa.gov.in/HistoryofFLOOD/HistoryofFLOOD.pdf (accessed 07 Feb
2012).
14. Health and Family Welfare Department, Government of Odisha. Annual Activity
Report 2011-12. Health and Family Welfare Department,2012.
http://203.193.146.66/hfw/PDF/Annual_Report_2011_12_English.pdf (accessed 24 Oct
2012).
15. National Disaster Education Coalition. Floods and flash floods. In: Talking About
Disaster: Guide for Standard Messages. Washington DC: National Disaster Education
Coalition, 2004.
http://www.disastereducation.org/library/public_2004/Floods.pdf (assessed 24 Oct 2012).
16. Bich TH, Quang LN, Ha L TT, Hanh TTD, Guha-Sapir D. Impacts of flood on health:
epidemiologic evidence from Hanoi,Vietnam. Global Health Action 2011; 4: 6356.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3160808/pdf/GHA-4-6356.pdf(accessed
24 Oct 2012).
17. Jonkman SN, Kelman I. An analysis of the causes and circumstances of flood disaster
deaths. Disasters 2005; 29: 75−97.
18. Ahern M, Kovats RS, Wilkinson P, Few R, and Matthies F. Global Health Impacts of
Floods- Epidemiologic Evidence. Epidemiol Rev 2005; 27: 36–46.
19. Tapsell SM, Penning-Rowsell EC, Tunstall SM, Wilson TL. Vulnerability to
flooding: health and social dimensions. Phil. Trans. R. Soc. Lond A 2002; 360: 1511-
1525.
http://rsta.royalsocietypublishing.org/content/360/1796/1511.full.pdf (accessed 09 Jun
2012).
20. Du W, FitzGerald GJ, Clark M, Hou XY. Health impacts of floods. Prehosp Disaster
Med 2010; 25: 265–272.
21. MICRODIS. Health impacts of floods in Europe-Data gaps and information needs
from a spatial perspective. MICRODIS, 2010.
http://www.cred.be/sites/default/files/Health_impacts_of_floods_in_Europe.pdf (accessed
08 Jun 2012).
22. Rodriguez-Llanes JM, Dash SR, Degomme O, et al. Child malnutrition and recurrent
flooding in rural eastern India: a community-based survey. BMJ Open 2011; 1: e000109.
23. Furbee PM, Coben JH, Smyth SK, Manley WG, Summers DE, Sanddal ND, et al.
Realities of rural emergency medical services disaster preparedness. Prehosp Disast Med
2006; 21: 64–70.
24. Phalkey R, Reinhardt JD, Marx M. Injury epidemiology after the 2001 Gujarat
earthquake in India: a retrospective analysis of injuries treated at a rural hospital in the
Kutch district immediately after the disaster. Glob Health Action 2011; 4: 7196.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3144753/pdf/GHA-4-7196.pdf (accessed
09 Jun 2012).
25. Axelrod C, Killam P, Gaston M, Stinson N. Primary health care and the Midwest
flood disaster. Public Health Rep 1994; 109: 601-605.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1403546/pdf/Pubhealthrep00058-
0011.pdf (accessed 09 Jun 2012).
26. Watson J T, Gayer M, Connolly M A. Epidemics after Natural Disasters. Emerging
Infectious Diseases 2007; 13: 1-5.
http://wwwnc.cdc.gov/eid/article/13/1/pdfs/06-0779.pdf (accessed 09 Jun 2012).
27. Barbera JA, Yeatts DJ, Macintyre AG. Challenge of hospital emergency
preparedness: analysis and recommendations. Disaster Med Public Health Prep 2009; 3:
S74-S82.
http://www.dmphp.org/cgi/reprint/3/Supplement_1/S74 (accessed 09 Jun 2012).
28. McCarthy ML, Aronsky D, Kelen GD. The measurement of daily surge and its
relevance to disaster preparedness. Acad Emerg Med 2006; 13: 1138-1141.
http://www.hopkins-cepar.org/sebin/a/t/Measurement_DailySurge.pdf (accessed 09 Jun
2012).
29. Stratton SJ, Tyler RD. Characteristics of medical surge capacity demand for sudden-
impact disasters. Acad Emerg Med 2006; 13: 1193-1197.
http://onlinelibrary.wiley.com/doi/10.1197/j.aem.2006.05.008/pdf (accessed 09 Jun
2012).
30. Estacio PL. Surge capacity for health care systems: early detection, methodologies,
and process. Acad Emerg Med 2006; 13: 1135-1137.
http://onlinelibrary.wiley.com/doi/10.1197/j.aem.2006.07.018/pdf (accessed 09 Jun
2012).
31. Tekeli-Yesil S. Public health and natural disasters: disaster prepared-ness and
response in health systems. J Public Health 2006; 14: 317-324.
http://www.springerlink.com/content/c640l00665471163/fulltext.pdf (accessed 09 Jun
2012).
32. Fundter DQP, Jonkman B, Beerman S, Goemans CLPM, Briggs R, Coumans F, et al.
Health impacts of large-scale floods: Governmental decision-making and resilience of the
citizens. Prehospital Disaster Med 2008; 23: s70–s73.
33. Mahoney LE, Reutershan TP. Catastrophic disasters and the design of disaster
medical care systems. Ann Emerg Med 1987; 16: 1085-91.
34. Neil R. A call for help. Collaboration with community officials is key. Mater Manag
Health Care 2003; 12: 22-6.
35. Gausche-Hill M. Pediatric disaster preparedness: are we really prepared? J Trauma
2009; 67: S73-6S.
36. Djalali A, Hosseinijenab V, Hasani A, Shirmardi K, Castrén M, Öhlén G, et al. A
fundamental, national, disaster management plan: An education based model. Prehosp
Disaster Med 2009; 24: 565–569.
37. Abaya SW, Mandere N, Ewald G. Floods and health in Gambella region, Ethiopia: a
qualitative assessment of the strengths and weaknesses of coping mechanisms. Global
Health Action 2009. DOI: 10.3402/gha.v2i0.2019.
http://www.globalhealthaction.net/index.php/gha/article/view/2019/2482 (accessed 09
Jun 2012).
38. Kaji AH, Lewis RJ. Assessment of the reliability of the Johns Hopkins/Agency for
Healthcare Research and Quality hospital disaster drill evaluation tool. Ann Emerg Med
2008; 52: 204-210.
http://www.sciencedirect.com/science/article/pii/S0196064407014400# (accessed 24 Oct
2012).
39. Guha-Sapir D. What have we learned? Capacity building for health responses in
disasters. Prehosp Disast Med 2005; 20: 480–482.
40. Ministry of Home Affairs, Government of India. Provisional population totals rural-
urban distribution figures at a glance Orissa 2011.
http://censusindia.gov.in/2011-prov-results/paper2/data_files/Orissa/5-fig-orissa-9.pdf.
(accessed 24 Oct 2012).
41. Few R. Flooding, vulnerability and coping strategies: local response to global threat.
Progr Develop Studies 2003; 3: 43-58.
http://www.pitt.edu/~mramsey/courses/geol2640/docs/few2003.pdf (accessed 09 Jun
2012).
42. Phalkey R, Dash SR, Mukhopadhyay A, Runge-Ranzinger S, Marx M. Prepared to
react? Assessing the functional capacity of the primary health care system in rural Orissa,
India to respond to the devastating flood of September 2008. Glob Health Action 2012; 5:
10964.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3307669/pdf/GHA-5-10964.pdf
(accessed 08 Jun 2012).
43. Varvasovszky Z, Brugha R. A stakeholder analysis. Health Policy and Planning
2000; 15: 338-345.
44. Government of India. Indian Public Health Standards (IPHS) for Community Health
care Centres (CHC): revised guidelines, 2010. Services DGoH, ed. New Delhi: Ministry
of Health & Family Welfare,Government of India, 2010.
http://mohfw.nic.in/NRHM/IPHS_Revised_Draft_2010/CHC_Revised_Draft.pdf
(accessed 09 Jun 2012).
45. Health and Family Welfare Department, Government of Odisha. List of major health
institutions.
http://203.193.146.66/hfw/PDF/kendrapara.pdf (accessed 24 Oct 2012).
46. Government of India. Indian Public Health Standards (IPHS) for Primary Health care
Centres (PHC): revised guidelines, 2010. Services DGoH, ed. New Delhi: Ministry of
Health & Family Welfare,Government of India, 2010.
http://mohfw.nic.in/NRHM/IPHS_Revised_Draft_2010/PHC_Revised_Draft.pdf
(accessed 09 Jun 2012).
47. Government of India. Indian Public Health Standards (IPHS) for Sub-Centres: revised
guidelines 2010. Services DGoH, ed. New Delhi: Ministry of Health & Family Welfare,
Government of India, 2010.
http://mohfw.nic.in/NRHM/IPHS_Revised_Draft_2010/Subcentre_Revised_Draft.pdf
(accessed 09 Jun 2012).
48. National Rural Health Mission, Government of India. Mission document. New Delhi:
Government of India.
http://www.mohfw.nic.in/NRHM/ Documents/Mission_Document.pdf (accessed 24 Oct
2012).
49. Sangwan, N, Maru RM. The Target-Free Approach: An Overview. Journal of Health
Management 1999; 1: 71-96.
http://www.cwds.ac.in/library/collection/elib/pop_policy/pp_the_target_free.pdf.
(accessed 24 Oct 2012).
50. Kent R. Disaster preparedness. Disaster management training programme, 1994.
http://iaemeuropa.terapad.com/resources/8959/assets/documents/UN%20DMTP%20-
%20Disaster%20Preparedness.pdf (accessed 24 Oct 2012).
51. Green A. An introduction to health planning for developing health system. Oxford
university press, 2007.
52. Qureshi K, Gershon RRM, Sherman MF, Straub T, Gebbie E, McCollum M, et
al.Health care workers’ ability and willingness to report to duty during catastrophic
disasters. Journal of urban health 2005; 82: 378-388.
53. Koenig KL, Lim HCS, Tsai S. Crisis standard of care: Refocusing health care goals
during catastrophic disasters and emergencies. J Exp clin med 2011; 3: 159-165.
54. Ji G , Zhu C. A study on emergency supply chain and risk based on urgent relief
service in disasters. Systems Engineering Procedia 2012; 5: 313-325.
55. Counts CS. Disaster preparedness: is your unit ready? Nephrol Nurs J 2001; 28: 491-
499.
https://www.annanurse.org/download/reference/journal/SO2001/28491499.pdf (accessed
24 Oct 2012).
56. The Commission on Climate Change and Development. Climate Change and Health.
The Commission on Climate Change and Development, 2009.
http://www.ccdcommission.org/Filer/commissioners/Health.pdf (assessed 23 Jan 2012).
57. Few R. Floods, health and climate change: responses to the health risks from flooding.
In: Health and climate change: A strategic review. Tyndall Centre for Climate Change
Research, 2004.
http://www.tyndall.ac.uk/sites/default/files/wp63.pdf (accessed 09 Jun 2012).
58. Damme W V, Lerberghe W V, Boelaert M. Primary health care vs. emergency
medical assistance: a conceptual framework, Health Policy and Planning 2002; 17: 49-60.
http://heapol.oxfordjournals.org/content/17/1/49.full.pdf+html ( accessed 24 Oct 2012).
59. Partington AJ, Savage PEA. Disaster planning: managing the media. BMJ 1985; 291:
590-592.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1418238/pdf/bmjcred00463-0036.pdf
(accessed 09 Jun 2012).
60. Friedman FD. Public relations in disaster management and planning for emergency
physicians.The Journal of Emergency Medicine 1995; 13: 661-668.
61. Hsu EB, Thomas TL, Bass EB, Whyne D, Kelen GD, Green GB. Healthcare worker
competencies for disaster training. BMC Med Educ 2006; 6: 19.
http://www.biomedcentral.com/content/pdf/1472-6920-6-19.pdf (accessed 09 Jun 2012).
62. Chapman K, Arbon P. Are nurses ready? Disaster preparedness in the acute setting.
Australasian Emergency Nursing Journal 2008; 11: 135-144.
Health System in Odisha
Minister of Health and Family Welfare
Commissioner -cum- Secretary
Mission Director, NRHM
Project Director, OSACS
Director, Medical Education and Training
Director, AHRCC
Director, Family Welfare
Director, Health Services
Director, Public Health
Director, SIHFW
Director, ISM & Homeopathy
Drugs Controller
Special Secretary
Additional Secretary
Joint Secretary
Deputy Secretary
Under Secretary
District level
Officers ADMO, Public Health ADMO, Medical ADMO, Family
Welfare
Chief District Medical Officer
Sub Divisional
Medical Officer
Annexure-1
Source-http://www.orissa.gov.in/health_portal/index.html
Map of Kendrapara Annexure-2
1
Annexure-3
Public health system response
to flood: A study on public health workers
in Kendrapara district of Odisha, India
Ref No
RESPONDENT INFORMATION CUM INFORMED CONSENT FORM
Namaskar, I am Dr.Saumya Ranjan Mishra. I live in Kendrapara town. I am presently doing
Master of Public Health (MPH) course at Achutha Menon Centre for Health Science Studies,
SCTIMST, Thiruvananthapuram, Kerala. As part of my course, I am required to undertake a
study on a topic of public health importance. The topic I have selected is “Public health
system response to flood: A study on public health workers in Kendrapara district of
Odisha, India”.
As a health care provider in your locality, you must have the experience of health care
situation and management of health needs of the population during floods. Your first hand
experience is invaluable for the public health system to modify the strategy of providing
health care in flood situations. This can be helpful in planning for other disasters also.
Hence I request you to cooperate with me and spare some time with me discussing various
aspects of flood situation in your area and sharing your own experience during flood
situation. Any time during the discussion, you can ask me to stop temporarily, come back at a
later date or even to refuse to cooperate further. You also have the right not to answer some of
my questions. If at any time you feel that you are unable to hold your emotions, you can ask
me to stop either temporarily or totally.
I also request you to provide me any document related to flood available with you which I
will analyse later.
The information you provide shall be used only for research purpose and shall not be shared
with any one, not connected with the study. All information will be safely stored. When the
study results will be published, it shall be ensured that your personal details shall not be made
public under any circumstances and anonymity will be maintained strictly.
There will be no direct benefit for you from the study. But as I have already mentioned, your
cooperation will help in developing strategies to manage the situation of health crisis during
and after floods.
You have the full right to accept or reject my request to join the study. Your decision to take
part in the study shall not in any way affect your position in the health department in future.
Block Participant
Code Participant
Code Sl
No Sl
No
2
Each of your statements and narrations are of vital importance to the study. So I cannot afford
to lose any information that you may be providing during the interview. Hence I request you
to permit me to record the interview. The recordings will be destroyed after making
transcripts of the same.
If you have any further queries or doubts, you are always free to ask me to clarify the same,
which I shall do to the best of my ability. For any queries related to the study, you may
contact me either directly or on my phone number 9853117720. For any queries related to the
authenticity of the study or my credentials, you may also contact my research guide Dr K
Srinivasan, Associate Professor, AMCHSS,SCTIMST (Ph: 0471-2524243) or Dr. Anoop
Kumar T, Member secretary, Institutional Ethics Committee, SCTIMST (Ph: 0471-2520-
256/257).
If you are willing to take part in the study kindly express your willingness for the same.
Informed consent
Dr. Saumya Ranjan Mishra has explained me all details of the study. After I have clarified all
my doubts and have understood the purpose of the study, I am expressing my willingness to
take part in the study. I am also giving consent for recording the interview with me and
consent for photocopying the documents provided by me.
Place: Signature of respondent:
Date:
Place:
Signature of interviewer:
Date:
Annexure-4
And they also stated
Public health workers also pointed out some of the positive aspects which make them
confident and satisfied to provide continued services even if they are themselves
affected by flood. These are experience, local residence, daily allowance for flood
duty, recognition of contribution by flood duty certificate. Some also complained about
the irregularity in disbursing daily allowances and distributing certificates. A health
worker mentioned
‘I joined the department during 2008 flood. Now I am confident, people know me and I
am doing my job smoothly.’(Interview 7)
Another health worker said
‘We are local people. We are used to it.’ (Interview 41)
Two female health workers complained that they were getting salary erratically often
after 4-5 months and this increases their plight during flood because they were also
affected by flood. On the other hand two health worker females described how they
had spent from their purse for providing service to the community. They said
‘In 2006 flood, I had arranged a boat by the help of local Sarpancha for Rs 200 per
day.’(Interview 29)
‘There is no provision of boat from the department of health. In 2011, I hired a small
personal boat for 1 ½ month for Rs 1800.’ (Interview 5)
Public health workers found it easier to distribute medicines, disinfectants and IEC
materials to the villagers through ASHAs. ASHAs were of great help in collecting
information. But health department didn’t have any form of incentives for ASHAs
although ASHAs were also affected by the flood.
Appreciating the contribution of ASHAs, a health worker said
‘Much of the work is possible due to presence of ASHAs in villages. Otherwise working
at that time in villages is difficult.’ (Interview 8)
1
Annexure-5a Public health system response to flood: A study on public health workers in
Kendrapara district of Odisha, India Interview Guideline
For Health Worker Female Ref No-
Date of interview- Place of interview- _________________________________________________________________________________________________ General information
What is your name?
What is your current residence address?
What is the name of the institution where you are working currently?
How far is your residence from the institution where you are working currently?
Since how many years are you in the service?
What is the nature of your service? (such as permanent/temporary/ad-
hoc/contractual)
Since how many years are you in the current working station?
What are your normal duties?
Who supervise your work?
Who is your reporting authority?
Health problems during flood
What are the public health problems in your area?
What are the common public health problems during flood?
Are these problems change after flood subsides?
Are new health problems arise?
How the public health problems change when there is flood along with
cyclone/heavy rain?
What are the health needs of vulnerable people (extremely aged,
differently able (physical & mental), children, adolescent, pregnant
women, widow, destitute)?
What happens to nutritional status of people especially children during
and after flood?
What are the problems of chronic disease patients like TB, HIV, diabetes,
hypertension etc during flood?
Block Participant
Code Participant
Code Sl
No Sl
No
2
How the acute complications of chronic diseases due to disruption of
ongoing treatment regimens are managed?
How are they ensured of supply of required medications?
What are the conditions of the other public health services? (drinking
water, food hygiene, sanitation, sewage system and disposal of excreta)
Kindly share some experience of emergency situations you have handled?
Status of usual services delivery during flood
How do you deliver services during flood?
What are the services provided to people under national health
programmes during flood?
How ANC/ PNC visits are arranged?
How deliveries are attended?
How contraceptives are distributed?
How immunisation sessions are arranged?
How you follow up malnourished children and mothers?
How you distribute iron and folic acid tablets?
What are the problems you face during delivery of these services?
What are the problems you face due to community displacement during
flood?
Special practices during and after flood
What are the procedures you follow when a critically ill patient is brought to
you?
How do you deal with unconscious patients?
How do you deal with patients brought dead?
How do you manage over-crowding by friends and relatives of deceased
patients?
How do you manage over-crowding by friends and relatives of critically ill
patients?
How do you manage media?
How do you manage political people?
3
Is the basic life support (primary resuscitation and maintenance of vital
functions like maintenance of airway, control of haemorrhage,
preparation for transportation e.g. use of splints, stretchers etc) available?
How do you maintain registers?
How they are preserved during flood?
How do you provide service to a person if he/she has no written
document (BPL card, immunization card, prescription, pregnancy
registration card with him/her?
How do you get instruction/information from your supervisor or medical officer
during flood?
What are the reporting procedures/formats followed during flood?
How do you assess the health situation of your area during flood?
What are the procedures followed?
How do community informants contribute in assessing the situation?
Is there any provision of post disaster management of mental health problems
and counselling?
Does any mobile health unit operate in your area during flood situation?
Do health camps are organized in your area during flood situation?
Damage to health centre due to flood
What kind of damage occurred to sub-centre/health centre?
Is there any retrofitting of sub-centre/ health centre?
How the security of sub-centre/health centre is maintained?
Personal protection
Please describe if you have ever been affected by flood?
Please describe if there are any instances of deaths/critical conditions of health
care personnel during flood operation?
How the health department responded to it?
What are the measures taken for protection of health care delivery personnel
during service delivery?
Institutional preparedness for flood response
How do you prepare yourself for flood response?
Does your institution have flood preparedness manual?
4
Is the identification of the temporary space other than sub-centre for
emergency service provision done before flood strikes?
Do you have the update address and telephone numbers of your
supervisor, medical officer, PHC, referral centres, private doctors etc?
Do you have checklist of equipments and drugs for your health centre?
How do you ensure the buffer stock of medicines and other materials?
How do you ensure the availability of other consumables like bleaching
powder, halogen tablets, ORS sachets etc?
How do you ensure functional status of the medical equipments?
Are there any provision for emergency light and power supply and
telecommunication?
How do you transport critical patients to higher health centres?
What are the modes of transport used?
Do you arrange transport for the patients?
Is there any prior arrangement with private service providers or NGOs?
Is there any prior arrangement for boat facility during flood?
Do you have purchase capacity and funds with you to meet the contingency
expenditure in emergency situations?
Community preparedness
How the community prepare themselves for flood response?
Is there a village/panchayat level disaster preparedness plan?
Is the seasonality calendar of disasters for the village /panchayat has been
made?
Is mapping exercises (PRA) of the village /panchayat done?
Is the village/panchayat level committees and teams been formed?
Is there any volunteer’s skill development training done?
Is there any capacity building activity for the community especially
vulnerable community?
Are the IEC materials (Do’s and Don’ts) distributed at the community
level?
Are there any film shows, discussions and house to house campaigns done
in villages?
5
Whether flood preparedness rehearsal and drill has been done?
Is there mass drill in institutions like schools and colleges?
Is there any community contingency fund available where households
contribute?
What is your role in it?
What are the roles of health worker male, health supervisor female, health
supervisor male, ASHA, AWW, ward member, panchayat members and medical
officer in it?
Coordination
How coordination is done with other public departments?
How frequently coordination meetings are convened?
Who are the participants in these meetings?
What types of decisions are taken in these meetings?
How the decisions are implemented?
How the local government take part in coordination meeting and decision
taking?
How coordination is done with other health service providers like private health
care providers, AYUSH practitioners, retired health staffs and informal health
care providers?
Please share your experience of participation in intra-departmental planning and
coordination meetings?
How frequently these meetings are convened?
Who are the participants in these meetings?
What types of decisions are taken in these meetings?
How the decisions are implemented?
How do you work with field NGOs working in your area in collaboration with
health department?
What are their roles before flood?
What are their roles after flood?
Please share your experience working with outside NGOs during flood?
How do you work in coordination with the ASHAs and AWWs during flood?
Do you face any difficulty in working with them?
6
Training and capacity building
What is your educational qualification?
What are the trainings you have undergone?
Have you undergone training for disaster management?
Have you undergone any special training for flood management?
Have you undergone any training on outbreak investigation and control?
...........................................................................................................................................................................
Thank you very much for your cooperation.
1
Annexure-5b Public health system response to flood: A study on public health workers in
Kendrapara district of Odisha, India Interview Guideline
For Health Worker Male
Ref No-
Date of interview- Place of interview- _________________________________________________________________________________________________ General information
What is your name?
What is your current residence address?
What is the name of the institution where you are working currently?
How far is your residence from the institution where you are working currently?
Since how many years are you in the service?
What is the nature of your service? (such as permanent/temporary/ad-
hoc/contractual)
Since how many years are you in the current working station?
What are your normal duties?
Who supervise your work?
Who is your reporting authority?
Health problems during flood
What are the public health problems in your area?
What are the common public health problems during flood?
Are these problems change after flood subsides?
Are new health problems arise?
How the public health problems change when there is flood along with
cyclone/heavy rain?
What are the health needs of vulnerable people (extremely aged,
differently able (physical & mental), children, adolescent, pregnant
women, widow, destitute)?
What happens to nutritional status of people especially children during
and after flood?
Block Participant
Code Participant
Code Sl
No Sl
No
2
What are the problems of chronic disease patients like TB, HIV, diabetes,
hypertension etc during flood?
How the acute complications of chronic diseases due to disruption of
ongoing treatment regimens are managed?
How are they ensured of supply of required medications?
What are the conditions of the other public health services? (drinking
water, food hygiene, sanitation, sewage system and disposal of excreta)
Kindly share some experience of emergency situations you have handled?
Status of usual services delivery during flood
How do you deliver services during flood?
What are the services provided to people under national health
programmes during flood?
How contraceptives are distributed?
How immunisation sessions are arranged?
How safe water is ensured for community?
What are the problems you face during delivery of these services?
What are the problems you face due to community displacement during
flood?
Special practices during and after flood
What are the procedures you follow when a critically ill patient is brought to
you?
How do you deal with unconscious patients?
How do you deal with patients brought dead?
How do you manage over-crowding by friends and relatives of deceased
patients?
How do you manage over-crowding by friends and relatives of critically ill
patients?
How do you manage media?
How do you manage political people?
3
Is the basic life support (primary resuscitation and maintenance of vital
functions like maintenance of airway, control of haemorrhage,
preparation for transportation e.g. use of splints, stretchers etc) available?
How do you maintain registers?
How they are preserved during flood?
How do you provide service to a person if he/she has no written
document (BPL card, immunization card, prescription, pregnancy
registration card with him/her?
How do you get instruction/information from your supervisor or medical officer
during flood?
What are the reporting procedures/formats followed during flood?
How do you assess the health situation of your area during flood?
What are the procedures followed?
How do community informants contribute in assessing the situation?
Is there any provision of post disaster management of mental health problems
and counselling?
Does any mobile health unit operate in your area during flood situation?
Do health camps are organized in your area during flood situation?
Damage to health centre due to flood
What kind of damaged occurred to sub-centre/health centre?
Is there any retrofitting of sub-centre/ health centre?
How the security of sub-centre/health centre is maintained?
Personal protection
Please describe if you have ever been affected by flood?
Please describe if there are any instances of deaths/critical conditions of health
care personnel during flood operation?
How the health department responded to it?
What are the measures taken for protection of health care delivery personnel
during service delivery?
4
Institutional preparedness for flood response
How do you prepare yourself for flood response?
Does your institution have flood preparedness manual?
Is the identification of the temporary space other than sub-centre for
emergency service provision done before flood strikes?
Do you have the update address and telephone numbers of your
supervisor, medical officer, PHC, referral centres, private doctors etc?
Do you have checklist of equipments and drugs for your health centre?
How do you ensure the buffer stock of medicines and other materials?
How do you ensure the availability of other consumables like bleaching
powder, halogen tablets, ORS sachets etc?
How do you ensure functional status of the medical equipments?
Are there any provision for emergency light and power supply and
telecommunication?
How do you transport critical patients to higher health centres?
What are the modes of transport used?
Do you arrange transport for the patients?
Is there any prior arrangement with private service provider or NGOs?
Is there any prior arrangement for boat facility during flood?
Do you have purchase capacity and funds with you to meet the contingency
expenditure in emergency situations?
Community preparedness
How the community prepare themselves for flood response?
Is there a village/panchayat level disaster preparedness plan?
Is the seasonality calendar of disasters for the village /panchayat has been
made?
Is mapping exercises (PRA) of the village /panchayat done?
Is the village/panchayat level committees and teams been formed?
Is there any volunteer’s skill development training done?
Is there any capacity building activity for the community especially
vulnerable community?
5
Are the IEC materials distributed at the community level?( Do’s and
Don’ts )
Are there any film shows, discussions and house to house campaigns done
in villages?
Whether flood preparedness rehearsal and drill has been done?
Is there mass drill in institutions like schools and colleges?
Is there any community contingency fund available where households
contribute?
What is your role in it?
What are the roles of health worker female, health supervisor male, health
supervisor female, ASHA, AWW, ward member, panchayat members and medical
officer in it?
Coordination
How coordination is done with other public departments?
How frequently coordination meetings are convened?
Who are the participants in these meetings?
What types of decisions are taken in these meetings?
How the decisions are implemented?
How the local government take part in coordination meeting and decision
taking?
How coordination is done with other health service providers like private health
care providers, AYUSH practitioners, retired health staffs and informal health
care providers?
Please share your experience of participation in intra departmental planning and
coordination meetings?
How frequently these meetings are convened?
Who are the participants in these meetings?
What types of decisions are taken in these meetings?
How the decisions are implemented?
How do you work with field NGOs working in your area in collaboration with
health department?
6
What are their roles before flood?
What are their roles after flood?
Please share your experience working with outside NGOs during flood?
How do you work in coordination with the ASHAs and AWWs during flood?
Do you face any difficulty in working with them?
Training and capacity building
What is your educational qualification?
What are the trainings you have undergone?
Have you undergone training for disaster management?
Have you undergone any special training for flood management?
Have you undergone any training on outbreak investigation and control?
...........................................................................................................................................................................
Thank you very much for your cooperation.
1
Annexure-5c Public health system response to flood: A study on public health workers in
Kendrapara district of Odisha, India Interview Guideline
For Health Assistant Female/Health Supervisor Female
Ref No-
Date of interview- Place of interview- _________________________________________________________________________________________________ General information
What is your name?
What is your current residence address?
What is the name of the institution where you are working currently?
How far is your residence from the institution where you are working currently?
Since how many years are you in the service?
What is the nature of your service? (such as permanent/temporary/ad-
hoc/contractual)
Since how many years are you in the current working station?
What are your normal duties?
Who supervise your work?
Who is your reporting authority?
Health problems during flood
What are the public health problems in your area?
What are the common public health problems during flood?
Are these problems change after flood subsides?
Are new health problems arise?
How the public health problems change when there is flood along with
cyclone/heavy rain?
What are the health needs of vulnerable people (extremely aged,
differently able (physical & mental), children, adolescent, pregnant
women, widow, destitute)?
What happens to nutritional status of people especially children during
and after flood?
What are the problems of chronic disease patients like TB, HIV, diabetes,
hypertension etc during flood?
Block Participant
Code Participant
Code Sl
No Sl
No
2
How the acute complications of chronic diseases due to disruption of
ongoing treatment regimens are managed?
How are they ensured of supply of required medications?
What are the conditions of the other public health services? (drinking
water, food hygiene, sanitation, sewage system and disposal of excreta)
Kindly share some experience of emergency situations you have handled?
Status of usual services delivery during flood
How do you deliver services during flood?
What are the services provided to people under national health
programmes during flood?
How ANC/ PNC visits are arranged?
How deliveries are attended?
How contraceptives are distributed?
How immunisation sessions are arranged?
How malnourished children and mothers are followed up?
How iron and folic acid tablets are distributed?
What are the problems you face during delivery of these services?
What are problems you face due to community displacement during
flood?
What difficulties you face in supervising the work of health worker
female?
Special practices during and after flood
What are the procedures you follow when a critically ill patient is brought to
you?
How do you deal with unconscious patients?
How do you deal with patients brought dead?
How do you manage over-crowding by friends and relatives of deceased
patients?
How do you manage over-crowding by friends and relatives of critically ill
patients?
How do you manage media?
How do you manage political people?
3
Is the basic life support (primary resuscitation and maintenance of vital
functions like maintenance of airway, control of haemorrhage,
preparation for transportation e.g. use of splints, stretchers etc) available?
How do you maintain registers?
How they are preserved during flood?
How do you provide service to a person if he/she has no written
document (BPL card, immunization card, prescription, pregnancy
registration card with him/her?
How do you get instruction/information from your supervisor or medical officer
during flood?
What are the reporting procedures/formats followed during flood?
How do you assess the health situation of your area during flood?
What are the procedures followed?
How do community informants contribute in assessing the situation?
Is there any provision of post disaster management of mental health problems
and counselling?
Does any mobile health unit operate in your area during flood situation?
Do health camps are organized in your area during flood situation?
Damage to health centre due to flood
What kind of damaged occurred to sub-centre/health centre?
Is there any retrofitting of sub-centre/ health centre?
How the security of sub-centre/health centre is maintained?
Personal protection
Please describe if you have ever been affected by flood?
Please describe if there are any instances of deaths/critical conditions of health
care personnel during flood operation?
How the health department responded to it?
What are the measures taken for protection of health care delivery personnel
during service delivery?
Institutional preparedness for flood response
How do you prepare yourself for flood response?
Does your institution have flood preparedness manual?
4
Is the identification of the temporary space other than sub-centre/health
centre for emergency service provision done before flood strikes?
Do you have the update address and telephone numbers of health worker
females, medical officer, PHC, referral centres, private doctors etc?
Do you have checklist of equipments and drugs for your health centre?
How do you ensure the buffer stock of medicines and other materials?
How do you ensure the availability of other consumables like bleaching
powder, halogen tablets, ORS sachets etc?
How do you ensure functional status of the medical equipments?
Are there any provision for emergency light and power supply and
telecommunication?
How do you indent, procure and supply materials to Health Worker
Females?
How do you ensure supply to contraceptive depot holders?
How do you transport critical patients to higher health centres?
What are the modes of transport used?
Do you arrange transport for the patients?
Is there any prior arrangement with private service providers or NGOs?
Is there any prior arrangement for boat facility during flood?
Do you have purchase capacity and funds with you to meet the contingency
expenditure in emergency situations?
Community preparedness
How the community prepare themselves for flood response?
Is there a village/panchayat level disaster preparedness plan?
Is the seasonality calendar of disasters for the village /panchayat has been
made?
Is mapping exercises (PRA) of the village /panchayat done?
Is the village/panchayat level committees and teams been formed?
Is there any volunteer’s skill development training done?
Is there any capacity building activity for the community especially
vulnerable community?
5
Are the IEC materials distributed at the community level?( Do’s and
Don’ts )
Are there any film shows, discussions and house to house campaigns done
in villages?
Whether flood preparedness rehearsal and drill has been done?
Is there mass drill in institutions like schools and colleges?
Is there any community contingency fund available where households
contribute?
What is your role in it?
What are the roles of health worker female, health worker male, health
assistant/supervisor male, ASHA, AWW, ward member, panchayat members and
medical officer in it?
Coordination
How coordination is done with other public departments?
How frequently coordination meetings are convened?
Who are the participants in these meetings?
What types of decisions are taken in these meetings?
How the decisions are implemented?
How the local government take part in coordination meeting and decision
taking?
How coordination is done with other health service providers like private health
care providers, AYUSH practitioners, retired health staffs and informal health
care providers?
Please share your experience of participation in intra departmental planning and
coordination meetings?
How frequently these meetings are convened?
Who are the participants in these meetings?
What types of decisions are taken in these meetings?
How the decisions are implemented?
How do you work with field NGOs working in your area in collaboration with
health department?
What are their roles before flood?
6
What are their roles after flood?
Please share your experience working with outside NGOs during flood?
How do you work in coordination with the ASHAs and AWWs during flood?
Do you face any difficulty in working with them?
Training and capacity building
What is your educational qualification?
What are the trainings you have undergone?
Have you undergone training for disaster management?
Have you undergone any special training for flood management?
Have you undergone any training on outbreak investigation and control?
...........................................................................................................................................................................
Thank you very much for your cooperation.
1
Annexure-5d Public health system response to flood: A study on public health workers in
Kendrapara district of Odisha, India Interview Guideline
For Health Assistant Male/Health Supervisor Male
Ref No- Date of interview- Place of interview- _________________________________________________________________________________________________ General information
What is your name?
What is your current residence address?
What is the name of the institution where you are working currently?
How far is your residence from the institution where you are working currently?
Since how many years are you in the service?
What is the nature of your service? (such as permanent/temporary/ad-
hoc/contractual)
Since how many years are you in the current working station?
What are your normal duties?
Who supervise your work?
Who is your reporting authority?
Health problems during flood
What are the public health problems in your area?
What are the common public health problems during flood?
Are these problems change after flood subsides?
Are new health problems arise?
How the public health problems change when there is flood along with
cyclone/heavy rain?
What are the health needs of vulnerable people (extremely aged,
differently able (physical & mental), children, adolescent, pregnant
women, widow, destitute)?
What happens to nutritional status of people especially children during
and after flood?
What are the problems of chronic disease patients like TB, HIV, diabetes,
hypertension etc during flood?
Block Participant
Code Participant
Code Sl
No Sl
No
2
How the acute complications of chronic diseases due to disruption of
ongoing treatment regimens are managed?
How they are ensured of supply of required medications?
How do you ensure drug compliance in TB and leprosy patients?
What are the conditions of the other public health services? (drinking
water, food hygiene, sanitation, sewage system and disposal of excreta)
Kindly share some experience of emergency situations you have handled?
Status of usual services delivery during flood
How do you deliver services during flood?
What are the services provided to people under national health
programmes during flood?
How contraceptives are distributed?
How immunisation sessions are arranged?
How safe water is ensured for community?
What are the problems you face during delivery of these services?
What are problems you face due to community displacement during
flood?
What are the problems you face in supervising the work of health worker
male?
Special practices during and after flood
What are the procedures you follow when a critically ill patient is brought to
you?
How do you deal with unconscious patients?
How do you deal with patients brought dead?
How do you manage over-crowding by friends and relatives of deceased
patients?
How do you manage over-crowding by friends and relatives of critically ill
patients?
How do you manage media?
How do you manage political people?
3
Is the basic life support (primary resuscitation and maintenance of vital
functions like maintenance of airway, control of haemorrhage,
preparation for transportation e.g. use of splints, stretchers etc) available?
How do you maintain registers?
How they are preserved during flood?
How do you provide service to a person if he/she has no written
document (BPL card, immunization card, prescription, pregnancy
registration card with him/her?
How do you get instruction/information from your supervisor or medical officer
during flood?
What are the reporting procedures/formats followed during flood?
How do you assess the health situation of your area during flood?
What are the procedures followed?
How do community informants contribute in assessing the situation?
Is there any provision of post disaster management of mental health problems
and counselling?
Does any mobile health unit operate in your area during flood situation?
Do health camps are organized in your area during flood situation?
Damage to health centre due to flood
What kind of damaged occurred to sub-centre/health centre?
Is there any retrofitting of sub-centre/ health centre?
How the security of sub-centre/health centre is maintained?
Personal protection
Please describe if you have ever been affected by flood?
Please describe if there are any instances of deaths/critical conditions of health
care personnel during flood operation?
How the health department responded to it?
What are the measures taken for protection of health care delivery personnel
during service delivery?
Institutional preparedness for flood response
How do you prepare yourself for flood response?
Does your institution have flood preparedness manual?
4
Is the Identification of the temporary space other than sub-centre for
emergency service provision done before flood strikes?
Do you have the update address and telephone numbers of health worker
males, medical officer, PHC, referral centres, private doctors etc?
Do you have checklist of equipments and drugs for your health centre?
How do you ensure the buffer stock of medicines and other materials?
How do you ensure the availability of other consumables like bleaching
powder, halogen tablets, ORS sachets etc?
How do you ensure functional status of the medical equipments?
Are there any provision for emergency light and power supply and
telecommunication?
How do you transport critical patients to higher health centres?
What are the modes of transport used?
Do you arrange transport for the patients?
Is there any prior arrangement with private service provider or NGOs?
Is there any prior arrangement for boat facility during flood?
Do you have purchase capacity and funds with you to meet the contingency
expenditure in emergency situations?
Community preparedness
How the community prepare themselves for flood response?
Is there a village/panchayat level disaster preparedness plan?
Is the seasonality calendar of disasters for the village /panchayat has been
made?
Is mapping exercises (PRA) of the village /panchayat done?
Is the village/panchayat level committees and teams been formed?
Is there any volunteer’s skill development training done?
Is there any capacity building activity for the community especially
vulnerable community?
Are the IEC materials distributed at the community level?( Do’s and
Don’ts )
Are there any film shows, discussions and house to house campaigns done
in villages?
5
Whether flood preparedness rehearsal and drill has been done?
Is there mass drill in institutions like schools and colleges?
Is there any community contingency fund available where households
contribute?
What is your role in it?
What are the roles of health worker female, health worker male, health
assistant/supervisor female, ASHA, AWW, ward member, panchayat members
and medical officer in it?
Coordination
How coordination is done with other public departments?
How frequently coordination meetings are convened?
Who are the participants in these meetings?
What types of decisions are taken in these meetings?
How the decisions are implemented?
How do you ensure nutritional supplement in coordination with ICDS?
How the local government take part in coordination meeting and decision
taking?
How coordination is done with other health service providers like private health
care providers, AYUSH practitioners, retired health staffs and informal health
care providers?
Please share your experience of participation in intra departmental planning and
coordination meetings?
How frequently these meetings are convened?
Who are the participants in these meetings?
What types of decisions are taken in these meetings?
How the decisions are implemented?
How do you work with field NGOs working in your area in collaboration with
health department?
What are their roles before flood?
What are their roles after flood?
Please share your experience working with outside NGOs during flood?
How do you work in coordination with the ASHAs and AWWs during flood?
6
Do you face any difficulty in working with them?
Training and capacity building
What is your educational qualification?
What are the trainings you have undergone?
Have you undergone training for disaster management?
Have you undergone any special training for flood management?
Have you undergone any training on outbreak investigation and control?
...........................................................................................................................................................................
Thank you very much for your cooperation.
1
Annexure-5e Public health system response to flood: A study on public health workers in
Kendrapara district of Odisha, India Interview Guideline
For Support Staff -PHC Ref No-
Date of interview- Place of interview- _________________________________________________________________________________________________ General information What is your name?
What is your current residence address?
What is the name of the institution where you are working currently?
How far is your residence from the institution where you are working currently?
Since how many years are you in the service?
What is the nature of your service? (such as permanent/temporary/ad-
hoc/contractual)
Since how many years are you in the current working station?
What are your normal duties?
Who supervise your work?
Who is your reporting authority?
Health problems during flood
What are the public health problems in your area?
What are the common public health problems during flood?
Are these problems change after flood subsides?
Are new health problems arise?
How the public health problems change when there is flood along with
cyclone/heavy rain?
What are the health needs of vulnerable people (extremely aged,
differently able (physical & mental), children, adolescent, pregnant
women, widow, destitute)?
What happens to nutritional status of people especially children during
and after flood?
Block Participant
Code Participant
Code Sl
No Sl
No
2
What are the problems of chronic disease patients like TB, HIV, diabetes,
hypertension etc during flood?
How the acute complications of chronic diseases due to disruption of
ongoing treatment regimens are managed?
How they are ensured of supply of required medications?
What are the conditions of the other public health services? (drinking
water, food hygiene, sanitation, sewage system and disposal of excreta)
Kindly share some experience of emergency situations you have handled?
Status of usual services delivery during flood
How do you deliver services during flood?
What are the services provided to people under national health
programmes during flood?
How deliveries are attended?
How contraceptives are distributed?
How immunisation sessions are arranged?
How do you follow up malnourished children and mothers?
How do you distribute iron and folic acid tablets?
What are the problems you face during delivery of these services?
Special practices during and after flood
What are the procedures you follow when a critically ill patient is brought to
you?
How do you deal with unconscious patients?
How do you deal with patients brought dead?
How do you manage over-crowding by friends and relatives of deceased
patients?
How do you manage over-crowding by friends and relatives of critically ill
patients?
How do you manage media?
How do you manage political people?
Is the basic life support (primary resuscitation and maintenance of vital
functions like maintenance of airway, control of haemorrhage,
preparation for transportation e.g. use of splints, stretchers etc) available?
3
How do you maintain registers?
How they are preserved during flood?
How do you provide service to a person if he/she has no written
document (BPL card, immunization card, prescription, pregnancy
registration card with him/her?
How do you get instruction/information from your supervisor or medical officer
during flood?
What are the reporting procedures/formats followed during flood?
How do you assess the health situation of your area during flood?
What are the procedures followed?
How do community informants contribute in assessing the situation?
Is there any provision of post disaster management of mental health problems
and counselling?
How does the mobile health unit operate in your area during flood situation?
What problems do you face during the operation of mobile health unit?
How the health camps are organized in your area during flood situation?
What problems do you face during organization of health camps?
Damage to health centre due to flood
What kind of damaged occurred to sub-centre/health centre?
Is there any retrofitting of sub-centre/ health centre?
How the security of sub-centre/health centre is maintained?
Personal protection
Please describe if you have ever been affected by flood?
Please describe if there are any instances of deaths/critical conditions of health
care personnel during flood operation?
How the health department responded to it?
What are the measures taken for protection of health care delivery personnel
during service delivery?
Institutional preparedness for flood response
How do you prepare yourself for flood response?
Does your institution have flood preparedness manual?
4
Is the identification of the temporary space other than sub-centre/health
centre for emergency service provision done before flood strikes?
Do you have the update address and telephone numbers of field staffs,
medical officer, referral centres, private doctors etc?
Do you have checklist of equipments and drugs for your health centre?
How do you ensure the buffer stock of medicines and laboratory
reagents?
How do you ensure the availability of other consumables like bleaching
powder, halogen tablets, ORS sachets etc?
How do you ensure functional status of the medical equipments?
Are there any provision for emergency light and power supply and
telecommunication?
How do you transport critical patients to higher health centres?
What are the modes of transport used?
Do you arrange transport for the patients?
Is there any prior arrangement with private service providers or NGOs?
Is there any prior arrangement for boat facility during flood?
Do you have purchase capacity and funds with you to meet the contingency
expenditure in emergency situations?
Community preparedness
How the community prepare themselves for flood response?
Is there a village/panchayat level disaster preparedness plan?
Is the seasonality calendar of disasters for the village /panchayat has been
made?
Is mapping exercises (PRA) of the village /panchayat done?
Is the village/panchayat level committees and teams been formed?
Is there any volunteer’s skill development training done?
Is there any capacity building activity for the community especially
vulnerable community?
Are the IEC materials distributed at the community level?( Do’s and
Don’ts )
5
Are there any film shows, discussions and house to house campaigns done
in villages?
Whether flood preparedness rehearsal and drill has been done?
Is there mass drill in institutions like schools and colleges?
Is there any community contingency fund available where households
contribute?
What is your role in it?
What are the roles of field staffs, ASHA, AWW, ward member, panchayat
members and medical officer in it?
Coordination
How coordination is done with other public departments?
How frequently coordination meetings are convened?
Who are the participants in these meetings?
What types of decisions are taken in these meetings?
How the decisions are implemented?
How the local government take part in coordination meeting and decision
taking?
How coordination is done with other health service providers like private health
care providers, AYUSH practitioners, retired health staffs and informal health
care providers?
Please share your experience of participation in intra departmental planning and
coordination meetings?
How frequently these meetings are convened?
Who are the participants in these meetings?
What types of decisions are taken in these meetings?
How the decisions are implemented?
How do you work with field NGOs working in your area in collaboration with
health department?
What are their roles before flood?
What are their roles after flood?
Please share your experience working with outside NGOs during flood?
6
Training and capacity building
What is your educational qualification?
What are the trainings you have undergone?
Have you undergone training for disaster management?
Have you undergone any special training for flood management?
Have you undergone any training on outbreak investigation and control?
............................................................................................................................. ..............................................
Thank you very much for your cooperation
1
Annexure-5f Public health system response to flood: A study on public health workers in
Kendrapara district of Odisha, India Interview Guideline
For Medical Officer Ref No-
Date of interview- Place of interview- _________________________________________________________________________________________________ General information
What is your name?
What is your current residence address?
What is the name of the institution where you are working currently?
How far is your residence from the institution where you are working currently?
Since how many years are you in the service?
What is the nature of your service? (such as permanent/temporary/ad-
hoc/contractual)
Since how many years are you in the current working station?
What are your normal duties?
Who supervise your work?
Who is your reporting authority?
Health problems during flood
What are the public health problems in your area?
What are the common public health problems during flood?
Are these problems change after flood subsides?
Are new health problems arise?
How the public health problems change when there is flood along with
cyclone/heavy rain?
What are the health needs of vulnerable people (extremely aged,
differently able (physical & mental), children, adolescent, pregnant
women, widow, destitute)?
What happens to nutritional status of people especially children during
and after flood?
What are the problems of chronic disease patients like TB, HIV, diabetes,
hypertension etc during flood?
Block Participant
Code Participant
Code Sl
No Sl
No
2
How the acute complications of chronic diseases due to disruption of
ongoing treatment regimens are managed?
How they are ensured of supply of required medications?
How do you ensure drug compliance in TB and leprosy patients?
What are the conditions of the other public health services? (drinking
water, food hygiene, sanitation, sewage system and disposal of excreta)
Kindly share some experience of emergency situations you have handled.
What kind of emergency situations field staffs of your area handled?
Status of usual services delivery during flood
How do you deliver services during flood?
What are the services provided to people under national health
programmes during flood?
How deliveries are conducted?
How contraceptives are distributed?
How immunisation sessions are arranged?
How the cold chain is maintained?
How malnourished children and mothers are followed up?
How iron and folic acid tablets are distributed?
How safe water is ensured for community?
What are the problems you face during delivery of these services in your area?
What are the problems field staffs face during delivery of these services?
What are problems you face due to community displacement during
flood?
What problems you face in supervising field staffs?
Special practices during and after flood
What are the procedures you follow when a critically ill patient is brought to
you?
How do you deal with unconscious patients?
How do you deal with patients brought dead?
How do you manage over-crowding by friends and relatives of deceased
patients?
3
How do you manage over-crowding by friends and relatives of critically ill
patients?
How do you manage media?
How do you manage political people?
Is the basic life support (primary resuscitation and maintenance of vital
functions like maintenance of airway, control of haemorrhage,
preparation for transportation e.g. use of splints, stretchers etc) available?
How do you maintain registers?
How they are preserved during flood?
How do you provide service to a person if he/she has no written
document (BPL card, immunization card, prescription, pregnancy
registration card with him/her?
How do you get instruction/information from your supervisor/CDMO during
flood?
What are the reporting procedures/formats followed during flood?
How do you assess the health situation of your area during flood?
What are the procedures followed?
How do community informants contribute in assessing the situation?
Is there any provision of post disaster management of mental health problems
and counselling?
How does the mobile health unit operate in your area during flood situation?
What problems do you face during the operation of mobile health unit?
How the health camps are organized in your area during flood situation?
What problems do you face during organization of health camps?
Damage to health centre due to flood
What kind of damaged occurred to sub-centres/ primary health centre?
Is there any retrofitting of sub-centre/ primary health centre?
How the security of sub-centre/primary health centre is maintained?
Personal protection
Please describe if you have ever been affected by flood?
Please describe if there are any instances of deaths/critical conditions of health
care personnel during flood operation?
4
How the health department responded to it?
What are the measures taken for protection of health care delivery personnel
during service delivery?
Institutional preparedness for flood response
How do you prepare yourself for flood response?
Does your institution have flood preparedness manual?
Is the identification of the temporary space other than sub-centre/health
centre for emergency service provision done before flood strikes?
Do you have the update address and telephone numbers of your
supervisor/CDMO, referral centres, field staffs and private doctors etc?
Do you have checklist of equipments and drugs for your health centre?
How do you ensure the buffer stock of medicines and other materials?
How do you ensure the availability of other consumables like bleaching
powder, halogen tablets, ORS sachets etc?
How do you ensure functional status of the medical equipments?
Are there any provision for emergency light and power supply and
telecommunication?
How the sub-centres and field staffs prepare themselves?
How do you transport critical patients to higher health centres?
What are the modes of transport used?
Do you arrange transport for the patients?
Is there any prior arrangement with private service provider or NGOs?
Is there any prior arrangement for boat facility during flood?
Do you have purchase capacity and funds with you to meet the contingency
expenditure in emergency situations?
Community preparedness
How the community prepare themselves for flood response?
Is there a village/panchayat level disaster preparedness plan?
Is the seasonality calendar of disasters for the village /panchayat has been
made?
Is mapping exercises (PRA) of the village /panchayat done?
Is the village/panchayat level committees and teams been formed?
5
Is there any volunteer’s skill development training done?
Is there any capacity building activity for the community especially
vulnerable community?
Are the IEC materials distributed at the community level?( Do’s and
Don’ts )
Are there any film shows, discussions and house to house campaigns done
in villages?
Whether flood preparedness rehearsal and drill has been done?
Is there mass drill in institutions like schools and colleges?
Is there any community contingency fund available where households
contribute?
What is your role in it?
What are the roles of field staffs, ASHA, AWW, ward member, panchayat
members and staffs of other department in it?
Coordination
How coordination is done with other public departments?
How frequently coordination meetings are convened?
Who are the participants in these meetings?
What types of decisions are taken in these meetings?
How the decisions are implemented?
How do you ensure nutritional supplement in coordination with ICDS?
How the local government take part in coordination meeting and decision
taking?
How coordination is done with other health service providers like private health
care providers, AYUSH practitioners, retired health staffs and informal health
care providers?
Please share your experience of participation in intra departmental planning and
coordination meetings?
How frequently these meetings are convened?
Who are the participants in these meetings?
What types of decisions are taken in these meetings?
How the decisions are implemented?
6
How do you work with field NGOs working in your area in collaboration with
health department?
What are their roles before flood?
What are their roles after flood?
Please share your experience working with outside NGOs during flood?
How do you seek cooperation from other organisations?
Training and capacity building
What is your educational qualification?
What are the trainings you have undergone?
Have you undergone training for disaster management?
Have you undergone any special training for flood management?
Have you undergone any training on outbreak investigation and control?
Do you think these trainings are required for you and other health staffs
working under you?
............................................................................................................................. ..............................................
Thank you very much for your cooperation.
