Strengthening Public Health Preparedness: A Conversation with Dr. JVR Prasada Rao
Historically, India has grappled with various national calamities and emergencies, such as floods, droughts, cyclones, and earthquakes, ever since gaining independence. Over time, the nation has evolved a robust disaster preparedness system, with the establishment of the National Disaster Management Authority around the turn of the century. This framework, fortified by dedicated field missions at the state and district levels, was primarily geared towards responding to natural disasters.
However, a critical realization dawned when the world was thrust into the throes of a public health crisis — the COVID-19 pandemic. Suddenly, India, like many other nations, found itself grappling with an entirely different kind of emergency. This crisis not only impacted the health of its citizens but also strained the country’s healthcare infrastructure, communities, and even its GDP. It was in the crucible of this unprecedented challenge that the importance of public health preparedness, response, and emergency management came into sharp focus. The Indian government, alongside several state governments, began to take public health preparedness with utmost seriousness, instituting reforms to fortify the nation’s healthcare response mechanisms. It is in this context that we delve into conversation with Dr. JVR Prasada Rao, to explore the evolving landscape of public health preparedness, the pivotal role that communities play and building partnerships with government in shaping a healthier future.
Dr Prasada Rao, a distinguished figure in the realm of public health, brings a wealth of experience to this discussion, having served in key government roles as Union Health Secretary, Government of India and UN Secretary-General Special Envoy on AIDS in Asia Pacific, Dr Rao is a passionate advocate for strengthening community involvement in public health initiatives. Beyond his government service, he has lent his expertise to organizations dedicated to child rights, child health, hygiene, and HIV-related issues. Dr. Rao also plays a vital advisory role in the Global Disease Burden Studies Program at the Institute of Health Metrics and Evaluation in Seattle, USA.
Q: To audiences who might not be familiar, can you briefly explain what Public Health Preparedness is?
Public health preparedness, also formally referred to as ‘Public Health Emergency Management’ is primarily about getting ready for health emergencies. There are four key steps to think about.
First, we need to prepare. This means watching out for signs of diseases and using our health systems and communities to spot any new emerging problems. We collect data and information, but that’s not enough. We need to analyze it for any warning signals on emerging new pathogens or re-emerging of earlier ones. We also need to make sure our health system and other stakeholders are ready to handle an emergency. That’s where we often fall short, like what happened with COVID-19.
Second, if an emergency happens, we have to respond fast. It’s like putting out a fire when it’s small. We want to stop the disease from spreading everywhere. Timely response is a big part of public health preparedness.
Third, after the emergency, we need to think about the social and economic impact on the people affected. How can we help them recover? It’s like helping people rebuild after a big storm. So, public health preparedness also includes helping people get back on their feet.
And lastly, mitigation. This refers to measures to reduce the chance of an emergency happening or reduce the damaging effects of unavoidable emergencies. For example, targeted human and animal vaccination efforts, food safety, social support and sanitation practices to reduce the impact of an infectious disease outbreak or environmental exposure risks in the context of a disaster.
In simple terms, public health preparedness is about getting ready for health emergencies by preparing, responding quickly, helping people recover afterwards and setting mitigation measures to avoid it from happening again. It’s like a plan to keep everyone safe and healthy.
Q: What is the role of collaboration and community engagement in Public Health Preparedness?
Often, the importance of collaboration between different groups and community organizations isn’t fully appreciated by policymakers and those responsible for putting plans into action. This collaboration involves bringing in non-governmental organizations, professional groups, and all those who are doing exceptional work in the field, collecting valuable data and information. How do we make the most of all this collective effort?
There are shining examples where we’ve seen great success when we’ve bridged this gap. Take, for instance, the case of HIV. Back in 1997, when we launched the second phase of the National AIDS Control Program, I realized there was a significant trust deficit between the government and civil society. Although NGOs and other organizations received funding, their role was primarily seen as contractors to implement tasks and report back to the government. They weren’t regarded as true partners in the process. While civil society organizations often viewed the government as a heartless bureaucracy that didn’t care about the people, the government's view was there was no accountability on the part of CSOs. This perception gap still lingers today, unfortunately.
To change this, we decided to reach out to civil society. I realized that standing on a high pedestal wouldn’t work. I needed to meet them on equal ground and invite them to be genuine partners in what we were doing. Initially, they may have been sceptical, thinking it was just a token gesture, but as we started involving them in planning and strategy discussions, not just as money recipients, they began to see that we meant what we said. Over time, we built trust between these civil society partners and the government, and this trust was a crucial factor in the tremendous success of the AIDS control program. We achieved results that were beyond our expectations.
Regrettably, this successful model hasn’t been widely replicated in other programs, whether disease control or data generation. This is unfortunate because involving the community and civil society has two major advantages. First, people’s participation is always a positive force helping to extend the reach of government programmes to the last mile. Second, the government often fails to account for the resilience and adaptability that vulnerable populations can develop over time, which may not be reflected in the epidemiological data alone.
When it comes to community-led data collection, there’s a general reluctance in government to fully utilize community-generated data in their planning and analysis. This needs to change. Unless we incorporate community data into our policy planning, our analysis will always be incomplete. We need more collaboration, and organizations like the Indian Alliance for Public Health Preparedness, with their credibility and professionalism, can help bridge the gap. They can assure the government that the data they provide isn’t just random pieces of information but goes through rigorous quality checks and is gathered by competent individuals. Trust between all parties can open up incredible opportunities for progress.
Q: For those who are currently working with the government health system, what lessons can you share with them to build successful partnerships with the government?
Looking back at the COVID-19 pandemic, there was a lack of collaboration between the government and the community, especially in the initial stages. The government’s approach was enforcement-oriented, relying heavily on the police rather than public health experts. But the community didn’t just sit idle; organizations like SWASTI, for example, continued doing their work independently. They organised the Community Action Collaborative (CAC) with the participation of diverse stakeholders to create a new model for coordinating efforts to accelerate recovery, resilience, and impact. However, it would have been much more effective if both the government and civil society organizations had worked together.
Looking ahead, I believe one should seek out ‘Champions’ within the government, especially individuals who are passionate about the cause. It’s important to remember that structures don’t respond on their own; it’s the people within those structures who do. So, we need to identify friends and champions within the government with whom we can collaborate and make them true advocates for community involvement in national programmes.
Building bridges between the government and civil society is crucial, and this can often be done more effectively at the state and district levels, than at the national level. These functionaries are closer to the field, and they’ve witnessed the suffering up close, unlike those working from remote national and state headquarters. We need to actively seek out champions and friends among these individuals. Some district collectors, for instance, have done remarkable work because they were passionate about the program and had the skills to handle emergencies. These are the people whose involvement will be crucial.
Q: What is the role of participatory surveillance in public health? How does it contribute to health equity?
A: The idea of environmental equity and public health is gaining attention these days but it can be quite a vague concept unless we break it down and demystify it. When we talk about health and environmental equity in public health, we need to consider a few essential things -
First, there are socio-economic factors that play a significant role. Environmental issues often affect poor and vulnerable people more than others. For instance, pollution might impact those living in slums more than those in nice apartments. We need to understand why this happens and how vulnerable people cope with it. That’s where the equity part comes in. If we just talk about pollution as a broad issue that affects everyone in the same way, we miss the point. We have to dig deeper and figure out how pollution, whether it’s in the air or water, disproportionately affects these vulnerable populations and how we can lessen that impact. That’s where health equity becomes crucial.
Another thing to note is that community members are rarely involved in monitoring their environment. Government agencies and researchers often collect data on their own, without involving the people who live in the affected areas. This needs to change. We should open up science to the public and let them understand why we’re collecting samples and what the purpose is. When people understand the why, they might even suggest what data needs to be collected. This participatory approach is essential.
This gap between the research community and the general public, especially vulnerable communities, exists not only in India but also in other countries. To truly address health equity, we need to break down these barriers. So, we should take steps to involve local communities in environmental monitoring through pilot projects. Once we demonstrate how this can be done effectively and treat it as a best practice, we can spread the word. It’s a process that might take time, but it’s necessary for achieving true health equity.
Q: What is the potential you see if the government and communities synergize their efforts for public health preparedness?
A: Communities tend to take action on their own when things need to get done. We’ve seen this during the COVID-19 pandemic. Communities did tremendous work, and the government also stepped up, but often separately. Imagine the power and impact if they had worked together from the start. We could achieve so much more if we could bridge that gap and truly collaborate between government efforts and community action. That’s where the real potential lies.
It’s all about making people feel like they are not just passive beneficiaries but active partners in the entire effort. When you treat people as beneficiaries, they remain distant from the process. However, when you treat them as active participants, you build trust and ensure they understand what’s happening. The impact of this trust and partnership, which might not be easily quantified, is immensely significant. For instance, during the COVID-19 pandemic, many people felt demoralized and needed timely counselling. But imagine if they had received assistance and felt that their government had truly come to their rescue. That feeling, that sense of “my government has done a fantastic job for me,” is immeasurable in numbers. It’s about restoring faith and a sense of community belonging that goes beyond statistics and figures.
In conclusion, building community partnerships in public health preparedness is crucial for achieving health equity and effective emergency responses. Trust, collaboration, and involving communities as equal partners are key principles in strengthening public health systems. By learning from successful models and championing community involvement, we can create a more resilient and equitable healthcare system that benefits all.
