Disaster management and primary health care: implications for medical education

Natural and manmade disasters often result in the breakdown of social system and services with pronounced effects on human development and economy. They also cause illhealth and deaths either directly or through the disruption of health systems, leaving the affected communities without access to healthcare in times of emergency. Empirical evidence shows that these negative effects are disproportionally concentrated in the developing countries which accounts for 68.2% of globally reported disaster mortalities in 2012.1 The geophysical risks, urbanization, population growth and climate changes further increase the vulnerability to natural disasters, particularly, in developing countries. The increased scale, frequency, and impact of natural and manmade disasters underpin the need for adaptation of context-specific, multi-sectoral and multidisciplinary disaster management interventions and plan. The plan shall encompass the coordination and integration of activities necessary to build, sustain and improve the capability to prepare for, protect against, respond to, and recover from any emergency. Moreover, it is essential to maintain a surge capacity at a local and national level to respond immediately when a health emergency or disaster struck. To this end, high-income countries have established efficient and effective emergency medical care systems, namely, Rescue 112. This system has played a crucial role in responding immediately and successfully managing medical emergencies such as injuries, trauma and other life-threatening conditions. However, establishing such a robust emergency medical care system in low-income countries is not possible due to substantial financial, human and material resources required to maintain and operate such services.2 Instead the primary health care exits in lowincome countries that provides an opportunity to integrate and mainstream disaster response services. The integration of the disaster management within the primary health care can be proved instrumental in the provision of optimal and low-cost emergency medical assistance by utilizing the existing primary health care network (physical infrastructure and human/financial capital). Additionally, the integration will pave a way in preparing households, communities and health systems in managing disaster related risks and hazards.3 Despite the need for adapting integrated approaches, primary healthcare and emergency medical assistance within the broader domain of disaster management have been portrayed and perceived as two separate entities with arguments in favour for and against each.4 These arguments revolve around the conceptual definitions whereas primary health care and emergency medical assistance are considered as developmental and emergency response intervention respectively. Considering the need for access to and availability of emergency medical assistance in the resource-poor settings, this paper discusses the implications for medical education with regard to: a) integration of disaster management in primary health care, and b) minimum disaster management competencies and skills required for physician/general practitioners working in the primary health care facilities.