Post on 21-May-2020
Collective action for better health outcomes
HEALTH CLUSTER COORDINATION TRAINING
May 2019, Brazzaville
Public Health Situation Analysis
Collective action for better health outcomes
Health cluster action
• Health Management Information System (HMIS)• Vaccination coverage estimation• Health Cluster Bulletin• Ad hoc Infographics
Health System Performance
• Public Health Situation Analysis (PHSA)• Rapid Health Assessment• Humanitarian Emergency Settings Perceived Needs (HESPER) Scale• Early Warning Alert and Response System (EWARS)• Population Mortality estimation•Monitoring Violence against Health (MVH)
Flow chart of Public Health Information Services
Health Status and Threats for affected
Populations
•Who, What Where (3W) matrix• Partners’ List• Health Resources Availability Monitoring System (HeRAMS)
Health Resources and Availability
Operational Indicator Monitoring
Collective action for better health outcomes
PHSA - Purpose
• Identify the current health status and potential health threats that the population may face, the functioning of the health system, and thehumanitarian health response.
• The PHSA aims to provide all health sector partners, including local and national authorities, nongovernmental organizations (NGOs), donor agencies and United Nations agencies with a common and comprehensive understanding of the public health situation in a crisis in order to inform evidence-based collective humanitarian health response planning.
• Also feeds inter-cluster products (e.g. HNO) and serves as quick summary of situation for new actors
Collective action for better health outcomes
SOPs
• http://www.who.int/entity/health-cluster/resources/publications/Public-Health-Situation-Analysis-SOPs.pdf?ua=1
Collective action for better health outcomes
Methodology
• Data source: secondary data review
• Led by:
– Level (CO, RO, HQ) depending on situation & capacity
– Independently or in collaboration
Collective action for better health outcomes
When and which version?
• New event
• Need of update
• Vulnerable context (preparedness)
• There are two versions:
– Short-form (first 48-72 hours, never updated)
– Long (Full)-form (within 2 weeks, updated as needed)
• Release of PHSA should not be delayed due to incomplete information
Collective action for better health outcomes
Geographic scope
• In multi-country crises, a separate PHSA should be conducted for
each affected country
• Where crises are confined to a well-demarcated sub-national
portion of a country, the PHSA should cover only that sub-national
area
• Where sufficient information exists to create sub-national analyses,
such analyses are encouraged.
Collective action for better health outcomes
Interactions between PHSA, RRA and STARProduct / aim Focus Method Aim When Team
Rapid Risk Assessment
Current event and its outbreak risk
RRA Providing risk assessment
Upon notification
DVA
Public HealthSituation Analysis
Potential risks/vulnerabilities/hazards/NCD health threats;Underlyingfactors
Secondary Data ReviewRRA
Providing overall situation analysis;Indentify priorities and info gaps
48-72 hrsUpon request
MDC
Strategic RiskAssessment
Long term Risk management cycle;All hazard approach
Expert judgement/ workshop
Identifypriorities for preparedness
Related to plan CPI
Collective action for better health outcomes
PHSA for WHO Grading and Re-Grading
• Generally it is expected that the PHSA will be done after initial
grading of a new emergency; further, it is most applicable to the
setting of an activated coordination mechanism (e.g., Health
Cluster), which is unlikely to be present at the very onset of a new
emergency. Thus, the PHSA is rarely helpful in determining the initial
grade.
• However, the PHSA is very useful at the time of re-grading, in order to provide the evidence on the scale of a health crisis, which
informs the regrading decision.
Collective action for better health outcomes
Distribution of PHSA
• While being based primarily on secondary data, a PHSA may
nevertheless contain information that is not in the public domain,
and as such may be sensitive
• Primary ownership of the PHSA rests with the relevant WCO. Thus,
the extent of distribution of the PHSA should be governed by the
WCO
• It is expected that the WCO will distribute the PHSA, at a minimum,
within the country Health Cluster
• Public dissemination encouraged (e.g., HR.info)
Collective action for better health outcomes
Presenting imprecise or conflicting data
• It is understood that a needs assessment, at least initially,
takes place in a dynamic, information-poor environment.
– As such, it is acceptable and indeed preferable to provide
rough ranges for percentages, totals and other statistics
• If no data available, say so!
• Indicate uncertainty – e.g. “some sources say xxx, others
disagree”
• If sex/age-disaggregation data not available, consider
using estimates from similar situations to improve
gender/etc. sensitivity
– e.g. we know there are 100,000 displaced persons, and we can
estimate that 5% of them are pregnant (from other similar
situations), so we need antenatal care for 5,000 people)
Collective action for better health outcomes
Source data
• vSHOC / Sharepoint (for existing crises)
• humanitarianresponse.info
• WHO Country Office records (e.g., annual reports)
• Ministry of Health website
• Risk profiles (especially STAR profile where available)
• Internet searches
Collective action for better health outcomes
PHSA Short-form Template
Collective action for better health outcomes
Sections of Short-form Template
1. Summary of the crisis
2. Map of the affected country/region
3. Health Status and Priority Threats
4. Health System Needs
5. Humanitarian Health Response (3/4W matrix)
6. Information gaps & recommended information sources
7. Key References
8. Contacts
Collective action for better health outcomes
Information at a glance
Snapshot of crisis at a quick glance
• Type of crisis displayed in humanitarian icons
• WHO Region
• INFORM-index.org – Risk assessment for countries in
humanitarian crisis
– Hazards & exposure, vulnerability , lack of coping capacity
Collective action for better health outcomes
Example
Collective action for better health outcomes
Summary of crisis & Key Figures
Summary of the crisis
• Brief - approximately 1 paragraph
• Key onset of crisis dates
• Main concerns
Key Figures
• Humanitarian profile
• Deaths
• Injuries
• Internally displaced persons
Collective action for better health outcomes
Example
Collective action for better health outcomes
Emergent Severe Health Concerns & Key Immediate Risks
Emergency severe health concerns• National and regional data• Brief but relevant information• Add additional headings if
necessary• Most up-to-date statistics• Reliable source of information• See suggested indicatorsKey immediate risks (1st month)• Complete table in consultation
with Regional office, Country office
Collective action for better health outcomes
Scoring the magnitude of health threats /needs
• For the vast majority of questions, one should be able to at least
make a plausible assumption about what could happen as a result
of the crisis. Only a few questions should be scored as ‘Unclear’.
• One should resist the temptation to score every question as ‘High’
• One should provide a score without thinking about the mitigating
impact of the humanitarian health response.
Collective action for better health outcomes
Underlying factors, Determinants of healthContext….
Collective action for better health outcomes
ExampleTo understand the key health threats, it is important to understand the pre-crisis burden of disease for the main groups of disease
Narratives that explain and justify table
Collective action for better health outcomes
Health System Status and Main Figures
Health system status
• National and regional information
• Brief – relevant information
Main figures on disruption of key health system components
• 1 or 2 sentences each heading
Collective action for better health outcomes
Example
Collective action for better health outcomes
National and International Humanitarian Capacity & No of partners
National and International humanitarian capacity
• Include Who-does-What-Where (3W) Map
N of partners
• Number of health cluster/sector partners
Collective action for better health outcomes
Information Gaps & Information priorities, action required
Information gaps
• Identify information gaps, action required and related outcome
Information priorities & action required
• Prioritize information gaps and corresponding action required – i.e. PRIMARY DATA (e.g. RHA)
Collective action for better health outcomes
Key documents
Key documents• Use most up-to-date statistics• Example of sources
– WHO • Country Profiles• Disease outbreak news• TB country profile• NCD country profile• Global Health Observatory country data• Vaccine-preventable diseases: monitoring
system. 2017 global summary (country specific)
– Cluster sources• Protection cluster gender-based violence
information management system
– UNAIDS Country level profile– International Diabetes Federation regional
fact sheets & country reports– The Mental health & Psychosocial Support
Network (MHPSS.net)
Complete the “confidence in available information” section after completion of the PHSA
Collective action for better health outcomes
Example
Collective action for better health outcomes
Long-form Template
• The long-form PHSA builds upon the short-form (hence most fields in
the short-form can be copied and pasted directly into the long-
form), adding depth to the information presented in the short-form
• A few unique additional elements
– Magnitude of expected health threats and their expected evolution
over time
– Disruptions to key health system components and their expected
evolution over time
Collective action for better health outcomes
Health Threats Evolution Table
Collective action for better health outcomes
Health Threats Evolution Methodology
• Where there are predicted changes in risk, the box should be used
to indicate the justification for the prediction
• Timing is primarily based either on predictable seasonality (such as
rainy season and malaria, or lean season and malnutrition) or on
predictable evolution from onset.
– An example of the latter would be trauma injuries after a sudden-onset
natural disaster: the timing of need would be immediate, and indeed
would dramatically decrease after one week
• If no plausible prediction can be made about the course of a given
threat (e.g., an outbreak with a rare pathogen), it is better to leave
it grey than make unfounded predictions.
Collective action for better health outcomes
Health System Disruptions Table
Collective action for better health outcomes
Health System Disruptions Methodology
• Timing of changes in disruption is more difficult to predict than
timing of changes to disease threats
• However there are situations where prediction can be made.
– For example, certain health system components are predictably less
functional during rainy seasons when roads become impassable.
– Another example is that financing shortfalls can sometimes be
predicted several months in advance (in the absence of mitigating
measures).
• For each of the above domains, it is useful to include a brief
narrative about the health system status prior to the crisis, in order to
provide context
Collective action for better health outcomes
A note about Recommendations
• The PHSA does not include recommendations about priority
interventions, as the PHSA is meant to serve as a springboard for on-
the-ground response joint response planning amongst all health
cluster/sector partners, informed by local capacities/resources/
limitations/political considerations.
• PHSA should be rapid, so no time for lengthy response planning
discussion with the partners prior to publication
• Stick to information gaps, not operational recommendations
Collective action for better health outcomes
Conclusions
• All complex crises need a PHSA
• For acute onset, go to short-form; otherwise just go to long-form
• Contact RO or HQ for support
Collective action for better health outcomes
PHSA in AFRO (2019)
• Long format: South Sudan, Mali, CAR,Ethiopia
• Short format: Mozambique, Comoros, Ethiopia, Congo, RDC(Kassai
region), Cameroon (2), Burkina faso
Collective action for better health outcomes
Challenges
• When to initiate the PHSA?
• Who initiate PHSA
• Finalise the PHSA and share information
• GBV information
• Updating PHSA long format
Collective action for better health outcomes