Health and Climate Health and Climate Change in Change in

MozambiqueMozambiquePresented by:

Dr. Maria HauengueDepartment of Environmental Health

Government of Mozambique

24 April 2007Early Lessons from Implementation of Climate Change Adaptation Projects

in South-eastern Africa Workshop

BACKGROUNDBACKGROUNDBACKGROUNDBACKGROUND

Miassa

Cabo Delgabo

Man

ica

Nampula

Zambezia

Sofala

TeTe

Inh

amb

ane

Gaza

Map

uto

Size: 799380km2, 2470 km Coast

Pop: 15774000, 47% : 53% M/F

77% Rural : 23% Urban

45% <= 15 yrs 10% >50 yrs

Health indicators:

Birth rate : 46.1 per 1000

Life expectancy : 45.5 years

Mortality rate : 18.0 per 1000

Infant mortality rate : 127.7 per 1000

Maternal mortality : ~ 1.000 per 100.000

FLOOD & FLOOD & CYCLONES CYCLONES

IMPACTIMPACT

HEALTH SYSTEM:Damaged/ Destroyed.. HEALTH SYSTEM:

Damaged/ Destroyed..

ENVIRONMENT:Poor sanitation

Conditions..

ENVIRONMENT:Poor sanitation

Conditions..

INCREASE OFDISEASE

INCREASE OFDISEASE

FLOOD´s IMPACTFLOOD´s IMPACT 2 millions people affected in 5 provinces; 500.000 displaced; 650.000 died More than 100 temporary accommodation centers; Very poor and unhygienic sanitary conditions; No adequate water supply, few latrines; Food distribution ‘inadequate’; Lack of shelters; People exposed to mosquito bites; Risk for outbreaks of endemic diseases:

. malaria,

. cholera,

. other preventable and communicable diseases.

FIVE FLOOD AFFECTED PROVINCESFIVE FLOOD AFFECTED PROVINCES

Manica:Affected population:

Health Cent.: %Number of affected Staff:

Manica:Affected population:

Health Cent.: %Number of affected Staff:

Inhambane:Affected population:

Health Cent.: %Number of affected Staff:

Inhambane:Affected population:

Health Cent.: %Number of affected Staff:

Gaza:Affected population:

Health Cent.: %Number of affected Staff:

Gaza:Affected population:

Health Cent.: %Number of affected Staff:

Maputo:Affected population:

Health Cent.: % Number of affected Staff:

Maputo:Affected population:

Health Cent.: % Number of affected Staff:

Man

ica

Inh

amb

ane

Gaza

Map

uto

Sofala

Nampula

Zambezia

TeTe

Sofala

Miassa

Cabo Delgabo

Nampula

Zambezia

Miassa

Cabo Delgabo

Sofala:Affected population:

Health Cent.: %Number of affected Staff:

Sofala:Affected population:

Health Cent.: %Number of affected Staff:

The health situation criteria

• Number of people affected at the assembling points

• Time that these people saty in accomodation centers

• Infrastructure, health conditions of the aco.centers

• Levels of organisation, prevention and control measures established

Diseases

• Malaria

• Cholera

• Other diseases (diarrhea, conjuctivitis and skin infections)

Weekly Cholera incidence Mozambique - 2000

45

125 119 133

218 208 194242 268

421

847

1391

1526

17781721

1555

1110

850

565

387340

145

0

200

400

600

800

1000

1200

1400

1600

1800

2000

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22

Semanas epidemiológicas

Ca

sos

CASOS: 14046OBITOS: 182T.L.: 1.3%

INÍCIO DAS CHUVAS

Cholera by affected Provinces Mozambique - 2000

0 1000 2000 3000 4000 5000 6000 7000 8000 9000

Tete

Manica

sofala

Inhambane

Gaza

P.Maputo

C.Maputo

PR

OV

ÍNC

IAS

CASOS

Series1 Series2

1318 288

202 203

10204

559

183 256

2142

13381

Weekly Cholera incidence Maputo City - 2000

4 7 2 5 6 10 10 2156

190

481

884

1113

12711238

1059

714

510

279

186 196

4600

200

400

600

800

1000

1200

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

SEMANAS EPIDEMIOLOGICAS

INICIO DAS CHUVAS

CASOS: 8288OBITOS: 131T.L.: 1,6%

Weekly Cholera incidence In Sofala Province - 2000

41

118 117128

212198

184

221212

231

366

427

246

300

153

72

90

152 4 0 00

50

100

150

200

250

300

350

400

450

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

SEMANAS EPIDEMIOLOGICAS

CA

SO

S

CASOS: 3,256OBITOS: 18T.L.: 0,55%

INICIO DAS CHUVAS

WEEKLY CHOLERA INCIDENCEWEEKLY CHOLERA INCIDENCE IN MAPUTO PROVINCE - 2000 IN MAPUTO PROVINCE - 2000

0 0 0 0 0 0 0 0 0 0 0

52

153

181

271

369

341

275

211

171

93 92

210

50

100

150

200

250

300

350

400

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

SEMANAS EPIDEMIOLÓGICAS

CA

SO

S INÍCIO DAS

Casos:2203 Óbitos:19TL: 0,9%

AIM OF ACTIVITIES ON THE HEALTH SECTOR

• Increase the capacity of the health sector to respond to the emergency situation.

• Prevent and treat outbreaks, namely cholera, meningitis and measles, among others.

• Treat on time cases of malaria among people affected by floods so as to avoid outbreaks.

AIM (cont.)

• Treat acute respiratory diseases;• Prevent vaccine- preventable diseases such as

meningitis, and measles;

• Prevent and treat malnutrition among children, pregnant and breast-feeding women;

• Respond to the needs of women in reproductive health

Framework for Public Health interventions

1. Rapid Assessment :

• To determine the extend of damage to the Health system and its capacity to respond to the crisis

• To identify urgent measures for prevention and treatment of IDPs

2. Reinforcement or development (in camps) of the Surveillance System :

• To increase the reporting system of keys diseases : Cholera, Malaria, Malnutrition

• (Communication using Pactors system)

1: Assessment 2: Immediate Reaction

Contingency Plan for major diseases, conditions and specific groups:

• Malaria

• Cholera

• ARI

• Sanitation

• Malnutrition

• Women (RPH)

• MST/AIDS

• Mental Health

• Immunization

• IEC ...

3: Initial rehabilitation

Reinforcement of Health System:

. Essential Infrastructure rehabilitation

. Drug and medical supplies,

. Staff issues:

- Training

- Redeployment

- Hiring new staff

- Consultants

- Other supplies including vehicles

(up to 6 months)

STRATEGIES ADOPTED

WITHIN THE FRAMEWORK OF EPIDEMIC CONTROL

Strategies

- Reinforce malaria treatment in the affected areas;

- Vaccination campaigns against mrningities and measles in the affected areas;

- Chlorinating of water in accomodation centers, as well as construction of latrines;

- Health education campaigns

Strategies

• Health education campaigns

• Production and disseminantion of guidelines in order to dispose of the solid and liquid residuals

• Pressure on relevant institutions to solve problems of hygiene and environment

LESSONS LEARNT

• Adaptation as a key issue for the present;

• Strengthen institutions;

• Involve those at risk;

• Use sector-based approaches;

• Expand information, awareness and technical knowledge;

• Adaptation compared to development

Lessons Learnt (Cont.)

• International financial assistance is necessary;

• Adaptation is context-specific;• The importance of the level of decision

making• Better coordination and people’s

motivation;• Try to remove the obstacles ASAP

THANK YOU THANK YOU

FORFOR

YOUR KIND SUPPORT…YOUR KIND SUPPORT…