HEALTH SECTOR ASSESSMENTS IN EMERGENCIES

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HEALTH SECTOR ASSESSMENTS IN EMERGENCIES. 3rd ANNUAL REGIONAL TRAINING COURSE ON THE MANAGEMENT OF PUBLIC HEALTH RISKS IN DISASTERS FOR THE EASTERN MEDITERRANEAN MPHR 3 CAIRO, 20-31 May 2007. Damage Assessment and Needs Analysis (DANA). - PowerPoint PPT Presentation

Transcript of HEALTH SECTOR ASSESSMENTS IN EMERGENCIES

DAMAGE ASSESSMENT AND NEEDS ANALYSIS FOR THE HEALTH SECTOR Development of Guidelines and ProtocolsSIXTH INTER-REGIONAL TRAINING COURSE ON PUBLIC HEALTH AND EMERGENCY MANAGEMENT IN ASIA AND THE PACIFIC
PHEMAP 6
IN EMERGENCIES
3rd ANNUAL REGIONAL TRAINING COURSE ON THE MANAGEMENT OF PUBLIC HEALTH RISKS IN DISASTERS FOR THE EASTERN MEDITERRANEAN
MPHR 3
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We can plan because we know 95% of what needs to be done
Exercise: ask participants to prepare a table for other hazards
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Assessment is the first step in an emergency reporting and monitoring SYSTEM – the sooner a reporting system kicks in, the better
PUCD = potentially unstable chronic diseases e.g. diabetes, asthma, renal failure etc. – these also need attention in disasters
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Damage Assessment and Needs Analysis (DANA)
A multi-sectoral, team activity that uses standard protocols to collect data that is analysed to define:
the main problems in relief
the causative factors of those problems
what needs to be done?
the extent of those problems
how much of which resources are needed?
the likely trends
for how long?
The information is used to:
set priorities and targets for the relief operation
allocate specific responsibilities to participating agencies
Ask: If health assessment data are used for planning, what variables would be analyzed?
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The support systems:
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Guides the setting of relief priorities:
Function and safety issues –– can a service be delivered, is a building safe (building “triage”)
Evacuate or not ?
Repair or provide a temporary service?
Needs caused by damage:
Direct needs e.g. treat the injured – will the damages affect this?
Indirect needs – caused by damage e.g. loss of access to water supply
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Questions and Answers
Work in your groups to answer the following question (30 minutes):
What are the health needs in emergencies ?
Construct the following table.
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Vector Born Disease, Vaccine Preventable Disease, Diseases of Epidemic Potential, Diseases of Public Health Significance, Potentially Unstable Chronic Disease)
Exercise: ask participants to construct this table – give them column 1 and row 1 only (40 minutes)
Message: not everything has to be done at once and by us alone – we need to prioritise by time and needs, and to coordinate – assessments help us work out how to do that
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Categories of information
The assessment involves the collection of two key categories of information:
Analysis of the damage to:
critical resources
immediate needs arising from the situation
future needs arising from damage/disruption to services/infrastructure
Ask: What would be the categories of information for damage assessment and needs analysis?
People dependent on public services
Victims can be classified according to their access to lifelines. The following is used to describe the severity of the impact on people:
affected - all those living within the geographical area involved;
severely affected - those who have lost one or more of their lifelines;
critically affected - those who have lost all of their lifelines or who have been displaced (and therefore are totally dependant on others to supply them).
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Information on victims
A report describing the impact of a hazard will provide the number of:
Number of casualties
Number of affected
total; severe; critical;
Therefore a report will describe the impact of a hazard will provide the number of:
casualties (killed, injured, sick);
affected (total, severe, critical).
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Classification based on severity
The following is used to describe the severity of the impact on people:
affected
severely affected
those who have lost one or more of their lifelines
critically affected
those who have lost all of their lifelines
OR who have been displaced i.e. those totally dependent on others to support them
Classification of severity helps to describe populations, set priorities and allocate scarce resources more effectively
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Critical services – basic needs and lifelines
Basic needs are the minimum requirements needed for the survival of the affected population (also called “pre-requisites for health”):
water
food
energy (fuel)
(acute medical care)
Lifelines are services that are needed to deliver the basic needs:
Utilities (water, electricity, gas) – sources and networks
Communications systems
Distribution systems
First priority of Government – restore lifelines and meet basic needs
Critical resources also for the health sector
In order to prioritize the allocation of scarce resources in the soonest possible time, it is essential to classify the victims. The following are considered essential to survival and are called lifelines:
water;
food;
shelter;
energy.
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Assessing facilities and services
For each facility or service in the affected area, the assessment classifies facilities according to function:
destroyed / no function possible
undamaged / full function
Victims can be classified according to their access to lifelines. The following is used to describe the severity of the impact on people:
affected - all those living within the geographical area involved;
severely affected - those who have lost one or more of their lifelines;
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For each facility or service in the affected area, the assessment grades function according to a pre-defined scale. The following is an example:
destroyed or unavailable;
undamaged.
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temporary population displacements
increased numbers of deaths and injuries
new cases of disease and disability
exacerbation of and increased numbers of cases of psychological and social behaviour disorders
food shortages and nutritional deficiencies
environmental disruption causing hazards – vectors, waste management, sanitation
destruction of infrastructure
disruption to routine disease surveillance and control services
diversion of capital investment funds to emergency relief and the rehabilitation or reconstruction of essential infrastructure
Let’s recap some of the public health consequences of disasters
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Community
This is all the areas of emergency response in which the health sector has interests and/or responsibilities
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This is the areas of work of the health sector
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Use the Coordination Mechanism
It is not necessary to go to the field to collect detailed information from other sectors
At the daily coordination meetings, reports and assessments from other sectors are shared – these can be sent as ANNEXES to health sector reports
The Emergency Reporting System should take over from assessments as soon as possible
Too much time is wasted collecting information that is already being collected by assessment teams from othersectors – the coordiantion mechansim should try to ensure that overlaps are avoided and gaps are addressed
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Natural Hazards
focus first on recording damage to health sector, then on the needs of the health facilities to restore some function, then on the meeting needs arising from actual and potential causes of morbidity and mortality
Technological Hazards
focus on capacity to meet the needs arising from the actual and potential causes of morbidity and mortality
Biological hazards
focus on capacity to meet the needs arising from the actual and potential causes of morbidity and mortality
Societal Hazards
In conflict - focus first on recording damage to health sector, then on the needs of the health facilities to restore some function, then on the meeting needs arising from actual and potential causes of morbidity and mortality
In other situations - focus on capacity to meet the needs arising from the actual and potential causes of morbidity and mortality
These are the hazard classes defined in the risk management module
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Damage and Needs Assessments and RHA - all you need to know
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PUCD = potentially unstable chronic diseases e.g. diabetes, asthma, renal failure etc. – these also need attention in disasters
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Needs from loss of function due to damage
Needs of health sector to deliver emergency services
Needs of the affected population that affect their health
?
Mental health
Nutritional status
Water quality
A rapid health assessment is not always needed in every emergency. All local health authorities should have the capacity and means to report damages and needs. Assessment teams from Provincial and National level are needed when local capacity is overwhelmed or cannot communicate its needs.
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Learning Objectives
By the end of this module, the participant should be able to:
Discuss the purpose of Damage Assessment and Needs Analysis (DANA)
Develop a model Rapid Health Assessment (Rapid Health Assessment) form/protocol for their country
Discuss the weaknesses and strengthens of DANA and Rapid Health Assessment processes, methods and technologies
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Immediate
first
24
hours
water detoxification /decontamination
public information system acute medical and surgical care (first line and referral)
emergency coordination, communication, logistics and
reporting systems (including
first week
energy (fuel, heating, light etc.) treatment and control of cases of VBD, VPD, DEP, DPHS, PUCD
environmental health services: strengthen blood banks and laboratories (diagnosis, confirmation, referral)
* vector control strengthen burns, spinal/head injury, orthotics/prosthetics, dental services
* personal hygiene strengthen referral system - curative, mental health and obstetric services
* sanitation, waste disposal etc. nutrition surveillance and support (including micronutrient supplementation)
dead and missing (emergency measles vaccination and Vitamin A)
Medium
protection (legal and physical) (re) establishment of the health information system
term
first month
employment restoration of preventative health care services such as EPI, MCH, etc.
public transport restoration of priority disease control programmes such as TB, malaria etc.
public communications restoration for services of non-communicable diseases/obstetrics
psychosocial services care of the disabled (mental and physical)
Long term
end of
disability and psychosocial care
restitution/rehabilitation revision of policies, guidelines, procedures and plans
prevention and preparedness upgrade knowledge and skills, change attitudes and practices
Communicable Disease Control in Emergencies
Diseases of Epidemic
case detection+case confirmation+case management+information/education2nd
outbreak containment and control
to all disasters to the hazard to the event
1. Organisation
place
communications
weather
transport
logistics and supplies geography
climate
loss of water, gas, electricity, phone, transport, fuel networks
security
search and rescue politics
economy
governance
high demand for beds, surgery, blood products, referral
security
emergency management capacity
high demand for orthotics, prosthetics, disability, dental
logistics capacity
demand for specialised spinal and head injury care
disposal of inappropriate donations
emergency public and environmental health
water, energy, clothing, tents, blankets
leadership
high demand for psychosocial support of victims and staff
solidarity
3. Recovery
corruption
lifelines
crime
(acute/chronic injury care - high, infectious disease - low,
looting
education
agriculture compensation claims
trade and commerce
insurance claims
4. Rehabilitation and Reconstruction
property disputes
environment
Health Sector Role in Relief
Health Assessment Surveillance Systems Organisation and Management
Structural damage and loss Community, hospital and laboratory Public Information
Staff/equipment damage and loss Public and private Guidelines and protocols
Organisation and management needs Injury (physical and mental) Referral systems
Access and logistics needs Communicable diseases Reporting system
Programme needs: Disability (physical and mental) Supplies and equipment
Acute medical/clinical Care Nutrition Logistics, transport and communications
Surveillance and Laboratories Water quality Human resources
Communicable Disease Control (Non communicable diseases) Professional information and education
Prerequisites for health (Vectors) Research
Medical Care Communicable Disease Control Prerequisites for Health
Acute primary care Diseases of Epidemic Potential Shelter, energy, water and sanitation
Care and treatment of injured Vaccine Preventable Diseases Environmental health
Care and treatment of disability Vector Borne Diseases Nutrition and food supply
Care and treatment of chronic disease Diseases of Public Health Significance Health information
Reporting System
Surge Capacity for:
reconstruction
Reporting
Laboratories headache + fever
water and sanitation malnutrition <5s
vector control trauma, disability
? workload ? investigation
institution focus disease focus
dailydaily
Assess resources and
Assess health status
sector infrastructure?
nutrition services in place / meeting needs
Is there damage to health
sector resources?
NO
2
Is there damage to lifelines?
3
public awareness, antenatal care etc
YES
YES
4
YES
5
Can the community cope?
NO
7
appropriate and sufficient
strengthen existing services/
organise temporary services
Mobilise additional resources
Seek expert advice
needs being meet
Organise epidemiological studies
issues of equity, access, coverage and risk
reduction