HEALTH SECTOR ASSESSMENTSIN 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

Disaster Management is:80% generic 15% specific 5% uniqueto all disasters to the hazard to the event

1. OrganisationEOC earthquake timecoordination large numbers of trapped and injured placecommunications large numbers of homeless and displaced weathertransport large numbers of dead and missinglogistics and supplies geographyinformation and media dead, injured and missing staff climatereporting and surveillance damaged critical infrastruture/resources (hospitals, vehicles)

loss of water, gas, electricity, phone, transport, fuel networks security

2. Response loss of road, sea, air, rail infrastructutre / accesssearch and rescue politicsevacuation long period of SAR, victim extraction economymass casualty management high demand for FA, stretchers, triage, medical transport governancemanagement of dead and missing high demand for beds, surgery, blood products, referralsecurity wound infections, amputations, tetanus, dust inhalation emergency management capacitytemporary shelter, clothing and utensils high demand for orthotics, prosthetics, disability, dental logistics capacityemergency water, sanitation and energy demand for specialised spinal and head injury care disposal of inappropriate donationsemergency food supplies high demand for temporary shelter, food, utensils, stoves,emergency public and environmental health water, energy, clothing, tents, blankets leadershipemergency engineering and public works high demand for psychosocial support of victims and staff solidaritymanagement of donated supplies/foreign teams morale

3. Recovery few outbreaks of communicable diseases corruptionlifelines variable demand for medicines and equipment crimecurative and public health care (acute/chronic injury care - high, infectious disease - low, lootingeducation potentially unstable chronic disease - medium)agriculture compensation claimstrade and commerce contamination of water, air and soil insurance claims

toxic chemical, sewerage and gas leaks/spills4. Rehabilitation and Reconstruction urban fires, explosions ownership disputespeople contaminated, infested and unsafe foods property disputesproperty increased vector breedingserviceslivelihoods loss of livelihoods, markets, distribution networksenvironment

THIS IS WHAT WE PLAN FOR ….

Health Needs Assessments (DANA, RHA)

Reporting + SurveillanceHospitals cough + feverClinics and Health Centres diarrhoea + feverLaboratories headache + feverPHC Programmes: rash + fever

nutrition myalgia + feverIMCI - epi, ari, cdd etc other fever

water and sanitation malnutrition <5svector control trauma, disability

MCH, safe motherhood DEP, VBD, VPD, DPHS, PUCD

? workload ? investigation

expected needs unexpected needs? enough supplies ? new supplies

? enough staff ? new staff? referral system working ? new referral system

institution focus disease focus

are we meeting the needs?

dailydaily

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 constraints (climatic, geographic, political, social,

logistical, organisational etc.)

The information is used to:• set priorities and targets for the relief operation • allocate specific responsibilities to participating agencies

Which Information?

The basic needs:• Shelter/clothing• Water/sanitation• Food/preparation• Energy/fuel

• Security• Acute medical care• Personal hygiene • Waste management• etc.

The population:• demography, culture,

geography, climate• baseline causes of

morbidity and mortality

The support systems:• coordination• communication• logistics• information flows• resource flows

Why assess damage?

• Guides planning for repair, rebuilding and reconstruction

• Guides the setting of relief priorities: Function and safety issues –– can a service be

delivered, is a building safe (building “triage”)• Evacuate or not ?• Can people access the service?• 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

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.

Needs in an EmergencyStage Time-frame General Needs Health Sector Responsibilities

Immediate first search and rescue safe extraction, resuscitation and first aid

24 evacuation / shelter triage and transport system

hours food primary medical care

water detoxification /decontamination

public information system acute medical and surgical care (first line and referral)

emergency coordination, communication, logistics and reporting systems (including injury and disability registers)

Short term end of security emergency epidemiological surveillance for VBD, VPD, DEP, DPHS

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 end of 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 education reconstruction and rehabilitation

3 months agriculture specific training programmes

environmental protection health information campaigns/health education programmes

disability and psychosocial care

Conclusion compensation/reconstruction evaluation of lessons learned

restitution/rehabilitation revision of policies, guidelines, procedures and plans

prevention and preparedness upgrade knowledge and skills, change attitudes and practices

Vector Born Disease, Vaccine Preventable Disease, Diseases of Epidemic Potential, Diseases of Public Health Significance, Potentially Unstable Chronic Disease)

Categories of information

The assessment involves the collection of two key categories of information:

• Analysis of the damage to: critical resources critical infrastructure and fixtures critical services

• Analysis of the needs of the victims immediate needs arising from the situation future needs arising from damage/disruption to

services/infrastructure

Information on victims

A report describing the impact of a hazard will provide the number of:

• Number of casualties• killed; injured; sick; disabled;• by age, sex, location and probable cause of

death

• Number of affected

• total; severe; critical;

Classification based on severity

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 i.e. those totally dependent on others to support them

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• shelter (and clothing in cold climates)• 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• Transport networks (air, sea, road)• Distribution systems

First priority of Government – restore lifelines and meet basic needs

Assessing facilities and services

For each facility or service in the affected area, the assessment classifies facilities according to function:

• destroyed / no function possible

• more than 50% reduction in capacity

• less than 50% reduction in capacity

• undamaged / full function

Public Health Consequences of Disasters

• 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 health services• disruption to routine disease surveillance and

control services• diversion of capital investment funds to emergency

relief and the rehabilitation or reconstruction of essential infrastructure

      VULNERABILITIES

CAPACITIES

 EMERGENCY

INDIRECT IMPACTS

DIRECT IMPACTS

HEALTH RESPONSE search and rescuefirst aidtriagemedical evacuationprimary care disease surveillance and

controlcurative careblood bankslaboratoriesreferral systemspecial units (burns, spinal) evacuation centresshelterwaterfood and nutritionenergysecurity environmental healthprimary health care care of the deadpsychosocial caredisability care recoveryreconstruction

ASSOCIATED FACTORS Climate/weather/time of dayLocationSecurity situationPolitical environmentEconomic environmentSocio-cultural environmentMorale, solidarity, spiritCompetence, corruption

Damageand

Needs

Emergencies and Health

Community

Health Sector Role in Relief

Health Assessment Surveillance Systems Organisation and Management

Structural damage and loss Community, hospital and laboratory Public InformationStaff/equipment damage and loss Public and private Guidelines and protocolsOrganisation and management needs Injury (physical and mental) Referral systemsAccess and logistics needs Communicable diseases Reporting systemProgramme needs: Disability (physical and mental) Supplies and equipment

Acute medical/clinical Care Nutrition Logistics, transport and communicationsSurveillance and Laboratories Water quality Human resources

Communicable Disease Control (Non communicable diseases) Professional information and educationPrerequisites for health (Vectors) Research

Medical Care Communicable Disease Control Prerequisites for Health

Acute primary care Diseases of Epidemic Potential Shelter, energy, water and sanitationCare and treatment of injured Vaccine Preventable Diseases Environmental healthCare and treatment of disability Vector Borne Diseases Nutrition and food supplyCare and treatment of chronic disease Diseases of Public Health Significance Health information

Reporting System

Preparedness building the capacity to do ALL of the above Surge Capacity for:

Response using AVAILABLE surge capacityscaling up emergency health services restoration of essential services (repair/replace) reconstruction

Communicable Disease Control in Emergencies

Diseases of Epidemic Potential

+Vaccine Preventable

Diseases+

Vector Born Diseases

+Diseases of Public Health Significance

cholera measles malaria TB

typhoid tetanus dengue HIV/AIDS

meningitis polio encephalitis STI

influenza pertussis typhus helminths

Public Safety Risk Management

safer communities

Strategy Options

Diseases of Epidemic Potential

Vaccine Preventable Diseases

Vector Born Diseases

Diseases of Public Health Significance

environmental control vaccination coverage vector control behaviour change 1st

case detection + case confirmation + case management + information/education 2nd

outbreak containment and control 3rd

Public Safety Risk Management

safer communities

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

Reference Values

Prepare tools to assist planning

Public Health Predictors template.xls

Health Sector Assessments by Hazard Class

1. Natural Hazardsfocus 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

2. Technological Hazardsfocus on capacity to meet the needs arising from the actual and potential

causes of morbidity and mortality

3. Biological hazardsfocus on capacity to meet the needs arising from the actual and potential

causes of morbidity and mortality

4. Societal HazardsIn 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

Needs Assessment and Programme Monitoring

Assess resources and Assess health status

infrastructure (morbidity, mortality, nutrition) Programme Indicators

Is there damage to health sector infrastructure?

1water, sanitation, waste, shelter, food supply and nutrition services in place / meeting needs

Is there damage to health sector resources?

Is there a major health problem? NO

2curative, preventative, promotional and rehabilitative services in place / meeting needs

Is there damage to lifelines? 3

situation specific preventative actions being taken – vector control, measles vaccination, vitamin A, public awareness, antenatal care etc

YES YES 4 guidelines issued and being followed

Can the health system cope? YES 5

reporting and surveillance systems for injury, disease, nutrition, water quality, vectors, food safety, mental health, disability in place

Can the community cope? 6referral systems in place, including laboratories, psychosocial, chronic diseases and disability care

NO 7essential drugs and equipment available, appropriate and sufficient

strengthen existing services/ organise temporary services

8management, logistics, security and communications systems in place / meeting needs

Mobilise additional resources 9 staff safety, information, training needs being met

Seek expert advice 10community health information / health education needs being meet

Organise epidemiological studies and surveys

11

plans for rehabilitation and reconstruction address issues of equity, access, coverage and risk reduction

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Health Needs Assessments (DANA, RHA)

Reporting + SurveillanceHospitals cough + feverClinics and Health Centres diarrhoea + feverLaboratories headache + feverPHC Programmes: rash + fever

nutrition myalgia + feverIMCI - epi, ari, cdd etc other fever

water and sanitation malnutrition <5svector control trauma, disability

MCH, safe motherhood DEP, VBD, VPD, DPHS, PUCD

? workload ? investigation

expected needs unexpected needs? enough supplies ? new supplies

? enough staff ? new staff? referral system working ? new referral system

institution focus disease focus

are we meeting the needs?

dailydaily

SUMMARY

Emergency

Rapid Health Assessment

Emergency Reporting system

Emergency Surveillance

System

+

Document URGENT damages and needs

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

?

Injury/disability

Disease/vectors

Mental health

Nutritional status

Water quality

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

HEALTH SECTOR ASSESSMENTSIN EMERGENCIES

Thank you