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
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