The Yolanda Experience: The Yolanda Experience: Lessons LearnedLessons Learned

44th Annual Convention of Philippine College of Physicians

5 May 2014

TEODORO J. HERBOSA, MD Undersecretary of Health

Coordinator, Disaster and Rehabilitation Management Task Force

Outline

• Introduction• What were prepared?• What happened?• What have been done?• Specific challenges and way forward

Introduction• On November 08, 2013, Typhoon “YOLANDA” made seven landfalls:

– Guiauan, Eastern Samar, 4:40am– Dulang-Tolosa, Leyte, 7:00am– Daanbantayan, Cebu, 9:40am– Bantayan Island Cebu, 10:40am– Concepcion, Iloilo, 12:00nn– Tibiao, Antique, 3:00pm– Busuanga, Palawan

• PAGASA’s morning bulletin recorded maximum sustained winds of 235 kph and gustiness of up to 275 kph

• Many areas have become out of reach as the typhoon destroyed power and communication lines

• Major airports and ports closed down• Major roads in greatly affected areas have become impassable due to

devastating effects of the typhoon

Typhoon “Yolanda” Landfalls

Typhoon “Yolanda” Storm Surges

Affected Areas in Eastern Visayas

What were prepared?

November 6:• Alert Memorandum was issued to all CHDs• Prepositioned logistics worth PhP 350MNovember 7• Code Blue alert was raised in the CHDs most

at risk• CHD OpCen opened for 24 hours• Continuous monitoring

Timeline of DOH Response

Nov 6 Nov 7 Nov 8 Nov 9 Nov 10 Nov 11

Alert memo issued to all

CHDs

Logistics prepositioned in CHDs VI, VII,

and VIII

Typhoon Yolanda Landfall

DOH-CO on Code Red

No lifelines in affected

areas

Medical response

teams ready to board C130

Code Blue raised in all CHDs at risk

OpCen operational 24

hours

Continuous monitoring of the situation

DOH personnel on duty at NDRRMC

No communication from CHD VIII;

Only qualitative info

and pictures from

mainstream media

CARAGA and Albay medical

response teams arrived

in Tacloban

Continuous monitoring of the situation

Secretary Ona and other

officials visited Tacloban

Teams from MM hospitals

arrived in Tacloban

Context: Unprecedented magnitude of Typhoon Yolanda effects

What happened?

What happened?Region Province Deaths Injured

IV-A Quezon, Batangas 3 6IV-B Palawan 19 63V Albay, Masbate, Camarines

Norte6 32

VI Iloilo, Aklan, Capiz, Antique, Negros Occidental

**285 2,733

VII Cebu, Bohol 74 22

*VIIITacloban City, Leyte, Samar, Eastern Samar, Biliran

5,803 26,123

IX Zamboanga 0 1CARAGA Surigao del Sur 0 1

Total 6,190 28,981

Note: *NDRRMC Sitrep No. 92 as of January 14, 2014 for Region VIII.**CHD VI reported 285 deaths while NDRRMC reported 294 deaths. Discrepancies in figures are still subject for validation by the CHD VI.

What happened?Other impactsOther impacts

People CHD personnel who reported for work in the first week

15 out of 267 (5.6%)

Local health personnel who reported for work in the first week

Ground estimate of 10 to 20%

Health Infrastructure

3 Damaged offices (Warehouse and prepositioned logistics destroyed)

PHP 50,350,000.00

50 out of 91 assessed hospitals are damaged (45 partial, 5 complete; 45 functional, 5 non functional)

PHP 696,810,800.00

550 out of 1,593 assessed RHU/BHS are damaged (354 partial, 183 complete; 350 functional, 180 non functional)

PHP 541,239,000.00

EVRMC as the only remaining functional hospital in Tacloban with personnel on duty for 3 straight days

250 bed hospital accommodating 60 admissions reaching 300 inpatients, and 70 E.R. Consultations (daily averages)

What happened?Health facility status

Region / Province

No. of existing

HF

No. of assessed

HF

No. of damaged

HF

Extent of Damage Operation StatusEstimated Cost of

DamagePartially damaged

Completely damaged

FunctionalNon-

functional

Region VIII 620 289 289 177 92 177 92 1,013,119,800.00

Leyte 334 195 195 153 42 153 42 665,354,300.00Eastern Samar 141 78 78 15 43 15 43 279,186,200.00

Western Samar 145 16 16 9 7 9 7 68,629,300.00

Region VII 1,007 74 71 19 52 19 52 29,930,000.00

Region VI 1,907 1,282 418 366 52 372 44 149,675,000.00

Region IV-B 146 42 41 41 0 41 0 100,625,000.00

Total 3,680 1,687 819 603 196 609 188 1,293,399,800.00

What have been done?Logistics provided

SourceSource RecipientRecipient Amount Amount

DOH-Central Office 

CHD IV A 80,640.00CHD IV B 702,640.00CHD V 932,658.00CHD VI 9,736,688.26CHD VII 8,009,607.30Washed Out (Tacloban Airport) 1,130,897.50CHD VIII 78,990,219.70Sub-allotment (EAMC, V, VII, and VIII) 42,300,000.00

Total DOH Central Office logisticsTotal DOH Central Office logistics 141,883,351.00DOH HOSPITALS CHD VIII 4,025,232.54CHD's (I,IV-A, IV-B, V, VI, VII, VIII, X, XI, XII, MM, CAR, CARAGA) CHD IV-A, IV-B V, VI, VII,VIII 46,882,754.10Total DOH Central Office logistics 50,907,986.64Local Donation CHD VI, VII, VIII 14,023,226.65International Donation CHD VII, VIII 21,006,027.40Total donationsTotal donations 35,347,174.05

GRAND TOTALGRAND TOTAL 228,138,511.69

Note: Logistics include essential medicines, aquatabs and ORS, hospital and laboratory equipments, family tent and cot beds, cadaver bags, fogging machines, generator sets, computer equipment

What have been done?

• As the Health Cluster lead, DOH provided support to 144 registered foreign medical teams as well as other local and international NGOs through:– Deployment coordination– Technical advice through provision of local

protocols and guidelines– Health services report consolidation– Early disease warning detection and response

What have been done?

• Facilitated the acceptance and quality control of donated medicines and medical supplies

• Health promotion activities and other public health advisories

• Provision of cadaver bags• Assistance to NBI and LGUs in the

management of the dead

What have been done?

• Deployment of composite team with toxicology experts to manage the secondary event of oil spill in Barangay Botongan, Estancia, Iloilo

What have been done?Summary of Services

Areas of ServiceAreas of Service Specific AccomplishmentsSpecific Accomplishments

Hospital services 34,522 patients served2,127 operations conducted

Health teams deployed (composite teams)

298 teams (154 national, 144 international). National teams are composed of 1,827 personnel). Approximately 20% were deployed to Tacloban while the rest are distributed across all affected areas

Public Health services 126,299 out-patient consultations46,865 measles immunization 12,165 tetanus vaccination No disease outbreak as of today

Nutrition services 73,730 children screened for acute malnutrition (141 cases managed)69,764 children received supplementary feeding program33,619 children received vitamin A supplementation27,020 children received multiple micronutrient powder8,876 pregnant/lactating women assessed and counseled for infant and young child feedingNo worsening of nutrition condition and no deaths related to malnutrition in the areas

Water, Sanitation, and Hygiene services

1,747 latrines constructed/ rehabilitated206,051 hygiene kits distributed199,278 water kits distributed

MHPSS services 1,196 recipients of Counseling6,924 recipients of Psychological First Aid12,875 recipients of Psychosocial Processing32 advance case referrals

What have been done? Hospital services

REGIONNo. of Patients

served

Consultations

AdmissionNo. of

Operations Conducted

Status

ER OPDNo. of

ReferralNo. of

DischargedNo. of Deaths

REGION VIII 30,375. 2,194. 30,896. 3,318. 2,046. 190. 619. 83.Leyte 30,375. 2,123. 30,810. 3,247. 1,944. 190. 600. 83.

Eastern Samar 0. 71. 86. 71. 102. 0. 19. 0.Western

Samar0. 0. 0. 0. 0. 0. 0. 0.

REGION VII 2,598. 0. 2,598. 149. 60. 0. 0. 3.REGION IV-B 155. 55. 61. 18. 21. 0. 0. 0.NCR (Patients from Reg.8; Villamor Airbase)

1,394. 690. 408. 226. 219. 10.

GRAND TOTAL:

34,522. 2,249. 34,245. 3,893. 2,127. 416. 838. 96.

What have been done?Team mobilization

PROVINCE CITY/MUNICIPALITY

DOH TEAMS DEPLOYED (120)

OTHER LOCAL HEALTH

RESPONDERS (34)

FOREIGN TEAMS (124)

TOTAL (278)

NO. OF TEAMS

NO. OF PERSONNEL

NO. OF TEAMS

NO. OF PERSONNEL

NO. OF TEAMS

NO. OF PERSONNEL

NO. OF TEAMS

NO. OF PERSONNEL

LEYTE TACLOBAN 53 626 15 367 14 279 82 1272ORMOC 4 59 8 34 8 127 20 220OTHERS 21 263 5 39 18 248 44 550

SAMAR EASTERN SAMAR 16 147 6 142 22 289WESTERN SAMAR 1 11 1 11

CEBU DAANBANTAYAN, MACTAN, CAMOSTES IS., SAN REMEGIO, TABUELAN, BORBON, TOBOGON, BOGO, STA. FE, MEDELLIN 8 49 4 90 10 167 22 306

METRO MANILA VILLAMOR AIRBASE, PASAY 11 72 1 4 12 76DSWD NROC 5 11 5 11

PALAWAN CULION 1 5 1 5ILOILO, CAPIZ, AKLAN, ANTIQUE

4 91 1 50 2 74 7 215

OTHERS 5 12 5 12

What have been done?Public Health services

What have been done?Nutrition services

What have been done?WASH services

REGION

No. of Population Served

Provision of Potable Water

Water TestingDistribution

of Water Container

Water Treatment/Disinfectant

Provision of Water for General/ Domestic

Use

Construction/ Installation of

Toilets & Latrines

Hygiene Kits Provided*

Jerry Cans Provided

Others (water

purifier, mobile water tanks)

VIII 20,681,572 41,008 230,385 84,380 224,137 1,610 166,815 251,802 193

Leyte 20,681,572 14,631 230,137 84,200 224,137 1,590 142,271 249,217 171Eastern Samar 0 20,905 248 180 0 20 20,020 2,585 22Western Samar - 5,472 - - - - 2,709 - -Biliran - - - - - - - - -

VII - 1,500 - - - - 3,886 - 2

VI 0 21,088 1,653 0 0 157 15,917 1,653 618

IV-B - 4,000 - - - - - - -

Total 20,681,572 67,596 232,038 84,380 224,137 1,767 184,803 253,455 813

What have been done?MHPSS services

REGION

No. of Population Served

PFACommunity &

Family SupportCounselling

Psycho-education

session

Psychosocial processing

Stress Management

Program

Referral of cases

DefusingMental Health

Services not specified

VIII 1,261 245 696 113 2,205 290 17 415 1,962Leyte 1,261 245 696 113 2,193 278 17 415 1,336Eastern Samar 0 0 0 0 12 12 0 0 626Western Samar - - - - - - - - -Biliran - - - - - - - - -Northern Leyte - - - - - - - - -VII 672 0 408 0 302 0 0 0 0VI 0 0 0 0 9,917 0 0 0 0IV-B - - - - - - - - -NCR 4,991 311 92 155 451 310 15 5 15

Total 6,924 556 1,196 268 12,875 600 32 420 1,977

Gaps identified

In consideration of the magnitude of Typhoon Yolanda and the new normal, there is a need to:

• Update logistics and lifeline needs for emergency health sector response

• Ensure health facilities to remain functional during disasters

• Enhance equipment and preparation of health response teams (local and international)

• Update health emergency preparedness, response, and recovery plans

• Update systems for health service delivery especially for mega disasters

Some specific challenges identified

• Current procurement plan accounted mainly for non-capital outlay needs during emergency/disaster

• Some operational issues on cash advance releases/ liquidation experienced

• Team mobilization, composition, qualifications, and deployment not clearly defined in responding to Yolanda

• Current policies and guidelines covering most aspects of health emergency and disaster response lack provisions in addressing “mega” or “new normal” emergencies and disasters

• Current CHD and hospital response plans did not match the surge capacities requirements contingency and business-continuity components

Way forward

On February 19 to 21, top management level of the Department of Health held a strategic planning workshop to increase its capacity to respond to emergencies and disasters. There were five identified strategic objectives:

1. Improve the responsiveness of policies and plans at all levels to mega disasters

2. Institutionalize effective ICS at all levels supported by functional OpCen and IMS

3. Enhance the logistics and financing capacities to support response operations

4. Build-up the resiliency of hospitals and other health facilities against mega disasters

5. Enhance the adequacy, timeliness and appropriates of health services delivered