Capacity Building for Health Workforce

First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

Learning Objectives

By the end of this module, the participant should be able to:

 Describe the elements of capacity to manage health risks of emergencies  Identify key elements of capacity for specific health service delivery functions  Describe the role of a health emergency manager in health emergency management systems and in developing health emergency management capacity

First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

Health Workforce

 all persons currently participating in the health labor market

Health Workers

 all people engaged in actions whose primary intent is to enhance health • • • • • • • • • Physician Nursing and midwifery personnel dentistry personnel pharmaceutical personnel laboratory health workers environmental and public health workers community and traditional health workers other health service providers health management and support workers

First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

Defining Capacity

Sum of:

capability resources relationships

Within

community organization country region world

Aims

– –

Reducing illness, disability and death from risks Promoting health, safety and security

First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

Defining Capacity

System definition of capacity

• Capacity includes and skills) of the component parts, the (financial, equipment) which support the system, and the capability relationships (knowledge, attitude resources which together form the system.

Capacity is a quantitative measure • Measurement of human and material resources i.e. number or volume or size. For example, the capacity of the hospital is 500 beds

First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

Relevance of Risk Management to HEM Capacity Development

Risk = Hazard x Vulnerability Capacity

In managing Risk: Capacity is needed to: • Reduce Hazard • Reduce vulnerability • Increase Capacity

First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

Health Emergency Management Capacity

Capacity to perform the following functions:

    Reduce hazard Reduce vulnerability Respond to reduce and manage consequences Recover and reconstruct for better

Preparedness Response Recovery First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

Disaster Risk Management Framework Response

(Capacity utilization)

Preparedness

(Capacity building)

Recovery

(Capacity rebuilding for better) (Capacity to Reduce/prevent Hazard)

Prevention

(Capacity to Lessen Impact of hazard)

Mitigation First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

ANATOMY OF COMMUNITY RISK MANAGEMENT hazard indicators: probability scale/magnitude/ strength/intensity spread duration biological hazards: season, infectivity, latency, transmission resistance, etc.

natural phenomena famine diseases of epidemic potential events/crowds intoxification infestations transport accidents structural failures industrial accidents chemical accidents pollution refugees war terrorism

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community vulnerability indicators: People: access to health care measles vaccination under 5 nutrition under 5 mortality access to clean water access to sanitation adequate housing employment/ income female literacy Property: health infrastructure Services: vehicles medical supplies curative care services ambulance services public health services health info system Environment: water/soil/air quality readiness multisectoral, all hazards indicators: Community risk indicators: policy, plans, procedures knowledge, skills, attitudes resources legislation national & sectoral policy administrative procedures response & recovery plans preparedness plans technical guidelines management structure institutional managements information systems warning systems human resources material resources financial resources simulations & training education public information community participation research publications risk of: death injury (mental/ physical) disease (mental/physical) loss of life displacement loss of property loss of income secondary hazards breakdown in security damage to infrastructure breakdown in services Contamination Prevention & Mitigation Programme

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Vulnerability Reduction Programme

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Emergency Preparedness Programme = Community Risk Management 12 – 23 March 2011. Muscat, Oman

Elements Of capacity to Perform Functions Organizations Systems People First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

Organizations

In the context of health emergency: • • • • • Designated/organized body Defined organizational structure Clear roles and directions United action or functions Legal framework

First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

Systems

Definition: a “regularly interacting or interdependent group of items forming a unified whole” ( Merriam Webster Dictionary ) an orderly grouping of facts, principles, or methods in a certain field; any formulated method or plan; a manner of arrangement or procedure (The Random House Dictionary)

First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

Systems to Manage Health Risks of Emergencies Systems

• • • • systems operating at each administrative level systems in specific sectors systems to manage specific types of risks (hazards and vulnerabilities) systems for specific functions or services

First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

People People contribute to organizations and systems by providing:

• skills, knowledge and attitudes • Competency

People may be:

• Career (or paid), volunteer and community • Managers, coordinators, operators or responders

First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

Evacuation Site Scenario

• Damaged lifelines • Overcrowding • Poor environmental sanitation • No access to safe water • Inadequate sanitary toilets • Health workers are direct victims • Disrupted basic health services

First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

Evacuation Site Scenario: Typhoon

•Poor environmental sanitation • No access to safe water • Inadequate sanitary toilets • No community surveillance system • Disrupted basic health services • Foul smell of decomposing bodies • Severe depression of the bereaved and other health workers

First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

Group Activity 1

In your group, address one of the following:

1. Poor environmental health condition 2. Disrupted communicable disease services 3. Poor management of the dead and the missing 4. Lack of mental health and psychosocial support Assess the risk and identify capacity needed in terms of organization, systems and people. Write your answers on a flip chart for presentation.

Risks Services/ Functions

Organization

Capacities needed

System People

First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

Environmental Health in Evacuation Center

• • • •

Environmental health risks are assessed, including:

Water supply services Waste handling and disposal Food safety Garbage disposal Local Capacity ( laboratory services, sampling, diagnosis and analysis; equipment etc.

) Inventory of organizations with environmental health roles and responsibilities (laboratories, surveillance, chemical industries, water supply services, waste disposal services, fire service, etc.) Availability of supplies, reagents, medicines

First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

Environmental Health in Evacuation Center

• Environmental health risks: Food and water borne diseases • • • • • Environmental Capacity Environmental assessment, surveillance Environmental teams Environmental distribution logistics including systems Laboratories and other confirmation devices Reporting, monitoring, evaluation of

First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

Communicable Disease

• • • • Communicable heal th risks are assessed including: Diseases of Epidemic Potential Vaccine Preventable Diseases Vector Born Diseases Diseases of Public Health Significance • • • • • Considerations: Health status Local capacity, program implementation Inventory of Organizations Availability of health services, facilities Availability of drugs, medicines, supplies, vaccines

First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

Communicable Disease

• Communicable health risks: Epidemic and Outbreak • • • • • • • • Communicable Disease Capacity Surveillance System in place in evacuation centers Surveillance teams available Case definition etc..

Epidemiological investigation logistics including systems of distribution Laboratories and other confirmation devices Reporting, monitoring, evaluation Networking and referral system

First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

Management of the Dead and Missing

• • • • MDM Issues: Identification of the Dead Cultural Considerations Final Disposal of the Dead Management of the Relatives Considerations: Legal framework, functioning coordination mechanisms and organizational structure in place for health emergency preparedness and response Local capacity Inventory of Organizations Mortuary System

First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

Management of the Dead and Missing

• • MDM health risks?

Myths and realities about dead bodies Mass burial • • • • • • MDM Capacity Organizational/Institutional Arrangements; roles and responsibilities; management structures Procedures (identification, keeping of records, fingerprinting, dental records, DNA and photographing) Provisions for notification of relatives (next of kin) Logistics Reporting, monitoring, evaluation Networking and referral system

First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

Mental Health and Psychosocial Support

• • • • Psychosocial heal th risk assessment: Coverage Silent victims, Family displacement Medical Responders/Leaders Early identification and referral Considerations: • Local capacity for emergency provision of essential services and supplies • Inventory of organizations, health facilities, Availability of drugs, medicines, supplies, Availability of training modules and trainers

First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

Mental Health and Psychosocial Support

• • • • • • • Psychosocial health risks: • Long lasting; affects rehabilitation and recovery (children, responders, etc.) Psychosocial Capacity Policies and Plan Training modules, pool of trainers ; range of services Advocacy and awareness through information management and communication education, Health facilities, drugs and medicines Reporting, monitoring, evaluation Networking and referral system; Inter and Intra sectoral coordination Local capacity for emergency provision of essential services and supplies

First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

Elements Of capacity To manage Health risks of emergencies

• Legal framework • Policies • Guidelines • Procedures • Resources • Plans • Knowledge • Attitude • Skills Organizations Systems People

First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

EMERGENCY AND HEALTH

EMERGENCY COMMUNITY

DIRECT IMPACT VULNERABILITIES CAPACITIES INDIRECT IMPACT

DAMAGE AND NEEDS ASSOCIATED FACTORS

Climate/ weather/ time of the day Location Security situation Political environment Economic environment Socio-cultural environment Morality, solidarity, spirit Competence, corruption

12 – 23 March 2011. Muscat, Oman RESPONSE CAPACITIES

Search and rescue First Aid Triage Medical evacuation Primary care Disease surveillance and control Curative care Blood banks Laboratories Referral system Special units (burn, spinal) Evacuation centers Shelter and Water Food and nutrition Energy and Security Environmental health Primary Health Care Care of the dead Psychosocial care Disability care

EPIDEMIC EMERGENCIES

Specific morbidity and mortality

OUTBREAK

- in health facilities - in the community - in health facilities Risk for health and lab workers Difficult access Agent unknown

NEEDS RESPONSE CAPACITIES

Case definition Admission criteria Case confirmation Case management Discharge criteria Contact tracing Vector control Environmental controls Surveillance system Referral system Professional education Public Information and awareness Laboratory plans Hospital plans Supplies and equipment Borders control Quarantine Animal culling

12 – 23 March 2011. Muscat, Oman

      

General or Cross-cutting Functions

  Communication and transport Information management Health surveillance Mental health Reproductive health Environmental health Food safety, emergency feeding and nutrition Water supply management Waste management

First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

Specific Emergency Response and Emergency Recovery Functions

 First aid, self-aid and first-responder health assistance  Incident site management  Assessing needs  Mass-casualty management  Decontamination  Epidemiological investigation

First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

Specific Emergency Response and Emergency Recovery Functions

 Forensic investigation  Management of the dead and the missing/ fatality management  Shelter and temporary accommodation (including evacuation shelters)  Community support  Longer-term issues (health effects, recovery, rehabilitation, reconstruction)

First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

Role of the Health Emergency Manager

• • • • • • • Determine the risk and plan to manage it Identify the capacity needed in terms of Organization, Systems and People Determine strategies to reach the goals set Determine resource requirements (Compare from what is available to what is required and what is the gap) Look for resources, identify partners, co share Determine a point person, time frame and indicators Monitor and evaluate

First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman