Transcript DAMAGE ASSESSMENT AND NEEDS ANALYSIS FOR THE …

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
Disaster Management is:
80% generic
to all disasters
1. Organisation
EOC
coordination
communications
transport
logistics and supplies
information and media
reporting and surveillance
2. Response
search and rescue
evacuation
mass casualty management
management of dead and missing
security
temporary shelter, clothing and utensils
emergency water, sanitation and energy
emergency food supplies
emergency public and environmental health
emergency engineering and public works
management of donated supplies/foreign teams
3. Recovery
lifelines
curative and public health care
education
agriculture
trade and commerce
4. Rehabilitation and Reconstruction
people
property
services
livelihoods
environment
15% specific
5% unique
to the hazard
to the event
earthquake
time
place
weather
large numbers of trapped and injured
large numbers of homeless and displaced
large numbers of dead and missing
dead, injured and missing staff
damaged critical infrastruture/resources (hospitals, vehicles)
loss of water, gas, electricity, phone, transport, fuel networks
loss of road, sea, air, rail infrastructutre / access
long period of SAR, victim extraction
high demand for FA, stretchers, triage, medical transport
high demand for beds, surgery, blood products, referral
wound infections, amputations, tetanus, dust inhalation
high demand for orthotics, prosthetics, disability, dental
demand for specialised spinal and head injury care
high demand for temporary shelter, food, utensils, stoves,
water, energy, clothing, tents, blankets
high demand for psychosocial support of victims and staff
few outbreaks of communicable diseases
variable demand for medicines and equipment
(acute/chronic injury care - high, infectious disease - low,
potentially unstable chronic disease - medium)
contamination of water, air and soil
toxic chemical, sewerage and gas leaks/spills
urban fires, explosions
contaminated, infested and unsafe foods
increased vector breeding
loss of livelihoods, markets, distribution networks
THIS IS WHAT WE PLAN FOR ….
geography
climate
security
politics
economy
governance
emergency management capacity
logistics capacity
disposal of inappropriate donations
leadership
solidarity
morale
corruption
crime
looting
compensation claims
insurance claims
ownership disputes
property disputes
Health Needs Assessments (DANA, RHA)
+
Reporting
Hospitals
Clinics and Health Centres
Laboratories
PHC Programmes:
nutrition
IMCI - epi, ari, cdd etc
water and sanitation
vector control
MCH, safe motherhood
daily
Surveillance
cough + fever
diarrhoea + fever
headache + fever
rash + fever
myalgia + fever
other fever
malnutrition <5s
trauma, disability
DEP, VBD, VPD, DPHS, PUCD
daily
? workload
? investigation
expected needs
unexpected needs
? enough supplies
? enough staff
? referral system working
? new supplies
? new staff
? new referral system
institution focus
disease focus
are we meeting the needs?
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 population:
• demography, culture,
geography, climate
• baseline causes of
morbidity and
mortality
The support systems:
• coordination
• communication
• logistics
• information flows
• resource flows
The basic needs:
• Shelter/clothing
• Water/sanitation
• Food/preparation
• Energy/fuel
•
•
•
•
•
Security
Acute medical care
Personal hygiene
Waste management
etc.
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 Emergency
Stage
Immediate
Time-frame
General Needs
search and rescue
first
evacuation / shelter
24
food
hours
Health Sector Responsibilities
safe extraction, resuscitation and first aid
triage and transport system
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
first week
security
emergency epidemiological surveillance for VBD, VPD, DEP, DPHS
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
Medium
term
Long term
end of
first month
end of
3 months
(emergency measles vaccination and Vitamin A)
protection (legal and physical)
(re) establishment of the health information system
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)
education
reconstruction and rehabilitation
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
•
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•
•
•
•
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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 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
Emergencies and Health
search and rescue
first aid
triage
medical evacuation
primary care
Community
DIRECT
IMPACTS
VULNERABILITIES
CAPACITIES
EMERGENC
Y
INDIRECT
IMPACTS
ASSOCIATED FACTORS
Climate/weather/time of day
Location
Security situation
Political environment
Economic environment
Socio-cultural environment
Morale, solidarity, spirit
Competence, corruption
HEALTH RESPONSE
Damage
and
Needs
disease surveillance and
control
curative care
blood banks
laboratories
referral system
special units (burns, spinal)
evacuation centres
shelter
water
food and nutrition
energy
security
environmental health
primary health care
care of the dead
psychosocial care
disability care
recovery
reconstruction
Health Sector Role in Relief
Health Assessment
Structural damage and loss
Staff/equipment damage and loss
Organisation and management needs
Access and logistics needs
Programme needs:
Acute medical/clinical Care
Surveillance and Laboratories
Communicable Disease Control
Prerequisites for health
Medical Care
Acute primary care
Care and treatment of injured
Care and treatment of disability
Care and treatment of chronic disease
Surveillance Systems
Community, hospital and laboratory
Public and private
Injury (physical and mental)
Communicable diseases
Disability (physical and mental)
Nutrition
Water quality
(Non communicable diseases)
(Vectors)
Communicable Disease Control
Diseases of Epidemic Potential
Vaccine Preventable Diseases
Vector Borne Diseases
Diseases of Public Health Significance
Organisation and Management
Public Information
Guidelines and protocols
Referral systems
Reporting system
Supplies and equipment
Logistics, transport and communications
Human resources
Professional information and education
Research
Prerequisites for Health
Shelter, energy, water and sanitation
Environmental health
Nutrition and food supply
Health information
Reporting System
Preparedness
Response
building the capacity to do ALL of the above
using AVAILABLE surge capacity
Surge Capacity for:
scaling up emergency health services
restoration of essential services (repair/replace)
reconstruction
Communicable Disease Control in Emergencies
Diseases of Epidemic
Vaccine Preventable
+
+
Potential
Diseases
cholera
typhoid
meningitis
influenza
measles
tetanus
polio
pertussis
Vector Born
Diseases
+
malaria
dengue
encephalitis
typhus
Diseases of Public
Health Significance
TB
HIV/AIDS
STI
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
case detection
vaccination coverage
case confirmation
vector control
case management
behaviour change
information/education
+
+
outbreak containment and control
Public Safety Risk Management
safer communities
+
1st
2nd
3rd
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 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
2. Technological Hazards
focus on capacity to meet the needs arising from the actual and potential
causes of morbidity and mortality
3. Biological hazards
focus on capacity to meet the needs arising from the actual and potential
causes of morbidity and mortality
4. 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
Needs Assessment and Programme Monitoring
Assess health status
infrastructure
(morbidity, mortality, nutrition)
Programme Indicators
Is there damage to health
sector infrastructure?
Is there damage to health
sector resources?
Is there a major health problem?
NO
Is there damage to lifelines?
YES
YES
1
water, sanitation, waste, shelter, food supply and
nutrition services in place / meeting needs
2
curative, preventative, promotional and
rehabilitative services in place / meeting needs
3
situation specific preventative actions being taken –
vector control, measles vaccination, vitamin A,
public awareness, antenatal care etc
4
guidelines issued and being followed
5
reporting and surveillance systems for injury,
disease, nutrition, water quality, vectors, food
safety, mental health, disability in place
6
referral systems in place, including laboratories,
psychosocial, chronic diseases and disability care
NO
7
essential drugs and equipment available,
appropriate and sufficient
strengthen existing services/
organise temporary services
8
management, logistics, security and
communications systems in place / meeting needs
Mobilise additional resources
9
staff safety, information, training needs being met
Seek expert advice
10
community 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
Can the health system cope?
Can the community cope?
YES
Monitor and Evaluate
Assess resources and
Health Needs Assessments (DANA, RHA)
+
Reporting
Hospitals
Clinics and Health Centres
Laboratories
PHC Programmes:
nutrition
IMCI - epi, ari, cdd etc
water and sanitation
vector control
MCH, safe motherhood
daily
Surveillance
cough + fever
diarrhoea + fever
headache + fever
rash + fever
myalgia + fever
other fever
malnutrition <5s
trauma, disability
DEP, VBD, VPD, DPHS, PUCD
daily
? workload
? investigation
expected needs
unexpected needs
? enough supplies
? enough staff
? referral system working
? new supplies
? new staff
? new referral system
institution focus
disease focus
are we meeting the needs?
SUMMARY
Emergency
?
Rapid Health
Assessment
Document URGENT
damages and needs
Needs from loss of function
due to damage
Emergency
Reporting system
Needs of health sector to
deliver emergency services
+
Injury/disability
Emergency
Surveillance
System
Disease/vectors
Mental health
Nutritional status
Water quality
Needs of the affected
population that affect their
health
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 ASSESSMENTS
IN EMERGENCIES
Thank you