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Humanitarian Action Plan Fiji Health & Nutrition Cluster
This document provides a draft action plan for the Health & Nutrition Cluster response to TC Winston.
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HUMANITARIAN ACTION PLAN FOR HEALTH & NUTRITION CLUSTER
Cluster Lead Co-Lead Agencies
Lead: Ministry of Health and Medical Services(MoHMS) Co-Leads: World Health Organization and UNICEF
Cluster Key Partners
MoHMS, NDMO, NFNC, UNICEF, WHO, UNFPA, UNAIDS, UNOCHA, UNWOMEN, FHSSP , IFRC, FRCS, SPC, RFHAF, PCF, SAVE THE CHILDREN, MSP, FNU, DFAT, NZMAT, IPPF, AUSTRALIAN AID, WORLD VISION,
Contact Information
Dr. Eric Rafai (MoHMS) 3306177 eric.rafai@govnet.gov.fj Vimal Deo (MoHMS) 9904131 vimal.deo@health.gov.fj or vimal24deo@yahoo.com Dr. Rokho Kim (WHO) 3234100 kimr@who.int Nahad Sadr-Azodi (UNICEF) 8024180 nsadrazodi@unicef.org
Budget
Requirement: FJD 29,085,272
Met: FJD 7,343,054
Unmet: FJD 21,742,218
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Sectoral Needs Analysis
Fiji is an island nation in the south-west Pacific, midway between Vanuatu and the Kingdom of Tonga, and is made up of 332 islands, of which one third are inhabited. Fiji has a land mass covering a total land area of 18333 square kilometres within 1.3 million square kilometres of the South Pacific. Fiji’s health system is based on a three-tier model that provides an integrated health service at primary, secondary and tertiary levels. The Ministry of Health & Medical Services generally delivers its health services through its four administrative divisions under Public Health Programs and Hospital Service. There are 214 health facilities serving an estimated population of about 933,0241.
Table 1 Estimated Population of Fiji by Divisions
Division Estimated Population Central 374,673 Eastern 39,651 Western 387,710 Northern 130,990
Total 933,024 The total workforce of the Ministry of Health and Medical Services is around 4,300 established staff and 1,300 unestablished staff. Fiji is geographically situated in one of the most natural disaster prone areas in the world affected mainly by tropical depressions and cyclones or as part of tropical weather conditions common to the region. Cyclones, Floods and Natural Disasters are a common occurrence to Fiji and the Pacific. The core function of the Ministry of Health & Medical Services (MoHMS) is to provide of health care, that includes ensuring that its resources, health facilities and staff are prepared to execute emerging disease control measures, disaster management plans and mitigate climate change impacts. The National Health Emergencies and Disaster Management Plan (HEADMAP) is the primary policy document for MoHMS during health emergency that is developed to assist health personnel address health emergency and disaster events. There are other plans and documents on disaster risk reduction and disaster management which assist HEADMAP operations for preparedness, response and recovery.
1 Based on MoH Annual Report 2015
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The MoHMS and WHO identified the following priority risks from a rapid public health2 assessment. Immediate priorities post disaster
1. Provision of safe and nutritious food, safe drinking-water, appropriate sanitation, shelter and other essential non-food items including WASH and Hygiene Kits
2. Trauma care for the wounded with tetanus vaccination 3. Provision of medicines and medical supplies to health facilities 4. Establishment of emergency primary and secondary health care services for
medical, surgical and obstetric emergencies 5. Strengthen disease surveillance for early detection of communicable disease
outbreaks expected after a disaster such as diarrhoea, respiratory infection and others
6. Risk communication on important public health events 7. Ensure continuity of care for patients with chronic diseases or infections, such as
diabetes, hypertension, TB and HIV. Short-term priorities
1. Re-establishment of essential health care services (primary, secondary and tertiary health care)
2. Emergency mental health care and psychosocial support 3. Waste management 4. Surveillance and Control of vector-borne diseases
Medium-term priorities
1. Post-surgical care, treatment of infected wounds and management of disabilities 2. Re-establish routine immunization 3. Monitor and respond to health care needs of displaced population (evacuees) 4. Surveillance of nutrition issues and management of acute malnutrition including
medical complications
Long-term priorities 1. Reconstruction of Cyclone Resilient Health Facilities (Build Back Better) 2. Review of HEADMAP processes and guidelines 3. Strengthen Risk Assessment and Early Warning Systems capacities for
HEADMAP 4. Advocate for more resources for HEADMAP
2 A “Rapid Public Health Risk Assessment” will be published jointly by WHO and MoHMS
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Cluster Objectives and Strategies
A Strengthen Coordination, Capacity and Advocacy within health cluster partners
B Provide immediate medical care for trauma and injury
C Assure continuity and re-establishment of medical and public health services through outreach services, rehabilitate and equip health facilities
D Prevention and control of communicable diseases related to water and vector such as leptospirosis, typhoid, dengue, Zika and prevent and manage diarrhoeal incidences
E Provide urgent nutrition support to treat and prevent deterioration of nutritional status of children and pregnant and lactating women (PLW) through delivery of maternal, infant and young child feeding support, treatment of severe acute malnutrition and provision of micronutrients in affected areas.
F Prevent exacerbation of existing non-communicable diseases and other disease threats
G Psychosocial Support and Mental illnesses associated with the traumatic experiences
H Reproductive Health Response including maternal, newborn and adolescent care and Gender Based Violence response
I Provide information and increased access to information education material (IEC) on health messages
J Provide environmental health services to evacuation centres, health facilities, schools, and affected communities including municipal councils and outer islands.
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List of Cluster Activities and Actions
Activity A1
Agency Ministry of Health and Medical Services Description National Cluster Coordination
Sub-national Cluster Coordination Information Management
Objective(s) To Strengthen Coordination, Capacity and Advocacy within health cluster partners (Immediate)
Beneficiaries All the affected people by TC Winston Partners Members of HnN Cluster Budget Requirement F $200,000
Funded F $20,000 MoHMS Unmet F $180,000
Expected Outputs and Impacts
Coordination of the Health & Nutrition Cluster as Lead Agencies
Community mobilization, health, environment and nutrition promotion and capacity building for health staff
Health Outreach programs support in the four divisions in Fiji Consolidation of Information and dissemination to partners
and members Monitoring and evaluation of the HAP projects
implementation Organization of the lessons learnt and debriefing meetings of
the stakeholders Production and dissemination of health and nutrition cluster
bulletin
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Activity B1
Agency Ministry of Health and Medical Services Description Provision of Phase 1 Health Response, which includes medical
care in terms of trauma, injury and urgent medical evacuations Objective(s) Provide immediate medical care for trauma and injury
(Immediate) Beneficiaries All the affected people by TC Winston Partners NDMO, RFMF, Aus/NZ Defense, WHO Budget Requirement F $700,000 Medivac
F $100,000 Transportation Funded F $ 200,000 MoHMS F $ 100,000 WHO (Flash Appeal) Unmet F $500,000
Expected Outputs and Impacts
Coordination of the immediate medical care and trauma assistance
Provision & Coordination of medivac assistance Confirmation of Fatalities Provision of acute medical care of population in need Coordination of medical equipment, pharmaceutical and
laboratory supplies needs from facilities providing services Long term rehabilitation for patients with the disabilities
from TC Winston
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Activity C1
Lead Agency Ministry of Works, Transport & Public Utilities & Ministry of Health and Medical Services
Description Minimize impacts on health care delivery through repairs and renovations to damaged health facilities. This project also includes health facilities providing RNMCAH services
Objective Assure continuity and re-establishment of medical and public health services through outreach services, rehabilitate and equip health facilities
Beneficiaries Affected communities who rely on core health services from these damaged facilities
Partners WHO, FHSSP, UNICEF, UNFPA Budget Requirement F $6,150,000.00
Funded F $1,500,000.00 MoHMS F $150,000 FHSSP/DFAT F $650,000 WHO (Flash Appeal) Unmet F $3,850,000
Expected Outputs and Impacts
A reconstruction program to ensure that damaged health facilities will have their core services rapidly restored (noting that there will be a delay restoration of some additional services that require more extensive repairs)
Delivery of power and safe water supply Build back better and climate-resilient health facilities
Activity C2
Lead Agency Ministry of Health and Medical Services Description Procurement of essential supplies of medicines, laboratory
consumables, power packs and vaccine cold chain equipment and devices
Objective Assure provision of supplies of medicines, laboratory consumables, power packs and vaccine cold chain equipment and devices to all health facilities
Beneficiaries Affected communities who rely on core health services from these damaged facilities
Partners UNICEF, WHO, Americares, Direct Relief Budget Requirement F $8,500,000
Funded F $1,000,000 UNICEF (Cold Chain) F $ AmeriCares (Medical supplies) F $ Direct Relief (Medical supplies) F $600,000 WHO Unmet F $6,900,000
Expected Outputs and Impacts
Power Packs and Cold chain equipment/devices procured, distributed and installed
Essential health equipment and medicines and laboratory and other medical supplies procured and distributed
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Activity C3
Lead Agency Ministry of Health and Medical Services Description Provision of public health/primary health care outreach services
to the affected population Objective Reduce mortality and morbidity from diseases and injuries
related to TC Winston aftermaths Beneficiaries Affected populations of 350,000 Partners WHO, AmeriCares, Direct Relief, AusMAT, NZMAT, RKM, MSP,
FRCS Budget Requirement F $4,000,000
Funded F $100,000 MoHMS F $300,000 WHO (through Americares, MSP and RKM CERF)
Unmet F $3,600,000 Expected Outputs and Impacts
Provision of essential health services and public health outreach to the affected population
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Activity D1
Agency Ministry of Health and Medical Services Description To enhance disease surveillance and early response to prevent
or minimize the impact of outbreaks of communicable diseases of concern, including: Diseases associated with contaminated water and food, such
as leptospirosis, typhoid, and diarrheal diseases Diseases associated with overcrowding, such as acute
respiratory infections Vector-borne diseases, such as dengue, chikungunya and Zika
virus. Objective Prevention and control of communicable diseases related to
water and vector such as leptospirosis, typhoid, dengue, Zika and prevent and manage diarrhoeal incidences - Improve surveillance and minimise the risk and impact of outbreaks of communicable disease associated with post-disaster settings
Beneficiaries All the people affected by TC Winston Partners WHO, FHSSP Budget Requirement F$800,000
Funded F$100,000 (MoHMS) F$ 150,000 FHSSP (DFAT) F$ 400,000 WHO (Flash Appeal) Unmet F$ 150,000
Expected Outputs and Impacts
Procurement of medical, technical and non-technical supplies, including laboratory diagnostic consumables and environmental health protection consumables
Strengthened surveillance for the early detection of outbreaks and strengthened outbreak response capacity (EWARS)
Linking with WASH Cluster in ensuring delivery of safe water supply and sanitation, and of personal hygiene supplies
Promotion of health-promoting behaviors, such as hand washing, food safety, cough etiquette, mosquito bite avoidance.
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Activity D2 Lead Agency Ministry of Health and Medical Services Description Protect people in the affected areas from outbreak-prone
waterborne diseases through relevant technical advice and information on prevention and control at the community level including evacuation centres and other hotspots Prevention and Urgent Response to outbreak-prone diseases such as Leptospirosis, Typhoid, Dengue Fever and Zika Virus
Objective Prevention and control of communicable diseases related to water and vector such as leptospirosis, typhoid, dengue, Zika and prevent and manage diarrhoeal incidences
Beneficiaries Health facilities and communities affected by TC Winston Partners WHO, SPC, UNICEF, FHSSP Budget Requirement F $1,500,000
Funded F $50,000 MoHMS F $200,000 WHO (Flash Appeal) Unmet F $1,250,000
Expected Outputs and Impacts
Community mobilization and multi-sectoral response to outbreaks
Integrated Vector Control Management approach taken to address vector-borne disease
Immunization of populations at risk of vaccine preventable disease outbreaks
Reduce mortality and morbidity from LTDs and Zika Virus
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Activity E1
Agency Ministry of Health and Medical Services Description Initial nutrition assessment of children U5 in the communities
and evacuation centres. Objective To conduct nutrition assessment of children U5 in the affected
communities and evacuation centres. Beneficiaries Children U5 Partners UNICEF, WHO, SPC Budget Requirement F$80,000
Funded F$5,000 (NFNC) Unmet F$75,000
Expected Outputs and Impacts
Baseline assessment report and evidence to inform decision making for appropriate nutrition intervention policies and programs.
Activity E2
Agency Ministry of Health and Medical Services Description Nutrition Communication Package for Disasters and
Emergencies Objective To promote appropriate maternal, infant and young child
feeding practices Beneficiaries Targeted - Children Birth to 6 months, U2, U5, Pregnant and
Lactating Women Partners UNICEF, WHO, SPC Budget Requirement F$150,000
Funded F$5,000 (NFNC) Unmet F$ 145,000
Expected Outputs and Impacts
Best practices for maternal, infant and young child feeding Optimal nutritional status of children U5
Activity E3
Agency Ministry of Health and Medical Services Description Promote, protect and support appropriate maternal and infant
and young child feeding Objective Ensure appropriate maternal, infant and young child feeding
practices are observed and practiced amongst care givers of children under five years of age.
Beneficiaries 36,000 children under 5 and 7640 PLWs in affected areas Partners UNICEF, WHO, UNFPA Budget Requirement F$ 30,000
Funded F$5,000.00 (MoHMS) Unmet F$25,000.00
Expected Outputs and Impacts
Care givers practicing appropriate infant feeding practices
No violation of the regulated BMS CODE
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Activity E4
Agency Ministry of Health and Medical Services Description Strengthen and scale up management of severe acute
malnutrition (SAM) Objective To strengthen integrated management of SAM at both
community and facility levels Beneficiaries 600 children (SAM cases only) Partners UNICEF & WHO Budget Requirement F$330,000.00
Funded F$10,000.00 (UNICEF) Unmet F$ 320,000.00
Expected Outputs and Impacts
Health workers will improve their knowledge and capacity for early detection and treatment of children assessed as moderately or severely malnourished.
SAM cases will receive appropriate care and treatment at both in-patient facilities and outpatient facilities
Activity E5 Agency Ministry of Health and Medical Services Description Protect the health of young children through proven, simple and
cost-effective nutrition interventions including: Vitamin A and deworming – needs no assessment in
emergencies, but boosts immunity of children against infections.
Oral Rehydration Salts – prevents dehydration resulting from diarrhea
Zinc – reduces duration and severity of diarrhea and prevents further episodes)
Multi-micronutrient powders and Albendazole – to treat and prevent anemia.
Deworming for children, pregnant and lactating women Objective To improve U5 children’s immunity against infectious diseases
and prevent further aggravation of micronutrient deficiencies Beneficiaries 36,000 children U5, Partners UNICEF, WHO Budget Requirement F$230,000.00
Funded F$5,000.00 (MoHMS) Unmet F$ 225,000.00
Expected Outputs and Impacts
Increased protection of children against infections especially given the precarious water and sanitation environment leading to reduced morbidity and mortality.
Protection against anaemia for women and children.
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Activity F1
Agency Ministry of Health and Medical Services Description Ensure the supply of essential medicines for people in affected
communities with existing non-communicable diseases (NCD), including diabetes, asthma, hypertension, and heart disease.
Objective Prevent exacerbation of existing non-communicable diseases and other disease threats
Beneficiaries National (Entire Population is at Risk) Partners WHO, AmeriCares, MSP, RKM, Direct Relief Budget Requirement F$1,000,000
Funded F$60,000 (MoHNS) F$250,000 WHO (Flash Appeal) Unmet F$690,000
Expected Outputs and Impacts
Health facilities and primary care services provided with sufficient supplies of medicines and related equipment to provide for those in the affected population in their areas who have NCDs.
SOPD patients displaced by TC Winston or residing at affected areas are followed up for continuity of care and replenished sufficient medicines and supplies.
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Activity G1
Agency Ministry of Health and Medical Services Description Training for the identification and management of psychological
illness and develop systems for the referral of severe cases. Objective Minimise the risk of psychological harm and mental illness
associated with impact of traumatic experiences through psychosocial support. Advocate for strategies that ensures the communities return to normality.
Beneficiaries Any persons affected by TC Winston requiring psychosocial support.
Partners WHO, UNICEF, UNFPA, Empower Pacific, Ministry of Social Welfare & Women
Budget Requirement F$260,000.00 Funded F$ 40,000.00 Unmet F$220,000.00
Expected Outputs and Impacts
Local health care workers trained in rapid psychological assessment of people in affected communities and basic interventions
Establish systems for referral of people from affected areas with more serious psychological impacts, for expert assessment and management
Provision of psychological support to health workforce staff involved in the emergency response
Redeployment of staff from unaffected areas to assist or relieve colleagues that were directly affected
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Activity H1
Agency Ministry of Health and Medical Services Description Assure safe, reliable and secure infrastructure and supportive
infrastructures are in place for reproductive, maternal, adolescent, newborn and & HIV/STI care services as well as services for gender based violence at health facilities in affected communities with special focus on life saving emergency obstetric and newborn care.
Objective 1. Rehabilitate damaged health facilities for the provision of effective obstetric and newborn , child, adolescent and HIV/STI health care services
2. Rehabilitate cold chain supportive infrastructure in all the four medical divisions in Fiji
3. To provide appropriate tools and equipments for the provision of safe RMNCAH services in affected health facilities.
Beneficiaries All the affected people by TC Winston Partners UNFPA, UNICEF, WHO, H4, Pacific Red Cross, REF, MSP,
Empower Pacific Budget Requirement F $1,595,272
Funded F $ 143,054 (DFAT) Unmet F $1,452,218
Expected Outputs and Impacts
Health facilities have skilled staff with special focus on responding to obstetric and newborn emergencies and gender based violence and prevention of HIV
Assessment of Health facilities have adequate equipment and devices for reproductive and maternal/child needs
Psychosocial support services available for GBV survivors and affected communities
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Activity H2
Agency Ministry of Health and Medical Services Description Services - Ensure provision of appropriate health services for
reproductive, maternal and newborn/child at health facilities in affected communities with a special focus on emergency obstetric and newborn care.
Objective 1. To provide immunization to all children and to ensure full
immunization coverage for all eligible clients.
2. To reduce the risk of a rise in IMCI and its complications from
delay in accessing health services
3. To ensure timely booking and follow up of all antenatal
mothers
4. To ensure reduction in postnatal complications by ensuring
timely follow up of postnatal mothers and newborn babies
5. To provide counselling and other forms of advocacy and
health promotion to people in the community
6. To ensure services reach all our clients including PLHIV
Beneficiaries All the affected people by TC Winston Partners UNFPA Budget Requirement F $1,000,000.00
Funded F $ 500,000.00 Unmet F $500,000.00
Expected Outputs and Impacts
Provision of Dignity Kits in collaboration with the WASH Cluster in supporting sanitation and hygiene
Psychosocial support services available for GBV survivors and affected communities
Provision of supplies commodities and vaccines are supported and improved
Provision of services is maintained and improved including providing mobile clinic services to affected communities who may have difficulties in accessing our facility based services.
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Activity I1
Agency Ministry of Health and Medical Services Description Provision of health risk prevention information, increased access
to information education material (IEC) on health messages, and promote social mobilisation to reduce health risks, such as clean-food safety, mosquito bite prevention and elimination of vector breeding sites
Objective Provide health risk communication messages and IEC material for the affected population to reduce risk of adverse physical and mental health outcomes
Beneficiaries National (Entire Population is at Risk) Partners UNICEF, WHO, Live and Learn, FHSSP, UNFPA Budget Requirement F$460,000.00
Funded: F$ 100,000.00 F$100,000 WHO Unmet F$ 260,000.00
Expected Outputs and Impacts
Mobilise communication campaign which includes, media (radio and television), print and social mobilisation to improve the early recovery process and strengthen preparedness at community level.
Deliver a broad range of activities to increase awareness and knowledge among affected communities and behaviour change to reduce health risks, utilizing local resources e.g. village health workers to for social mobilization
Improved knowledge, practice and positive change in behaviour for the population at risk.
Ongoing impact on emergency preparedness and response, leading to improved health status.
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Activity J1
Agency Ministry of Health and Medical Services Description To ensure effective environmental health services are provided to
affected populations, and coordinated at the national and sub-national levels, including effective and timely prevention measures such as sanitary facilities (toilets), vector control, safety drinking water, sanitation, hygiene, housing and building safety, school sanitation, inspection of evacuation centres, waste management, disinfection of villages and settlements, food safety, environmental biotoxins (ciguatera fish poisoning), environmental health impact assessments, and pollution control (land, water, air).
Objective(s) To prevent diseases and health risks associated with environmental hazards
Beneficiaries All the people affected by TC Winston Partners WHO, UNICEF, FHSSP Budget Requirement F $2,000,000
Funded F $600,000 WHO (Flash Appeal) Unmet F $1,400,000
Expected Outputs and Impacts
Reduction of water and food-borne diseases Prevention of communicable diseases in the vulnerable
communities Minimized impacts of pollution and wastes on water sources,
food and marine ecosystems Reduction of injuries and infections within communities
arising from environmental communities Strengthened enforcement of building codes on safety and
public health Empowerment and capacity building of EHOs and provision of
essential resources
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Activity Summary Costing: Health and Nutrition Cluster
Objective #
Sub# Required (FJ) Funded (FJ) Unmet (FJ)
A A1 $200,000 $20,000 $180,000 B A2 $800,000 $300,000 $500,000 C C1 $6,150,000 $2,300,000 $3,850,000
C2 $8,500,000 $1,600,000 $6,900,000 C3 $4,000,000 $400,000 $3,600,000
D D1 $800,000 $650,000 $150,000 D2 $1,500,000 $250,000 $1,250,000
E E1 $80,000 $5,000 $75,000 E2 $150,000 $5,000 $145,000 E3 $30,000 $5,000 $25,000 E4 $330,000 $10,000 $320,000 E5 $230,000 $5,000 $225,000 F F1 $1,000,000 $310,000 $690,000 G G1 $260,000 $40,000 $220,000 H H1 $1,595,272 $143,054 $1,452,218 H2 $1,000,000 $500,000 $500,000
I I1 $460,000 $200,000 $260,000 J J1 $2,000,000 $600,000 $1,400,000
Total $29,085,272 $7,343,054 $21,742,218
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Annex
Demography of Health Facilities & Population in Fiji
Health Facility Central Eastern Western Northern Total
National Referral Centre 2 0 0 0 2
Divisional Hospital 1 0 1 1 3
Sub Divisional Hospital (Level 1)
0 0 3 1 4
Sub Divisional Hospital (Level 2)
5 5 3 2 15
Health Centre (Level A) 7 0 4 1 12
Health Centre (Level B) 2 1 6 3 12
Health Centre (Level C) 11 14 17 14 56
Nursing Stations 22 36 28 21 107
Old People’s Home 1 0 1 1 3
Total 51 56 63 44 214
CENTRAL DIVISION Sub-Division Fijian Indian Others Total
Suva 127,288 70,350 19,959 217,597
Serua/Namosi 21,884 6,512 1,192 29,588
Rewa 51,995 31,183 1,694 84,872
Tailevu 21,076 1,198 110 22,384
Naitasiri 19,261 916 55 20,232
Total 241,504 110,159 23,010 374,673
WESTERN DIVISION Sub-Division Fijian Indian Others Total
Lautoka/Yasawa 59,401 68,357 4,627 132,385
Nadi 32,962 55,067 2,781 90,810
Ba 15,366 40,166 611 56,143
Nadroga 33,404 18,716 610 52,730
Tavua 12,988 13,058 330 26,376
Ra 19,443 9,721 102 29,266
Total 173,564 205,085 9,061 387,710
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NORTHERN DIVISION Sub-Division Fijian Indian Others Total
Macuata 31,815 31,720 904 64,439
Cakaudrove 24,464 3,463 5,107 33,034
Bua 13,970 2,214 684 16,868
Taveuni 13,422 2,546 681 16,649
Total 83,671 39,943 7,376 130,990
EASETERN DIVISION Sub-Division Fijian Indian Others Total
Lomaiviti 16,187 0 0 16,187
Kadavu 10,878 26 42 10,946
Lakeba 7,270 24 0 7,294
Lomaloma 3,285 52 21 3,358
Rotuma 124 10 1,732 1866
Total 37,744 112 1,795 39,651
NATIONAL TOTAL DIVISION Fijian Indian Others Total
CENTRAL 241,504 110,159 23,010 374,673
WESTERN 173,564 205,085 9,061 387,710
NORTHERN 83,671 39,943 7,376 130,990
EASETERN 37,744 112 1,795 39,651
GRAND TOTAL 536,483 355,299 41,242 933,024
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