directorate general of health services, ministry of health & family welfare welcome to...
TRANSCRIPT
Directorate General of Health Services, Ministry of Health &
Family Welfare
Welcometo presentation of
Directorate General of Health Services
Ministry of Health & Family Welfare
Directorate General of Health Services, Ministry of Health &
Family Welfare
Flood Impacton
Health & Hygieneof Rural Areas :
Mitigation Mitigation OptionsOptions
September 2004, Dhaka
Directorate General of Health Services, Ministry of Health &
Family Welfare
BackgroundFlooded area of Bangladesh in different yearSource: Bangladesh Water Development Board
Flooded area of Bangladesh in different yearSource: Bangladesh Water Development Board
2004
• Flood hits Bangladesh almost every year or every few years• Only the area or intensity differs• The people in area, where flood hits, suffer the same pain• The relief and medical operation teams in the affected area play the same role• In 1998, flood control room at DGHS office needed to work from June to
December : a full half year leaving aside many important regular activities• Can a country like Bangladesh afford such burden every year?
Directorate General of Health Services, Ministry of Health &
Family Welfare
The Issues
• How flood impacts the health and hygiene situation in our rural areas?
• How did we handle the 2004 flood?• Can MOHFW alone control those health
and hygiene impacts?• How can we improve medical care
during flood, minimize negative impacts, and continue health development activities?
Directorate General of Health Services, Ministry of Health &
Family Welfare
FloodTrapFloodTrap
Flood Impact on Health & Hygiene
Home goes under water
Toilets become
unprotected
Human & animal
excreta, rubbish &
contaminated soil mix with
water
Open defecation increases
Tube wells and safe water
sources are submerged
Cooking becomes difficult
People suffer from food shortage
Movement becomes difficult
Rural Area
Bathing, washing
and playing in flood water cause
disease
Directorate General of Health Services, Ministry of Health &
Family Welfare
Flood-borne Morbidities
• Water & Food-borne diseases
• Respiratory infections
• Skin diseases• Eye infections• Drowning• Snake bites• Accidents• Malnutrition
Flood Impact on Health & Hygiene…
Water & food-borne diseases
Diarrhea, dysentery, cholera, jaundice, typhoid,
helminthiasis
Scarcity in food supply &monotony of uncooked food•Malnutrition of vulnerable groups (children, pregnant and lactating mothers, elderly and sick persons)
•Lower immunity > More infections
Directorate General of Health Services, Ministry of Health &
Family Welfare
Flood Impact on Health & Hygiene…
• Many people live in small areas of flood shelters• Sanitary condition is compromised with respect to cleanliness, food hygiene, toilet, safe water and vector control
• Water/food borne diseases, scabies and respiratory infections spread• Privacy problem forces lactating mothers to delay breast feeding their young babies leading to child malnutrition
Over-crowding & Poor Hygiene in Flood Shelters
Directorate General of Health Services, Ministry of Health &
Family Welfare
Flood Impact on Health & Hygiene…
•Difficulty in food procurement, and seeking care in medical emergencies and for expecting mothers (antenatal, child birth and postnatal)
•Flood teams find difficulty to move to fields with logistics
•Disruption of normal health, family planning, nutrition and health education activities (center-based and domiciliary)
•Long term outcome: Population, Malnutrition, Maternal mortality, Low birth weight babies, Stunted children
Transportation Problem
Directorate General of Health Services, Ministry of Health &
Family Welfare
Other Impacts
Flood Impact on Health & Hygiene…
• Physical damage of health facilities• Deployment of important personnel and staff to field: Delay in routine decision making and services
• Active news media: More attention of Govt. to field Plus Negative international image as flood prone country > Decreased foreign investment
• Alert politicians and public representatives: More attention of Govt. to field > Pressure on limited manpower and resources
• Loss of crop, fish, animal & poultry: Malnutrition affecting specially vulnerable group (children, pregnant women, elderly, sick persons)
• Temporary loss of employment: Poverty and malnutrition• Soil contamination: Intestinal parasites > Malnutrition• Environmental pollution: Health hazards• Loss of household assets: Poverty > Psychological stress
Directorate General of Health Services, Ministry of Health &
Family Welfare
Flood Impact in Quantitative Terms
Loss of logistics (2004)
Medicines & Supplies
MOHFWMOHFW
Physical damage(2004)
DGHS: ~Tk. 32 crore
Source: DGHS, MOHFW (as of Aug 25, 2004)
No. of deaths (Flood 2004; On 25-8-04)Disease No.Diarrhoea 91Pneumonia 92Snake bite 85DrowningDrowning 202202Dysentery 0Jaundice 0Skin disease 0Eye disease 0Total 475
Flood 2004
No. of cases of different diseases in 2004 flood215,848
19,40051,430
931 2,41835,514
7,976
Diarrhoea Pneumonia Dysentery Jaundice Dengue Skindiseases
Eyediseases
Directorate General of Health Services, Ministry of Health &
Family Welfare
Flood Impact in Quantitative Terms…
2004 Flood : No. of diarrhoea cases by date
Directorate General of Health Services, Ministry of Health &
Family Welfare
Comparison of month-wise diarrhoea case load in 1998 and 2004
85,782
84,917
101,846
129,437
132,072
139,671
143,742
199,038189,810195,296
373,525
283,481
135,5
3612
9,802
150,2
92 182,2
5417
7,515
141,8
64
49,954
181,0
80
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Y1998 Y2004 (up to Aug 30, 2004)
Directorate General of Health Services, Ministry of Health &
Family Welfare
Flood Impact in Quantitative Terms…
Year-wise number of diarrhoea cases (1998-2004) (as of Aug 30, 2004)
2,215,255 1,958,844
2,599,225
2,287,263
1,081,847
Y1998 Y2001 Y2002 Y2003 Y2004
Directorate General of Health Services, Ministry of Health &
Family Welfare
Flood Impact in Quantitative Terms…
Year-wise number of diarrhoea deaths (1998-2004) (as of Aug 30, 2004)
2,752
823 1,022
1,282
471
Y1998 Y2001 Y2002 Y2003 Y2004
Directorate General of Health Services, Ministry of Health &
Family Welfare
Bacterial Pattern of diarrhoea stool samples(IEDCR, Dhaka; 2004 Flood]
Division No. of samples E. coli Vibrio cholerae 01 Salmonella typhiDhaka 34 33 0 1Sylhet 20 20 0 0Chittagong 4 4 0 0Rajshahi 29 26 2 1Barisal 4 3 0 1Total 91 (100.0%) 86 (94.5%) 2 (2.2%) 3 (3.3%)
Sensitivity• No bacteria were found sensitive to tetracycline, ampicillin,
erythromycin and cotrimoxazole• Nalidixic acid and cefalexin were also less sensitive• Ceftriaxone, pefloxacin and ciprofloxacin worked well to kill the
bacteria
Directorate General of Health Services, Ministry of Health &
Family Welfare
Flood Impact in Quantitative Terms…
Year-wise Average Daily No. of Diarrhoea Cases
5916626671219305
1998 2002 2003 2004
Year 2004 data are as of Aug 25, 2004
Year-wise diarrhoea case-fatality rates (1998-2004)
0.12%
0.04% 0.04%
0.06%
0.04%
Y1998 Y2001 Y2002 Y2003 Y2004
Directorate General of Health Services, Ministry of Health &
Family Welfare
Flood Impact in Quantitative Terms…
Medical supply Quantity supplied
Water Purifying Tablets 71,17,500 pcs
Clotech solution 10,698 Lits(10,69,80,000 Lits water)
IV Saline 54,41,388 Lits
ORS 1,17,61,650 sachets
Antibiotics cap & tab 95,63,300 pcs
Antibiotic syrup 10,450 bottles x 100 ml
Eye preparation 26,700 tubes
Benzyl benzoate 38,000 bottles X 100 ml
Multi vitamin Syrup 4,800 bottles
Anti-histamines 32,54,300 pcs
Paracetamol 41,95,500 pcs
Anti snake venom 1,125 vials
Medical supplies directly from DGHS
Transport Grants
>Tk. 10 million
Flood 2004
Directorate General of Health Services, Ministry of Health &
Family Welfare
Indirect Flood ImpactFlood 2004
Time given by Hon’ble Minister, MOHFW: 11d/22d(50% days)
(Jul 23–Aug 15, 2004)Time given by Hon’ble State Minister, MOHFW: SignificantTime given by Secretary, MOHFW: SignificantTime given by Director General (Health): Full time
supervisionDeployment of senior officials: 54
DGHS: 36MOHFW: 18
No. of medical teams: 4,353(~13,059 persons)
Directorate General of Health Services, Ministry of Health &
Family Welfare
Indirect Flood Impact …EPI service loss
BCG: 41,544 dosesMeasles: 41,544 dosesDPT: 1,24,632 dosesOPV: 1,24,632 dosesHepatitis B (25 dist &
5 City Corps): 4,800 dosesTT: 2,18,064 dosesEPI out-reach sessions(not held): 10,384 Nos.
NNP service loss• Programme Upazila affected: 70• Community Nutrition Centre (CNC)
did not function: 3,802• Nutrition gardens damaged: 88,369• Nursery damaged: 985• 1-day old chick died: 62,355• Chicken died: 51,807
Family planning service loss• Mother & child care• Ante-natal, natal & post-natal care• Sterilization camps• Clinic based services (IUD,
Injection, Norplant)• Home visits
Postponement of health & FP training/workshop/seminars: Many
Postponement of examinations in medical institutions: all in this period
Flood 2004
Directorate General of Health Services, Ministry of Health &
Family Welfare
Diarrhoea loadcaused by flood?
Observations
Diarrhea case load (%) between mansoon/flood months and non-mansoon months
51% 41% 46% 45% 39% 42%
49% 59% 54% 55% 61% 58%
0%
20%
40%
60%
80%
100%
120%
Y1998 Y2001 Y2002 Y2003 Y2004 Expected
Mansoon months Non-mansoon months
Monsoon moths: Jun-Oct; Non-monsoon months: Nov-May
Directorate General of Health Services, Ministry of Health &
Family Welfare
Government Initiatives …
Flood 2004One of the best
Flood Medical Care Managements
Approach to Management• DGHS opened 24-h Disaster
Monitoring Cell• Control Room at DGHS & National
Monitoring System were strengthened
• CMSD kept open for 24h• A 24h Drug Sub-Depot established
at EPI directorate under direct supervision of Director of Primary Health Care, DGHS > Quick supply
• DG (health) closely monitored all activities
Directorate General of Health Services, Ministry of Health &
Family Welfare
Government Initiatives …Approach to Management
• Quick decision: Switching from water purifying tablets to solutions
• Extra production of ORS & IV fluid at IPH & in 5 NORPs in different districts under DGHS by increasing daily shifts from 1 to 3 and also by EDCL
• Outside sale of all the productions from IPH, NORPs & EDCL was cancelled and reserved for use by DGHS
• DGHS provided allocation of extra fund for boat & transportation to all districts
• Good coordination & collaboration between MPs, administration and health managers at district and upazila levels
Flood 2004
Directorate General of Health Services, Ministry of Health &
Family Welfare
Government Initiatives …
Approach to Management• 4,353 medical teams and
36+18=54 senior health officials deployed to work in fields
• Lists of medical team members were given to local MPs and local administration for close monitoring & supervision
• All types of leaves, workshops, seminars, both in home & abroad were cancelled
MOHFW & DGHS managed the entire
medical care service without taking
assistance from armed forces unlike in
previous floods
Flood 2004
Directorate General of Health Services, Ministry of Health &
Family Welfare
Approach to Management• Comprehensive and improved reports
were sent to PM’s Monitoring Cell, MOHFW, and Disaster Monitoring Cell at MOFDM on daily basis
• Key health education messages were disseminated in flood camps and flood affected areas
• All of MOHFW staffs donated 1-day’s salary to PM’s Relief Fund
• News media were kept updated
Government Initiatives …Flood 2004
Directorate General of Health Services, Ministry of Health &
Family Welfare
Donor & Private Initiatives
UNICEFWHOUNFPABMA medical teams
Flood 2004
UN Flood Appeal
Directorate General of Health Services, Ministry of Health &
Family Welfare
Policies and Regulations
Strengths• Standing Order of MOHFW for
disaster management• Standing Guidelines of MOHFW
for Emergency Preparedness and Response
Weakness• GOB & MOHFW Orders and
Guidelines need more adherence
Flood 2004
Directorate General of Health Services, Ministry of Health &
Family Welfare
Status of Institutional Capacity
National Public Health Institutions (viz. IEDCR, NIPSOM, IPHN, IPH)do not have adequate fundingfor flood outbreak investigations and research
Flood 2004
Directorate General of Health Services, Ministry of Health &
Family Welfare
Observation&
Recommendation
Directorate General of Health Services, Ministry of Health &
Family Welfare
RecommendationManpower strength• Fill up vacancies at rural
centersFund and Authority• Provide adequate fund and
authority to district and upazila health managers for emergency purchase, repair or rental
• Provide adequate fund to National Public Health Institutions for flood outbreak investigations and research
• Vacancy (doctors and other staff) at rural centres
• District and upazila health managers do not have fund or authority for emergency purchase, repair or rental
• National Public Health Institutions do not have fund for flood outbreak investigations and research
Observation
Directorate General of Health Services, Ministry of Health &
Family Welfare
Better Transportation• Ensure jeeps for all Civil
Surgeons and Upazila Health Managers
• Raise fuel ceiling for field managers
• Provide motor bikes, bicycles, speed boats, river ambulances, country boats, floating hospital, etc. for field service
• Many Civil Surgeons don’t have vehicles
• Fuel ceiling for field managers is very low (200 L/month)
• No UHFPO has vehicle
• Motor bikes, bicycles, speed boats, river ambulances, country boats, etc. for field service are not available
Recommendation
Observation
Directorate General of Health Services, Ministry of Health &
Family Welfare
• Many Upazila Health Complexes don’t have digital phones
• Phone ceiling is low for residence of DGHS to CS and UH&FPO
• Most district and upazila health offices don’t have fax, computer, email and photocopier, etc.
Information Communication• Provide digital phones to all
Upazila Health Complexes• Withdraw residence phone
ceiling for CS, Div. Dir (health), like DCs and Div. Commissioners
• Withdraw residence phone ceiling for DG (Health)
• Provide fax, computer, email and photocopier, etc. to all district and upazila health offices
• Provide mobile phone for field service
Recommendation
Observation
Directorate General of Health Services, Ministry of Health &
Family Welfare
Recommendation
Logistic Support• Provide umbrella,
rain coat, gum boot, life jacket and BCC materials to field staff
• Provide generator/IPS to cope with power supply problem
• Maintain adequate buffer stock of medicines and supplies in all districts
• Field staff don’t have umbrella, rain coat, gum boot, life jacket and BCC materials
• Health facilities suffer from frequent interruption in supply of electricity - These don’t have generator / IPS
• Inadequate buffer stock of medicines for disaster management in some districts
Observation
Directorate General of Health Services, Ministry of Health &
Family Welfare
Recommendation
Coordination• Improve inter-
sectoral coordination between different departments (viz. with customs)
• Weak inter-sectoral coordination (viz. with customs)
Observation
Directorate General of Health Services, Ministry of Health &
Family Welfare
Training & Drills• Provide EPR
training to health personnel and staff
• Hold regular drills
• Inadequacy of trained health manpower on Emergency Preparedness & Response (EPR)
Observation
Recommendation
Directorate General of Health Services, Ministry of Health &
Family Welfare
RecommendationOrientation
• Conduct orientation programme for journalists and people’s representatives
Stakeholder involvement• Involve community
people, journalists and people’s representatives in flood planning process
Responding Proportionately
• Active news media
• Alert politicians and public representatives
Observation
Directorate General of Health Services, Ministry of Health &
Family Welfare
5 crucial factors
in flood impact managements
1. Keeping people above water level
2. Preventing water contamination
3. Maintaining hygiene & sanitation
4. Supply of adequate food
5. Health care & educationMinistry of Health & Family Welfare
looks after only the last factor
Directorate General of Health Services, Ministry of Health &
Family Welfare
Beyond MOHFWCombating
Flood Safely
Appropriate PlanSafe housingSafe water
Safe environmentSafe and adequate food
Imaginationis more importantthan knowledge !
Alb
ert
Ein
stei
n• Integrated local flood contingency
plan prioritizing flood prone zones• Appropriate river and water
reservoir management programme• Clustered community with housing
at high levels• Innovative and safe latrines• Innovative source for all time safe
water• Standard guidelines for food supply
during and after flood• Standard guidelines for flood
shelter setup and operation• Strong and sustained health
education campaigns• Better inter-sectoral collaboration
WeNeed
Directorate General of Health Services, Ministry of Health &
Family Welfare
If we don’t care for River Management
Directorate General of Health Services, Ministry of Health &
Family Welfare
Thank you