Management Management of of

Health & Medical Issues Health & Medical Issues in in

DisastersDisasters

Dr S.J.GandhiDr S.J.GandhiDeputy Director (Epidemic)Deputy Director (Epidemic)Commissioerate Of Health Commissioerate Of Health

Services, GandhinagarServices, Gandhinagar

Seven Fundamental Terms in Risk ManagementSeven Fundamental Terms in Risk Management

A Logical Framework of TerminologyA Logical Framework of TerminologyHazardHazardAny Any potentialpotential threat to public threat to public safety and / or public healthsafety and / or public health

RisksRisksThe The potentialpotential consequencesconsequences of hazard of hazard interacting with communityinteracting with community

EmergencyEmergencyAny Any actualactual threat to public threat to public safety and / or public healthsafety and / or public health

VulnerabilitiesVulnerabilitiesFactors which determine the type and Factors which determine the type and severity of those consequencesseverity of those consequences

DisasterDisasterA A civil emergencycivil emergency in which the in which the humanitarian needs are humanitarian needs are beyond local capacity to meet beyond local capacity to meet those needs i.e. the response those needs i.e. the response and recovery operation must and recovery operation must be managed at the national be managed at the national

and/or international leveland/or international level

Readiness for ResponseReadiness for ResponseA determinant of the severity and A determinant of the severity and manageability of those consequencesmanageability of those consequences

CommunityCommunity is is people, property, services, livelihoods and environmentpeople, property, services, livelihoods and environment i.e. the i.e. the elements exposed to hazardselements exposed to hazards

DefinitionsDefinitions

A Hazard is a Human-made or Natural Danger that causes damage A Hazard is a Human-made or Natural Danger that causes damage to people , property and the environment to people , property and the environment

A Risk is the Potential for something to go wrong or for something A Risk is the Potential for something to go wrong or for something harmful to occur harmful to occur

Vulnerability is the potential to be easily hurt or harmedVulnerability is the potential to be easily hurt or harmed

Capacity is an ability to cope up with a difficult situationCapacity is an ability to cope up with a difficult situation

HazardsHazards

There are 4 classes of hazardThere are 4 classes of hazard::

1.1. Natural hazardsNatural hazards

2. Technological hazards2. Technological hazards

3. Biological hazards3. Biological hazards

4. Societal hazards4. Societal hazards

A Community Consists of 5 A Community Consists of 5 Elements:Elements:

1.1. Their Their propertyproperty (infrastructure, possessions and assets; public, (infrastructure, possessions and assets; public, private and cultural)private and cultural)

2.2. Their Their servicesservices (government and non-government, commercial and (government and non-government, commercial and voluntary)voluntary)

3.3. Their Their livelihoodslivelihoods (urban and rural, formal and informal) (urban and rural, formal and informal)

4.4. The The peoplepeople

5.5. Their Their environmentenvironment (air, water and soil; urban and rural, built and (air, water and soil; urban and rural, built and natural)natural)

COMMUNITY RISKSCOMMUNITY RISKS

COMMUNITY RISKSCOMMUNITY RISKS are proportional toare proportional to

HAZARDSHAZARDS

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VULNERABILITIESVULNERABILITIES____________________________________________________

READINESS FOR RESPONSEREADINESS FOR RESPONSE

WARNING: this is not a mathematical formula!WARNING: this is not a mathematical formula!

VulnerabilitiesVulnerabilities

are:are:

Factors which determine how much riskFactors which determine how much risk

Higher vulnerability increases the risks Higher vulnerability increases the risks arising from a specific hazard in a specific arising from a specific hazard in a specific

community, or in sub-sections of that community, or in sub-sections of that community.community.

Indicators of VulnerabilitiesIndicators of VulnerabilitiesEach Each element of communityelement of community can be described in terms can be described in terms of its vulnerabilities:of its vulnerabilities:

– peoplepeople

– propertyproperty

– servicesservices

– livelihoodslivelihoods

– environmentenvironment

Indicators of Vulnerabilities (for people)Indicators of Vulnerabilities (for people)

• Access to health care

• Measles vaccination coverage rate

• Under 5 nutrition rate

• Under 5 mortality rate

• Access to safe water

• Access to sanitation

• Access to adequate housing

• Access to regular source of income

• Female literacy rates

Critical Services – Basic Needs and LifelinesCritical Services – Basic Needs and Lifelines

Basic needs for survival:Basic needs for survival:

– waterwater

– foodfood

– shelter (and clothing in cold climates)shelter (and clothing in cold climates)

– energy (fuel)energy (fuel)

– (acute medical care)(acute medical care)

ConsequencesConsequences

– injury (mental and physical)injury (mental and physical)

– disease (mental and physical)disease (mental and physical)

– secondary hazards (fire, disease etc.)secondary hazards (fire, disease etc.)

– contamination of the environmentcontamination of the environment

– displacementdisplacement

– breakdown in securitybreakdown in security

– damage to infrastructuredamage to infrastructure

– dead and missingdead and missing

– breakdown in essential servicesbreakdown in essential services

– loss of propertyloss of property

– loss of income …loss of income …

Public Health Consequences of DisastersPublic Health Consequences of Disasters

• temporary population displacementstemporary population displacements

• increased numbers of deaths and injuriesincreased numbers of deaths and injuries

• new cases of disease and disabilitynew cases of disease and disability

• exacerbation of and increased numbers of cases of exacerbation of and increased numbers of cases of psychological and social behaviour disorderspsychological and social behaviour disorders

• food shortages and nutritional deficienciesfood shortages and nutritional deficiencies

Public Health Consequences of Disasters - Public Health Consequences of Disasters -

cont.cont. • environmental disruption causing hazards – vectors, environmental disruption causing hazards – vectors,

waste management, sanitationwaste management, sanitation

– destruction of infrastructuredestruction of infrastructure

– disruption to routine health servicesdisruption to routine health services

– disruption to routine disease surveillance and control disruption to routine disease surveillance and control servicesservices

– diversion of capital investment funds to emergency diversion of capital investment funds to emergency relief and the rehabilitation or reconstruction of relief and the rehabilitation or reconstruction of essential infrastructureessential infrastructure

Health Services in EmergenciesHealth Services in Emergencies– Mass casualty management – first aid, triage, Mass casualty management – first aid, triage,

transport, pre-hospital care, in-patient care, post transport, pre-hospital care, in-patient care, post care follow-upcare follow-up

– Management of the dead and missingManagement of the dead and missing

– Environmental health (water and sanitation, Environmental health (water and sanitation, shelter, health care waste management, shelter, health care waste management, environmental pollution)environmental pollution)

– Psychosocial servicesPsychosocial services

– Reproductive healthReproductive health

– Communicable disease control measuresCommunicable disease control measures

– Feeding and nutritionFeeding and nutrition

– Health information and communicationHealth information and communication

Health Sector Role in Relief

Health Assessment Surveillance Systems Organisation and Management

Structural damage and loss Community, hospital and laboratory Public information/mediaStaff/equipment damage and loss Public and private Guidelines and protocolsOrganisation and management needs Injury Referral systemsAccess and logistics needs Communicable diseases Emergency reporting system/HIS/MISProgramme needs: Water quality Management of the dead/forensics

Acute medical/clinical care Nutritional status Supplies and equipmentSurveillance and Laboratories disability Logistics, transport and communications

Communicable Disease Control mental health Human resourcesMental Health non communicable diseases Professional information and education

Prerequisites for health vectors Research

Medical Care Communicable Disease Control Prerequisites for Health

Acute primary care/obstetrics Diseases of Epidemic Potential Shelter, energy, water and sanitationCare and treatment of injured Vaccine Preventable Diseases Environmental healthCare and treatment of disability Vector Borne Diseases Nutrition and food supplyCare and treatment of chronic disease Diseases of Public Health Significance Health promotion/information

Reporting System

Preparedness building the capacity to do ALL of the above Surge Capacity for:

Response using AVAILABLE surge capacityscaling up health services restoration of essential services (repair/replace) reconstruction

Challenges in Health Challenges in Health Emergency ManagementEmergency Management

– Lack of legal frameworks, policies, guidelines, Lack of legal frameworks, policies, guidelines, protocolsprotocols

– Lack of evidence base for policy developmentLack of evidence base for policy development

– Pressure from the public and mediaPressure from the public and media

– Emergency situations are dynamic and in Emergency situations are dynamic and in such situations, information is scarce, volatile such situations, information is scarce, volatile and often not sharedand often not shared

– Multiple health effects of hazardsMultiple health effects of hazards

Challenges in Health Challenges in Health Emergency ManagementEmergency Management

– Multiples agencies involved - inter / intra-Multiples agencies involved - inter / intra-sectoral, public / private, national / sectoral, public / private, national / internationalinternational

– Difficulty in coordinationDifficulty in coordination

– Planning is not coordinated within and Planning is not coordinated within and between sectors between sectors

– Plans do not exist or have not been testedPlans do not exist or have not been tested

Challenges in Health Challenges in Health Emergency ManagementEmergency Management

– Lack or mismatch of resourcesLack or mismatch of resources

– Inappropriate donations Inappropriate donations

– Response and recovery actions are done Response and recovery actions are done without needs assessmentswithout needs assessments

– Opportunities for enhancing risk reduction are Opportunities for enhancing risk reduction are lost during recovery and reconstructionlost during recovery and reconstruction

– Lessons from disasters are not Lessons from disasters are not institutionalisedinstitutionalised

– Lack of best practicesLack of best practices

HEALTH ISSUESHEALTH ISSUES

WATER & SANITATIONWATER & SANITATION There was a breakdown of the water and sewerage There was a breakdown of the water and sewerage

system.system.

HUMAN REFUSE GENERATIONHUMAN REFUSE GENERATION Relatives of injured people defecated / urinated in the Relatives of injured people defecated / urinated in the

open, in spite of deep trench latrines.open, in spite of deep trench latrines.

BIOMEDICAL WASTE DISPOSALBIOMEDICAL WASTE DISPOSAL Amputated limbs and other biomedical waste was disposed Amputated limbs and other biomedical waste was disposed

off by burning.off by burning.

SOCIAL ISSUESSOCIAL ISSUES

DISPOSAL OF DEAD BODIESDISPOSAL OF DEAD BODIES

The police was entrusted with the task of The police was entrusted with the task of identification, photographing and cremation / burial of identification, photographing and cremation / burial of the dead bodiesthe dead bodies..

ADMINISTRATIVE PROBLEMSADMINISTRATIVE PROBLEMSCOLLAPSE OF THE CIVIL HEALTH COMMAND AND CONTROL COLLAPSE OF THE CIVIL HEALTH COMMAND AND CONTROL STRUCTURESTRUCTURE

MH Bhuj whose role was to supplement civil resources had to serve as the MH Bhuj whose role was to supplement civil resources had to serve as the first responder.first responder.

STRUCTURAL DAMAGE TO HOSPITALSTRUCTURAL DAMAGE TO HOSPITAL

Patient care including surgery had to be carried out in the open under tent Patient care including surgery had to be carried out in the open under tent cover.cover.LACK OF COMMUNICATIONSLACK OF COMMUNICATIONS

No serviceable telephone / satellite phone available at mh bhuj during the first 72 No serviceable telephone / satellite phone available at mh bhuj during the first 72 hrshrs

NO WATER OR ELECTRICITY SUPPLY INITIALLYNO WATER OR ELECTRICITY SUPPLY INITIALLY

Generator sets became functional by 3 hrs post impact Water was provided through Generator sets became functional by 3 hrs post impact Water was provided through water- bowsers. water- bowsers.

ADMINISTRATIVE PROBLEMSADMINISTRATIVE PROBLEMS

HAPHAZARD INDUCTION OF CIVILIAN HEALTH PERSONNEL INTO HAPHAZARD INDUCTION OF CIVILIAN HEALTH PERSONNEL INTO THE DISASTER AREATHE DISASTER AREA

Personnel were inducted without adequate planning, briefing and Personnel were inducted without adequate planning, briefing and preparation. They were not self contained.preparation. They were not self contained.

LOGISTICS MANAGEMENT OF MEDICAL SUPPLIESLOGISTICS MANAGEMENT OF MEDICAL SUPPLIES

Influx of medical supplies was not necessarily need based. Difficulties were Influx of medical supplies was not necessarily need based. Difficulties were encountered in sorting out necessary items, accounting and storageencountered in sorting out necessary items, accounting and storage

ABSENCE OF LAUNDRY SERVICES INITIALLYABSENCE OF LAUNDRY SERVICES INITIALLY

Laundry services affected due to shortage of water and damage to the Laundry services affected due to shortage of water and damage to the washing point. Soiled linen could not be washed, disinfected and reused.washing point. Soiled linen could not be washed, disinfected and reused.

SHORTAGE OF TENTSSHORTAGE OF TENTS

No tents authorized to MH Bhuj on establishment. Tents had to be procured No tents authorized to MH Bhuj on establishment. Tents had to be procured from the local formation.from the local formation.

DOCUMENTATIONDOCUMENTATION

Adequate documentation of the massive influx of casualties was not possible Adequate documentation of the massive influx of casualties was not possible with the existing resources.with the existing resources.

PATIENT CARE DIFFICULTIESPATIENT CARE DIFFICULTIESSHORTAGE OF HOSPITAL BEDS AND LINENSHORTAGE OF HOSPITAL BEDS AND LINEN

MH Bhuj is a 99 bed hospital with a 25 bed crisis expansion capability. With MH Bhuj is a 99 bed hospital with a 25 bed crisis expansion capability. With the large influx of casualties it ran out of hospital beds, mattresses and linen. the large influx of casualties it ran out of hospital beds, mattresses and linen. Patients had to be treated on the ground.Patients had to be treated on the ground.

SHORTAGE OF OPERATING ROOM EQUIPMENT, INSTRUMENTS, SHORTAGE OF OPERATING ROOM EQUIPMENT, INSTRUMENTS, LINEN & DISINFECTANTSLINEN & DISINFECTANTS

The capacity of the operating rooms was overwhelmed by the number of the The capacity of the operating rooms was overwhelmed by the number of the casualties.casualties.

CROWD CONTROLCROWD CONTROL

Relatives of casualties demanded immediate attention from the limited Relatives of casualties demanded immediate attention from the limited number of medical / paramedical personnel. They broke cordons and number of medical / paramedical personnel. They broke cordons and barged into treatment / operating areas, interfering with prioritization and barged into treatment / operating areas, interfering with prioritization and provision of care.provision of care.

PATIENT CARE DIFFICULTIESPATIENT CARE DIFFICULTIES

CASUALTY CASUALTY EVACUATION TO EVACUATION TO OTHER HOSPITALSOTHER HOSPITALS

Inadequate number of Inadequate number of stretchers especially stretchers especially special stretchers for special stretchers for transporting patients with transporting patients with spinal injuries.spinal injuries.

Data Collection Methods and Profiling during emergencies

Inter-State Meeting on “Gujarat Earthquake: Health Sector

Perspectives”06-09 November 2001

INFORMATION MANGEMENTINFORMATION MANGEMENT

Lack of communications.Lack of communications.

Assessment of the magnitude of the disaster Assessment of the magnitude of the disaster impact was not available.impact was not available.

Information on health facilities for redistribution / Information on health facilities for redistribution / evacuation of patients was not available.evacuation of patients was not available.

Rapid Assessment- Team compositionRapid Assessment- Team composition

Public health expert/ EpidemiologistPublic health expert/ Epidemiologist

ClinicianClinician

MicrobiologistMicrobiologist

Environmentalist/entomologistEnvironmentalist/entomologist

SPHERESPHERE

Based on Two Principles:Based on Two Principles:

(a) Relieve and minimize human suffering arising out of calamity and conflicts(a) Relieve and minimize human suffering arising out of calamity and conflicts

(b) Affected community has a right to life with dignity and hence a right to (b) Affected community has a right to life with dignity and hence a right to receive assistance receive assistance

SPHERE initiative was launched in 1997 by a group of Humanitarian NGOs, SPHERE initiative was launched in 1997 by a group of Humanitarian NGOs, the Red Cross and Red Crescent movement –the Red Cross and Red Crescent movement –

By framing Humanitarian CharterBy framing Humanitarian Charter

By formulating minimum standards to be applied and achieved in areas By formulating minimum standards to be applied and achieved in areas affected by all types of Disastrous situations in terms of Five key factors affected by all types of Disastrous situations in terms of Five key factors (water supply and sanitation, nutrition, food aid, shelter and health (water supply and sanitation, nutrition, food aid, shelter and health services)services)

At present an Expert Group is working on the strategies of applying At present an Expert Group is working on the strategies of applying Sphere standards in Indian context and how best they can be Sphere standards in Indian context and how best they can be modified to be applicable in current state of affairsmodified to be applicable in current state of affairs

Humanitarian CharterHumanitarian Charter

Based on the principles and provisions of International Based on the principles and provisions of International Humanitarian Law, International Human Rights Law, Humanitarian Law, International Human Rights Law, Refugee’s Law & Code of Conduct of International Red Cross Refugee’s Law & Code of Conduct of International Red Cross etc. during disaster reliefetc. during disaster reliefIt asserts the Human rights of people affected by natural or It asserts the Human rights of people affected by natural or man-made disaster situations like armed conflicts, civil strife man-made disaster situations like armed conflicts, civil strife and other political emergencies –to have protection, avail and other political emergencies –to have protection, avail assistance to survive and live their life with dignityassistance to survive and live their life with dignityIt also pertains to Legal responsibilities of the states and It also pertains to Legal responsibilities of the states and warring parties to provide above services to the people under warring parties to provide above services to the people under crisis situation crisis situation If they are unable or unwilling to do so, they are obliged to If they are unable or unwilling to do so, they are obliged to allow Humanitarian Organizations to provide humanitarian allow Humanitarian Organizations to provide humanitarian assistance and protectionassistance and protection

Sphere standards alsoSphere standards also relate to the operational framework and relate to the operational framework and accountability aspects of service providersaccountability aspects of service providersIn all situations priority would be meeting the urgent survival In all situations priority would be meeting the urgent survival needs of people affected by disastersneeds of people affected by disastersAscertain their basic human right to life with dignityAscertain their basic human right to life with dignityIn all contexts , disaster response should support and/or In all contexts , disaster response should support and/or complement existing government services in terms of structure, complement existing government services in terms of structure, design and long term sustainabilitydesign and long term sustainabilityProviding valid information regarding availability and ensuring Providing valid information regarding availability and ensuring accessibility to support services by all groups in a non-accessibility to support services by all groups in a non-discriminatory manner as per their specific needs has to be co-discriminatory manner as per their specific needs has to be co-coordinated by continuous dialogue with Local Administrative coordinated by continuous dialogue with Local Administrative AuthoritiesAuthorities

Key Vulnerable Groups:Key Vulnerable Groups:WomenWomen

Children (age<18 yrs.)Children (age<18 yrs.)Older people (age > 60 yrs.)Older people (age > 60 yrs.)People with HIV/AIDSPeople with HIV/AIDSEthnic MinoritiesEthnic Minorities

Cross- cutting Issues:Cross- cutting Issues:Gender groupsGender groupsIsolated groupsIsolated groupsMalnourished groupsMalnourished groups

Sensitive IssuesSensitive IssuesExploitationExploitationAbductionAbductionRecruitment into fighting forcesRecruitment into fighting forcesSexual violenceSexual violenceLack of opportunity to participate in decision makingLack of opportunity to participate in decision making

Most harmful effects in such a situation will be felt by Children Most harmful effects in such a situation will be felt by Children and young peopleand young people

Gender Issues will always remain in Focus and priorityGender Issues will always remain in Focus and priorityEven the assessment teams should be framed up with equal participation by Even the assessment teams should be framed up with equal participation by

Female MembersFemale MembersProtection and Protection Assistance are two separate issues and NGOs can Protection and Protection Assistance are two separate issues and NGOs can

certainly help in providing assistance to Local Authoritiescertainly help in providing assistance to Local AuthoritiesHIV/AIDS plays it’s role in the way that as the Pandemic matures and more HIV/AIDS plays it’s role in the way that as the Pandemic matures and more

people die , communities would be left with disproportionate number of people die , communities would be left with disproportionate number of children, orphans and older people- which require special attention and children, orphans and older people- which require special attention and relief programs may be modified accordinglyrelief programs may be modified accordingly

Environmental Issues:Environmental Issues:The physical, chemical and biological environment in which affected people are The physical, chemical and biological environment in which affected people are

living in should not be subjected to over-exploitation, pollution and living in should not be subjected to over-exploitation, pollution and degradationsdegradations

NGOs also have to ensure their political clearance, fulfill their visa requirements NGOs also have to ensure their political clearance, fulfill their visa requirements and should have sufficient financial, human and material resources of their and should have sufficient financial, human and material resources of their own before they enter into above ventures.own before they enter into above ventures.

General Principles General Principles

Affected people’s capacities and available resources should be assessedAffected people’s capacities and available resources should be assessedIdentify gaps in essential services Identify gaps in essential services Support inherent skills of local populationSupport inherent skills of local populationNo single sector can be planned and considered in isolationNo single sector can be planned and considered in isolationShare the findings of assessment with local population Share the findings of assessment with local population Allow people to comment upon ongoing relief measuresAllow people to comment upon ongoing relief measuresPlan outreach services for specific groups identifiedPlan outreach services for specific groups identifiedDisaster Response Programs should support and complement existing Disaster Response Programs should support and complement existing services and local institutions in terms of structure and designservices and local institutions in terms of structure and designSuch activities should be sustainable after the external assistance stops and Such activities should be sustainable after the external assistance stops and should be framed after due local consultations and approvalsshould be framed after due local consultations and approvalsHost populations extending support to displaced populations should be Host populations extending support to displaced populations should be consulted and where appropriate the developments in disaster relief consulted and where appropriate the developments in disaster relief activities should also lead to a sustainable improvement in the livelihoods of activities should also lead to a sustainable improvement in the livelihoods of the host populationthe host population

Hygiene PromotionHygiene Promotion

Much depends upon effective exchange of information between Much depends upon effective exchange of information between people and service providers- should jointly list out risk factorspeople and service providers- should jointly list out risk factors

It is in addition to good sanitation and water suppliesIt is in addition to good sanitation and water supplies

Risk Factors: improper excreta disposal, use and maintenance of Risk Factors: improper excreta disposal, use and maintenance of toilets, lack of hand-washing with soap, unhygienic storage of water toilets, lack of hand-washing with soap, unhygienic storage of water and unhygienic storage and preparation of foodand unhygienic storage and preparation of food

Form water and sanitation committees made from members from Form water and sanitation committees made from members from various sections of community and half (50%) should be female various sections of community and half (50%) should be female membersmembers

Even such committees may be encouraged to manage water points, Even such committees may be encouraged to manage water points, public toilets and washing areaspublic toilets and washing areas

This will ultimately sustain the efforts for a long long timeThis will ultimately sustain the efforts for a long long time

Water SupplyWater Supply

Average water use for drinking, cooking and personal hygiene in any Average water use for drinking, cooking and personal hygiene in any household is at least 15 Liters per person per dayhousehold is at least 15 Liters per person per dayThe maximum distance from any household to the nearest water point is The maximum distance from any household to the nearest water point is 500 meters500 metersQueuing time at a water source is no more than 15 minutesQueuing time at a water source is no more than 15 minutesIt takes no more than Three minutes to fill a 20-liter water containerIt takes no more than Three minutes to fill a 20-liter water containerWater sources and systems are adequately maintained so as to have a Water sources and systems are adequately maintained so as to have a consistent and continuous water supplyconsistent and continuous water supplyGenerally ground-water sources are preferred , as they require no treatmentGenerally ground-water sources are preferred , as they require no treatmentPeople living with HIV/AIDS require extra water for drinking and personal People living with HIV/AIDS require extra water for drinking and personal hygienehygieneRequirements for Livestock and Agriculture crops have to paid attention Requirements for Livestock and Agriculture crops have to paid attention especially in drought situationespecially in drought situationPeople affected by emergency situation have increased vulnerability to People affected by emergency situation have increased vulnerability to communicable diseases and their water requirements are more than normal communicable diseases and their water requirements are more than normal situationssituations

Water Supply….Water Supply….

Excessive Queuing will result inExcessive Queuing will result in

(1) reduced per capita water consumption(1) reduced per capita water consumption

(2) increased consumption from unprotected water sources(2) increased consumption from unprotected water sources

(3) resulting in availability of less time for other survival tasks(3) resulting in availability of less time for other survival tasks

In urban areas it may be necessary to supply water into individual In urban areas it may be necessary to supply water into individual buildings to ensure that toilets continue to functionbuildings to ensure that toilets continue to function

All users need to be informed when and where water will be All users need to be informed when and where water will be availableavailable

Important Quality Indicators:Important Quality Indicators:

(1) There are no faecal colliforms per 100 ml at the point of delivery(1) There are no faecal colliforms per 100 ml at the point of delivery

(2) Free Residual Chlorine 0.5 mg per Liter (2) Free Residual Chlorine 0.5 mg per Liter

(3) Turbidity is below 5 NTU(3) Turbidity is below 5 NTU

Water Supply….Water Supply….

Faecal colliforms Bacteria (>99% of which are E. Coli ) are an Faecal colliforms Bacteria (>99% of which are E. Coli ) are an indicator of the level of human/animal waste contamination in waterindicator of the level of human/animal waste contamination in water

Animal excreta is not as harmful as human excretaAnimal excreta is not as harmful as human excreta

Disposal of Children Faeces requires more attention as they are Disposal of Children Faeces requires more attention as they are more dangerous than those of the adults because-more dangerous than those of the adults because-

(1) In children excreta related infections are on a higher side(1) In children excreta related infections are on a higher side(2) Children lack antibodies(2) Children lack antibodies

People have to be educated for the consumption of Chlorinated People have to be educated for the consumption of Chlorinated water- in terms of health advantageswater- in terms of health advantages

If the safe water does not taste good-people will continue to drink If the safe water does not taste good-people will continue to drink from unsafe water sources- thereby putting their health at riskfrom unsafe water sources- thereby putting their health at risk

Water Supply….Water Supply….

Each household should have minimum two containers of 20 Liters Each household should have minimum two containers of 20 Liters capacity to ensure continuous availabilitycapacity to ensure continuous availability

Water collection and storage containers should have narrow necksWater collection and storage containers should have narrow necks

At least 250 gms. of soap should be available per person per monthAt least 250 gms. of soap should be available per person per month

If soap is not available-use alternatives like ash, clean sand , soda If soap is not available-use alternatives like ash, clean sand , soda or various plants for washing and scrubbingor various plants for washing and scrubbing

At Communal Bathing facilities- sufficient cubicles should be At Communal Bathing facilities- sufficient cubicles should be available separately for men and women groups and should be available separately for men and women groups and should be used appropriately and equitablyused appropriately and equitably

At Communal Laundry facilities one washing cubicle is available per At Communal Laundry facilities one washing cubicle is available per 100 persons100 persons

Ensure private laundering facilities for women to wash and dry their Ensure private laundering facilities for women to wash and dry their undergarments and sanitary clothsundergarments and sanitary cloths

Excreta DisposalExcreta Disposal

Safe disposal of excreta creates the first barrier to excreta related disease, Safe disposal of excreta creates the first barrier to excreta related disease, helping to reduce transmission thro’ direct and indirect routeshelping to reduce transmission thro’ direct and indirect routes

People need to provided with adequate no of toilets, sufficiently close their People need to provided with adequate no of toilets, sufficiently close their residential premises to allow them rapid, safe and acceptable access at all residential premises to allow them rapid, safe and acceptable access at all times of the day and nighttimes of the day and night

Parameters:Parameters:

(1) one toilet per 20 persons(1) one toilet per 20 persons

(2) toilets segregated for men and women(2) toilets segregated for men and women

(3) adequately cleaned and maintained(3) adequately cleaned and maintained

(4) not more than 50 meters away from their dwellings(4) not more than 50 meters away from their dwellings

(5) children Faeces are disposed off immediately(5) children Faeces are disposed off immediately

At times of disasters it may necessary isolating parts of the system, which At times of disasters it may necessary isolating parts of the system, which are still working, re-routing of pipes, installing portable toilets and using are still working, re-routing of pipes, installing portable toilets and using septic tanks and containment tanks – which are regularly desludgedseptic tanks and containment tanks – which are regularly desludged

Excreta Disposal…..Excreta Disposal…..

During the initial phase of disaster mark-off an area to be used as During the initial phase of disaster mark-off an area to be used as defecation field or for trench latrinesdefecation field or for trench latrinesConsult public-educate them on health benefits of using toilets and help Consult public-educate them on health benefits of using toilets and help them to maintain toilets and keep them cleanthem to maintain toilets and keep them cleanSufficient no. of women cubicles need to be built up-roughly 3 times of men-Sufficient no. of women cubicles need to be built up-roughly 3 times of men-Wherever possible provide urinals for menWherever possible provide urinals for menPeople with HIV/AIDS frequently suffer with chronic diarrhea and require to People with HIV/AIDS frequently suffer with chronic diarrhea and require to use toilets moreuse toilets moreSite selection should be such that all sections of people are able access Site selection should be such that all sections of people are able access toilets easily-it should be particularly safe for women and girls throughout toilets easily-it should be particularly safe for women and girls throughout the day and nightthe day and nightShould provide privacyShould provide privacyShould allow for disposal of women’s sanitary protectionShould allow for disposal of women’s sanitary protectionShould minimize fly and mosquito breedingShould minimize fly and mosquito breedingShould have adequate supply of water for anal cleansing an d keep them Should have adequate supply of water for anal cleansing an d keep them cleanclean

Excreta Disposal….Excreta Disposal….

Separate water facility should be provided for hand washings and Separate water facility should be provided for hand washings and flushing after use of toiletsflushing after use of toilets

Pit latrines and soakaways (for most soils ) should be at least 30 Pit latrines and soakaways (for most soils ) should be at least 30 meters from any groundwater source and the bottom of any latrine meters from any groundwater source and the bottom of any latrine is at least 1.5 meters above the water tableis at least 1.5 meters above the water table

Community toilets should be provided with lightingCommunity toilets should be provided with lighting

Toilet paper may be required in certain settings instead of waterToilet paper may be required in certain settings instead of water

Women and girls who menstruate should have access to suitable Women and girls who menstruate should have access to suitable materials for the absorption and disposal of menstrual bloodmaterials for the absorption and disposal of menstrual blood

Soap-ash may be proidedSoap-ash may be proided

Toilets with water-seal, ventilated improved pit latrine design or Toilets with water-seal, ventilated improved pit latrine design or correct use of a lid on a squat hole may encourage constant use by correct use of a lid on a squat hole may encourage constant use by peoplepeople

Solid Waste DisposalSolid Waste Disposal

Organic wastes impose a constant danger ofOrganic wastes impose a constant danger of

(1) Fly and Rodent breeding(1) Fly and Rodent breeding

(2) Surface water pollution(2) Surface water pollution

(3) create an ugly and depressive feeling(3) create an ugly and depressive feeling

(4) Block drainage channels(4) Block drainage channels

Parameters:Parameters:

(1) Involve people in designing and management of waste disposal (1) Involve people in designing and management of waste disposal ProgrammeProgramme

(2) Household wastes are put in containers (2) Household wastes are put in containers

(3) Communal Refuse container should be available within 100 (3) Communal Refuse container should be available within 100 meters vicinity meters vicinity

(4) 100-liter refuse container should be available per 10 families(4) 100-liter refuse container should be available per 10 families

Solid Waste Management…..Solid Waste Management…..

Medical wastes should be separated and disposed-off separatelyMedical wastes should be separated and disposed-off separately

In disaster situation there is more possibility of infectious sharps and In disaster situation there is more possibility of infectious sharps and non-sharps e.g. wound-dressings, blood stained clothes ,placentas..non-sharps e.g. wound-dressings, blood stained clothes ,placentas..

Safety boxes need to be provided to HCWs.Safety boxes need to be provided to HCWs.

Disposal may be done by on-site burial or incinerationDisposal may be done by on-site burial or incineration

At public places like markets. slaughter houses Refuse pits, Bins or At public places like markets. slaughter houses Refuse pits, Bins or specified areas should be clearly marked and appropriately fencedspecified areas should be clearly marked and appropriately fenced

In case of disposal of waste by Burial method it should covered with In case of disposal of waste by Burial method it should covered with a thin layer of soil at least once in a week to prevent it getting a thin layer of soil at least once in a week to prevent it getting attracted by vectors like flies and rodents and becoming a breeding attracted by vectors like flies and rodents and becoming a breeding site for themsite for them

Such burial sites should also be fencedSuch burial sites should also be fenced

Prevent any laechate from such sites contaminating ground waterPrevent any laechate from such sites contaminating ground water

Solid Waste Disposal…Solid Waste Disposal…

At slaughter houses slaughter waste can often be disposed in a At slaughter houses slaughter waste can often be disposed in a large pit with a hole cover next to abattoirlarge pit with a hole cover next to abattoir

Blood etc. can be run from the abattoir into the pit through a slab –Blood etc. can be run from the abattoir into the pit through a slab –covered channel (reducing fly access to the pit)covered channel (reducing fly access to the pit)

Water should be made available for cleaning purposeWater should be made available for cleaning purpose

Controlled Tipping/Sanitary Land-fill:Controlled Tipping/Sanitary Land-fill:

(a) useful for large scale off-site disposal of waste(a) useful for large scale off-site disposal of waste

(b) Sufficient space and mechanical equipments are required(b) Sufficient space and mechanical equipments are required

(c) Waste that is tipped should be covered by soil at the end of each (c) Waste that is tipped should be covered by soil at the end of each day to prevent scavenging and vector breedingday to prevent scavenging and vector breeding

In all settings staff engaged in above work should be provided with In all settings staff engaged in above work should be provided with protective gloves, boots , masks ,soap and availability of waterprotective gloves, boots , masks ,soap and availability of water

Drainage FacilitiesDrainage Facilities

Surface Water near human settlements may be coming from: Surface Water near human settlements may be coming from: (1) household and water point Wastewater (1) household and water point Wastewater (2) leaking toilets and sewers(2) leaking toilets and sewers(3) rainwater or rising floodwater(3) rainwater or rising floodwaterHealth Risks:Health Risks:(1) contamination of water supplies and the living environment(1) contamination of water supplies and the living environment(2) damage to toilets and dwellings(2) damage to toilets and dwellings(3) vector breeding &(3) vector breeding &(4) drowning(4) drowningImportant Considerations:Important Considerations:(1) areas around water points and dwellings are kept free from standing wastewater(1) areas around water points and dwellings are kept free from standing wastewater(2) storm-water drains are kept clear(2) storm-water drains are kept clear(3) Water point drainage from washing and bathing points are well planned and (3) Water point drainage from washing and bathing points are well planned and maintainedmaintained(4) drainage water should not pollute existing surface or ground water sources or (4) drainage water should not pollute existing surface or ground water sources or erode themerode them(5) adequate tools ,equipments and human workforce is available for maintainance(5) adequate tools ,equipments and human workforce is available for maintainance

Drainage Facilities….Drainage Facilities….

Sullage or Domestic waste water when gets mixed with human excreta= Sullage or Domestic waste water when gets mixed with human excreta= Sewage Sewage In human settlements during disasters also domestic wastewater should not In human settlements during disasters also domestic wastewater should not allowed get mixed with human excretaallowed get mixed with human excretaSewage is more difficult and expensive to treat than domestic wastewaterSewage is more difficult and expensive to treat than domestic wastewaterAt water points and washing and bathing areas encourage to create small At water points and washing and bathing areas encourage to create small gardens to utilize wastewatergardens to utilize wastewaterSpecially protect toilets and sewers from flooding to avoid structural damage Specially protect toilets and sewers from flooding to avoid structural damage and leakageand leakageLocal community should be involved in providing small scale drainage works Local community should be involved in providing small scale drainage works as they have good knowledge of the natural flow of drainage water and as they have good knowledge of the natural flow of drainage water and where channels should be putwhere channels should be putIf off site disposal of wastewater is planned channels should be designed to If off site disposal of wastewater is planned channels should be designed to have sufficient flow-velocity for dry-weather sullage and to carry storm waterhave sufficient flow-velocity for dry-weather sullage and to carry storm waterWhere the slope is more than 5% apply proper engineering methods to Where the slope is more than 5% apply proper engineering methods to prevent excessive erosionprevent excessive erosionDrainage of residuals from any water treatment processes should be Drainage of residuals from any water treatment processes should be carefully controlledcarefully controlled

Health System in DisastersHealth System in Disasters

Accessibility to all without discriminationAccessibility to all without discrimination

Well trained professionalsWell trained professionals

During armed conflicts , medical facilities and civilian hospitals should not During armed conflicts , medical facilities and civilian hospitals should not be targeted for attackbe targeted for attack

Health and medical staff have rights to get protectedHealth and medical staff have rights to get protected

Public Health impacts may be seen in terms of injuries, psychological Public Health impacts may be seen in terms of injuries, psychological traumas, increased rates of infectious diseases, malnutrition, complications traumas, increased rates of infectious diseases, malnutrition, complications of chronic disease etc of chronic disease etc

Interventions should be planed on evidence based practices- like adequate Interventions should be planed on evidence based practices- like adequate quantity of safe water, sanitation, nutritional supplements, food aid/ security, quantity of safe water, sanitation, nutritional supplements, food aid/ security, shelter and basic clinical careshelter and basic clinical care

Health system beneficiaries are mostly women and children Health system beneficiaries are mostly women and children

Success Indicator of Health services is limitation of crude death rate as well Success Indicator of Health services is limitation of crude death rate as well as under-5 mortality rate to Less than twice the Baseline rate documentedas under-5 mortality rate to Less than twice the Baseline rate documented

Health Systems in Disasters……Health Systems in Disasters……

The average Base-line CMR for the least developed countries is The average Base-line CMR for the least developed countries is approximately 0.38 deaths/ 10000 / dayapproximately 0.38 deaths/ 10000 / day

Health agencies should aim to keep CMR at below 1.0/ 10000/ dayHealth agencies should aim to keep CMR at below 1.0/ 10000/ day

When the <5 CMR is unknown , Health agencies should aim to When the <5 CMR is unknown , Health agencies should aim to maintain this rate below 2.0 / 10000/ daymaintain this rate below 2.0 / 10000/ day

No alternate parallel Hospitals / Health facilities should be created No alternate parallel Hospitals / Health facilities should be created by Partners , unless it is clearly indicated by local health authoritiesby Partners , unless it is clearly indicated by local health authorities

When the local health authority is not in a position to take a lead in When the local health authority is not in a position to take a lead in crisis situation, this job can be taken over by United Nations crisis situation, this job can be taken over by United Nations Authority like WHO, UNICEF etcAuthority like WHO, UNICEF etc

After initial Health Assessment , a Health Document should be After initial Health Assessment , a Health Document should be created which mentions Health sector priorities and objectives-to be created which mentions Health sector priorities and objectives-to be shared with all Partners to achieve itshared with all Partners to achieve it

Health Systems in Disasters….Health Systems in Disasters….

Partner Health Agencies should adhere to the health standards and Partner Health Agencies should adhere to the health standards and guidelines of the country including treatment protocols and essential guidelines of the country including treatment protocols and essential drug listsdrug listsIt is advisable to provide resources to existing hospitals so that they It is advisable to provide resources to existing hospitals so that they can start working again or cope with the extra loadcan start working again or cope with the extra loadIf at all a Base Hospital is necessary to establish, it should not drain If at all a Base Hospital is necessary to establish, it should not drain on local resources , but should be able function on it’s own and it on local resources , but should be able function on it’s own and it must also be cost-effectivemust also be cost-effectiveAll the Health Agencies need to coordinate with local / nodal health All the Health Agencies need to coordinate with local / nodal health authority for their allocated responsibilitiesauthority for their allocated responsibilitiesA standardized Referral System should be established by Local A standardized Referral System should be established by Local /Nodal Authority and has to used by identical protocols by all/Nodal Authority and has to used by identical protocols by allPriority Health Messages to be spread to local population have to be Priority Health Messages to be spread to local population have to be developed by consensus and should be consistent for the contentsdeveloped by consensus and should be consistent for the contents

Health System in Disasters…..Health System in Disasters…..

Mobile clinics should be well planed for their routes, regularity of Mobile clinics should be well planed for their routes, regularity of comprehensive services and avoid duplications of visitscomprehensive services and avoid duplications of visits

Standardized management protocols need to develop and to be adhered by Standardized management protocols need to develop and to be adhered by allall

Drug donations are accepted only if they follow internationally recognized Drug donations are accepted only if they follow internationally recognized guidelinesguidelines

While staffing at treatment facility ,ensure to post at least one female health While staffing at treatment facility ,ensure to post at least one female health worker and one representative of a minority ethnic group which will increase worker and one representative of a minority ethnic group which will increase utilization of health care facility by women and people from minority groups utilization of health care facility by women and people from minority groups

In normal circumstance utilization rate would be 0.5-1.0 consultation /person In normal circumstance utilization rate would be 0.5-1.0 consultation /person /year/year

Among displaced populations: 4.0 consultations/ person /yearAmong displaced populations: 4.0 consultations/ person /year

Utilization should be equally represented amongst vulnerable groups like Utilization should be equally represented amongst vulnerable groups like women, children and persons belonging to minority-ethnic groupswomen, children and persons belonging to minority-ethnic groups

Health Services in Disasters….Health Services in Disasters….

During disaster situations also patient’s rights to privacy, During disaster situations also patient’s rights to privacy, confidentiality and dignity and informed consent have to enforcedconfidentiality and dignity and informed consent have to enforced

Drug management to be done on four basic principles i.e. selection, Drug management to be done on four basic principles i.e. selection, procurement, distribution and useprocurement, distribution and use

Bodies of deceased persons pose dangers from public health point Bodies of deceased persons pose dangers from public health point of view only during specific instances of Cholera and Haemorregic of view only during specific instances of Cholera and Haemorregic feversfevers

Health Information system should generate critical data-only Health Information system should generate critical data-only essential information is collectedessential information is collected

Data should be analyzed-feed back provided for timely actionsData should be analyzed-feed back provided for timely actions

Surveillance data should be able to provide warning signalsSurveillance data should be able to provide warning signals

Data should be shared by all working PartnersData should be shared by all working Partners

Control of Communicable DiseaseControl of Communicable Disease

At the time of natural calamities between 60%-90% of deaths are At the time of natural calamities between 60%-90% of deaths are contributed by Four major communicable diseases namely-Measles, contributed by Four major communicable diseases namely-Measles, Diarrhea, Acute respiratory infections and MalariaDiarrhea, Acute respiratory infections and Malaria

In no. of cases Acute Malnutrition is noticed as an Associated causeIn no. of cases Acute Malnutrition is noticed as an Associated cause

In certain disasters there have been increased no. of cases of In certain disasters there have been increased no. of cases of Meningococcal Meningitis, Yellow Fever, Viral Hepatitis and Meningococcal Meningitis, Yellow Fever, Viral Hepatitis and TyphoidTyphoid

As such outbreaks of communicable diseases are far less As such outbreaks of communicable diseases are far less commonly associated with acute onset natural disasterscommonly associated with acute onset natural disasters

General Preventive measures like water and sanitation, food-aid General Preventive measures like water and sanitation, food-aid and food-security, shelter etc. are coordinated by other sectorsand food-security, shelter etc. are coordinated by other sectors

Measles prevention is particularly indicated amongst displaced Measles prevention is particularly indicated amongst displaced population or the population affected by conflictpopulation or the population affected by conflict

Control of communicable diseases….Control of communicable diseases….

First of all an estimation of Measles coverage of children aged between 9 First of all an estimation of Measles coverage of children aged between 9 months to 15 years is donemonths to 15 years is doneIf above coverage is found to be Less than 90%, a Mass Measles If above coverage is found to be Less than 90%, a Mass Measles Vaccination campaign for all children in the age group 06 months-15 years Vaccination campaign for all children in the age group 06 months-15 years is initiated is initiated Simultaneously Vitamin – A is given to all children between 06-59 monthsSimultaneously Vitamin – A is given to all children between 06-59 monthsAbove activities should achieve minimum 95% coverageAbove activities should achieve minimum 95% coverageAll infants vaccinated between 6-9 months should receive another dose of All infants vaccinated between 6-9 months should receive another dose of Measles vaccine upon reaching 09 monthsMeasles vaccine upon reaching 09 monthsRoutine Programme of EPI is re-established to sustain 95% coverageRoutine Programme of EPI is re-established to sustain 95% coverageFor mobile or displaced populations activities are planned in such a way that For mobile or displaced populations activities are planned in such a way that at any point of time at least 95% coverage is maintained amongst all at any point of time at least 95% coverage is maintained amongst all newcomersnewcomersReasons for including children of 06-15 yrs in Measles vaccination: some Reasons for including children of 06-15 yrs in Measles vaccination: some older children may have escaped both earlier measles vaccination and older children may have escaped both earlier measles vaccination and measles disease also-hence they are vulnerable-and can serve as a source measles disease also-hence they are vulnerable-and can serve as a source of infection for infants and young children , who are at a higher risk of dying of infection for infants and young children , who are at a higher risk of dying from the diseasefrom the disease

Control of Communicable Diseases…..Control of Communicable Diseases…..

Malaria- Diagnostic facilities are geared up to have lab confirmation in 24 Malaria- Diagnostic facilities are geared up to have lab confirmation in 24 hours in every casehours in every caseAnti-malarial drugs are given in prescribed doses for the period specified in Anti-malarial drugs are given in prescribed doses for the period specified in the Programmethe ProgrammeVector control measures and distribution of Insecticide treated mosquito Vector control measures and distribution of Insecticide treated mosquito nets are synchronized nets are synchronized Patients of Tuberculosis are treated as per RNTCP guidelines by DOT Patients of Tuberculosis are treated as per RNTCP guidelines by DOT therapytherapySingle case=outbreak: stands true in diseases like Cholera, Measles, Yellow Single case=outbreak: stands true in diseases like Cholera, Measles, Yellow fever, Shigella and Viral Haemorregic Feversfever, Shigella and Viral Haemorregic FeversMeningococcal Meningitis:Meningococcal Meningitis:(a) for areas with >30,000 population:- 15 cases/100,000/week indicates an (a) for areas with >30,000 population:- 15 cases/100,000/week indicates an outbreak situationoutbreak situation(b) if no outbreaks of meningitis have occurred in previous +3 years and if (b) if no outbreaks of meningitis have occurred in previous +3 years and if vaccination coverage is< 80%- there is High outbreak risk- above thresh-vaccination coverage is< 80%- there is High outbreak risk- above thresh-hold would be 10 cases/100,000/weekhold would be 10 cases/100,000/week(c) for areas with <30,000 population:- incidence of 5 cases in one week or (c) for areas with <30,000 population:- incidence of 5 cases in one week or doubling of cases over a three week period confirms an outbreakdoubling of cases over a three week period confirms an outbreak

What is a Rapid Health What is a Rapid Health Assessment?Assessment?

““Collection of subjective and objective Collection of subjective and objective information in order to measure information in order to measure damagedamage and identify those basic and identify those basic needsneeds of the affected population that require of the affected population that require immediateimmediate response” response”

Rapid Health Assessment protocols for emergencies, WHO, 1999Rapid Health Assessment protocols for emergencies, WHO, 1999

Objectives of Rapid Health AssessmentsObjectives of Rapid Health Assessments

Collection objectives.Collection objectives.

– identify existing and potential public health needsidentify existing and potential public health needs

– identify gaps and problems in meeting urgent medical identify gaps and problems in meeting urgent medical needsneeds

– assess existing and potential environmental risk assess existing and potential environmental risk factorsfactors

– assess resource and logistics needsassess resource and logistics needs

– identify managerial, coordination and organisational identify managerial, coordination and organisational gaps, overlaps and problemsgaps, overlaps and problems

Objectives of Rapid Health AssessmentsObjectives of Rapid Health Assessments

Analysis objectivesAnalysis objectives

– set priorities for response / reliefset priorities for response / relief

– set priorities for information dissemination and set priorities for information dissemination and communicationcommunication

– identify resources needed to meet priorities – external identify resources needed to meet priorities – external and internaland internal

– identify additional information needs for the response identify additional information needs for the response and for planning recovery and reconstructionand for planning recovery and reconstruction

Questions Answered by a Questions Answered by a Rapid Health AssessmentRapid Health Assessment

– Is there an emergency or not?Is there an emergency or not?

– What is the existing response capacity?What is the existing response capacity?

– What decisions need to be made?What decisions need to be made?

– What information is needed to make these What information is needed to make these decisions?decisions?

– What are the sources of that information?What are the sources of that information?

The Purpose of Health The Purpose of Health AssessmentsAssessments

To give To give decision makersdecision makers information that will information that will allow them to make allow them to make timelytimely and and appropriateappropriate interventions to:interventions to:

• save livessave lives

• minimise injury and illnessminimise injury and illness

• prevent escalation of the emergencyprevent escalation of the emergency

• prevent spreadprevent spread

• support recovery planningsupport recovery planning

Rapid Health Assessment: Rapid Health Assessment: Common MistakesCommon Mistakes

– No policy or guidelines on assessmentNo policy or guidelines on assessment

– No standard collection formatsNo standard collection formats

– No training in assessment skillsNo training in assessment skills

– Different sectors use different terms and methodsDifferent sectors use different terms and methods

– Data cannot be consolidatedData cannot be consolidated

– Too much irrelevant/duplicate data collectedToo much irrelevant/duplicate data collected

– Too much time takenToo much time taken – accurate is better than – accurate is better than preciseprecise

– Those collecting the data don’t know how it will be Those collecting the data don’t know how it will be used and don’t have the opportunity to improve the used and don’t have the opportunity to improve the assessment systemassessment system

Rapid Health Assessment - Rapid Health Assessment - Common MistakesCommon Mistakes

The biggest mistake in forms used by the The biggest mistake in forms used by the health sector is that they focus too much health sector is that they focus too much on collecting (unavailable or unreliable) on collecting (unavailable or unreliable) morbidity and mortality data rather than morbidity and mortality data rather than health sector function informationhealth sector function information

What is Available in the EHA What is Available in the EHA Webpage?Webpage?

Recap: the Purpose of AssessmentsRecap: the Purpose of Assessments

To give To give decision makersdecision makers information that information that will allow them to make will allow them to make timelytimely and and appropriateappropriate interventions to: interventions to:• save livessave lives• minimise injury and illnessminimise injury and illness• prevent escalationprevent escalation• prevent spreadprevent spread• support recovery planningsupport recovery planning

Health Needs Assessments (DANA, RHA)

Reporting + SurveillanceHospitals cough + feverClinics and Health Centers diarrhea + feverLaboratories headache + feverPHC Programmes: rash + fever

nutrition myalgia + feverIMCI - epi, ari, cdd etc other fever

water and sanitation malnutrition <5svector control trauma, disability

MCH, safe motherhood DEP, VBD, VPD, DPHS, PUCD

? workload ? investigation

expected needs unexpected needs? enough supplies ? new supplies

? enough staff ? new staff? referral system working ? new referral system

institution focus disease focus

are we meeting the needs?

dailydaily

RAPID HEALTH ASSESSMENT FORMATSRAPID HEALTH ASSESSMENT FORMATS

FINAL REPORTFINAL REPORT

Rehabilitation Aspects in Disasters-Rehabilitation Aspects in Disasters-PHEMAPPHEMAP

Dr. S. J. GandhiDr. S. J. GandhiDeputy Director (Epidemic)Deputy Director (Epidemic)

Commissioner ate of Health ServicesCommissioner ate of Health ServicesGandhinagarGandhinagar