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HEALTH CLUSTER PAKISTAN Crisis in NWFP WEEKLY BULLETIN No

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HEALTH CLUSTER PAKISTAN Crisis in NWFP WEEKLY BULLETIN No HEALTH CLUSTER PAKISTAN Crisis in NWFP WEEKLY BULLETIN no. 14 14 October 2009 HIGHLIGHTS • The Health Cluster partners firm up health interventions in the districts of Swat, Buner, Lower Dir and Upper Dir as the IDP return process is in progress. To date, a total of 236 183 families have returned to their respective districts while 22 920 families are still sheltered in 10 IDP camps and 247 895 families remain living with host communities. Meanwhile, 17 new camps have been established in Malakand, Buner, Peshawar, Charsadda and Rissalpur, hosting 7594 families. (Source: Provincial Relief Commissionerate and Commissionerate for Afghan Refugees.) • From Dera Ismail Khan and Tank, 12 629 internally displaced families (94 249 individuals) are seeking shelter in host communities. Population has been displaced from Waziristan due to security issues. (Source: Commissionerate for Afghan Refugees) • Between 19-25 September, 35 279 consultations were reported from 180 disease surveillance sentinel sites in NWFP. Of the total reported consultations, 19 105 (54%) were female patients, 16 174 (46%) male, and 7217 (20%) children under five. • The leading causes of morbidity and death among children under five are acute diarrhoea and lower respiratory tract infection (LRTI). Between 19-25 September, there were 7217 consultations with children under five, of whom 1076 (15%) had acute diarrhoea and 290 (4%) suffered from LRTI. • After four cases of measles were reported from Jalozai camp, a measles vaccination campaign for children under 15 in the affected sector of Jalozai was conducted between 6-7 October. • As a follow up exercise to the recently conducted health assessment in DI Khan, the health sector has provided one inter-agency emergency health kit (coverinig 10 000 people for 3 months) and five mini emergency health kits (each kit covers 6 000 people for two months). • A health assessment for Swat District was carried out between 13-17 September and data gathered during the assessment is now being analyzed. The health assessment for Buner District was conducted between 5-10 October. Reports on the findings of the health assessments for Swat and Buner will be drafted and shared with health partners for further discussion and planning. • The security situation in Pakistan is volatile and fragile. Security incidents in Islamabad, Peshawar and Rawalpindi over the last week have resulted in temporary closure of UN offices in Peshawar and Islambad. Resumption of operations is subject to advisory from the UNDSS. ASSESSMENT The DoH of NWFP in collaboration with WHO, UNICEF and four cluster partners conducted a health assessment in Swat District from 13-17 September. The data gathered during the assessment is now being analyzed and will be shared with the health department/Health Cluster by 20 October 2009. The health assessment for Buner District was conducted between 5-10 October. The data entry is done by the health department of NWFP and will be shared with WHO for its analysis and reporting. Reports on the health assessments for Swat and Buner will be shared with partners. During the comprehensive health assessment conducted by the Health Cluster in DI Khan on 28 August, the following needs were identified: o For effective implementation of quality MNCH, RH and FP services in all the primary health care (PHC) facilities and hospitals, the lack of female medical staff should be addressed. o Supply of essential drugs and equipment is an ongoing process and proper mechanisms must be put in place to ensure timely delivery. The current situation of medical supplies in the district is not sufficient to cater for the population's needs. Health cluster partners should support the health department in the provision of medicines in primary and secondary health care facilities. o Water supply is available in only 42% of health facilities. WASH cluster should work in collaboration with the health department for immediate restoration of water supply in health facilities of DI Khan. o Provision of standby electric supply in all the PHC facilities. Electric supply is critical for the vaccination cold chain and for all emergency life-saving interventions. There is need for health education and awareness campaigns in the entire district to educate the community on hygiene, safe drinking water and effective health seeking behavior. o Strengthen the referral system to improve hospital capacities in the field of emergency obstetric care (EmOC) as well as the emergency medical/surgical trauma care. Well functioning secondary care hospitals will encourage the PHC network to confidently refer cases through the system. Based on the recommendations made in the DI Khan health assessment, WHO provided one inter-agency emergency health kit (covers 10 000 people for three months) and five mini emergency health kits (each kit covers 6000 people for two months.) Disease Surveillance A total of 180 sentinel sites of disease surveillance in NWFP (Swat, Buner, Lower Dir, Upper Dir and Malakand Agency) and four districts in southern NWFP (DI Khan, Tank, Lucky Marwat and Banu) have sent their reports during the week of 19-25 September and registered 35 279 consultations. The drop in the total number of consultations is due to Eid-ul-Fir holidays. Meanwhile, a decrease in the number of consultations in camps is expected as large numbers of IDPs from most of the camps have returned to their distrists. From the reported number of consultations, there were 191 visits for antenatal care, 332 consultations for chronic non-communicable diseases and 62 consultations for injuries. The table below shows the type of patient, number of consultations and the percentage as recorded between 19-25 September: Type of patient Number of consultations Percentage Female 19 105 54% Male 16 174 46% Children under 5 7 217 20% • The table below shows the leading causes of morbidity among IDPs inside and outside camps. Health facilities in IDP camps reported Upper Respiratory Tract Infection constituting the highest number of consultations and acute diarrhoea as the following. Disease Surveillance Most common conditions Percentage Acute Respiratory Tract Infection (ARI) • Acute Upper Respiratory tract Infection (URTI) 19% • Acute Lower Respiratory Infection (LRTI) 3% Acute Diarrhoea (AD) 7% Unexplained fever (UF) 5% Scabies (SCB) 5% Suspected malaria (MAL) 3% Bloody diarrhoea (BD) 1% • Health facilities in most of the IDP camps reported most consultations were for URTI and the second-most for scabies. An increasing number of consultations for scabies have been reported from two health facilities in Jalozai camp and from a health facility in Jalala Camp. Intensive hygiene promotion and water and sanitation interventions have been recommended in the camps for the prevention of waterborne and water-related diseases. Similarly, health posts in Jalozai IDP camp reported cases of suspected malaria, which also need urgent attention. The graph below shows the weekly morbidity pattern of the seven most common communicable diseases reported in IDP-hosting districts in NWFP between 19-25 September. Meanwhile, the morbidity trend, as shown in the graph below, is represented by the number of consultations of each disease per 1000 consultations. Since the start of the year, URTI has been the most common subject of consultations. Below’s graph shows the weekly morbidity pattern of the five most commonly reported communicable diseases in IDP-hosting districts in NWFP from epidemiological week 1 to week 39 of 2009. • The common causes of morbidity and leading causes of death among children under five are acute diarrhoea and LRTI. Between 19-25 September, there were 7217 consultations with children under five, of whom 1076 (15%) had acute diarrhoea and 290 (4%) had LRTI. Environmental Health One of the major commitments of the Health Cluster during the emergency is to control preventable ill health and ensure that environmental risks are recognized and properly managed. Enhancing the health-related living environment of IDPs and host communities is one of the cluster’s main objectives. In the immediate aftermath of the influx of returnees, WHO as the cluster lead agency stressed the risks of contaminated water supplies. Risks include diseases such as cholera and diarrhea. • In Swat district, 4 out of 6 water quality tests conducted in water sources in Islampur village were found unfit for drinking. An agreement has been reached with ACTED to start hygiene promotion training in Swat district. • In Swabi, WHO's Environmental Health team is supporting the District Headquarter Hospital Swabi to renovate and upgrade the hospital’s WASH facilities. • In Jalala camp, sufficient drinking water is available for IDPs. The camp’s drinking water is free from residual chlorine and found within the WHO standard limit. Sanitary conditions are satisfactory and pit latrines, which are for communal use, are also satisfactorily clean. COORDINATION Health Cluster, Swat District The 4th Health Cluster Coordination Meeting was held on 30 September in DHDC, Swat. Highlights: • Executive District Office-Health will conduct monitoring visits to health facilities to assess availability and quality of medicines. • He advised partners to consider assessing lady health volunteers rooms in health facilities for equipment availability and to address any gaps. • WHO has been requested by EDO-Health to hold additional DEWS trainings for all public and private health care providers in Swat district. The 5th Health Cluster Coordination Meeting for Swat District will be conducted on 14 October 2009 in DHDC. Health Cluster, Buner On 30 September, the 2nd Health Cluster Coordination Meeting was held at the PAIMAN hall, DHQ Daggar in Buner • DEWS implementation, trainings & reporting of DEWS data to WHO was discussed. • EDO requested partners to initiate activities in accordance with pledges made. WHO was given the task to coordinate with health teams and evaluate the performance of partners working for Buner’s health sector. Health Cluster, Peshawar District health cluster meeting was held on 29 September in EDO office.
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