Health and MHPSS Report The Finale: Typhoon Pablo Six Months Later June 1, 2013 He alt h an d M H PS S Finale Report Highlights: May 31, 2013  PHO ComVal holds Exit Conference and recognizes partners assistance

 Partners present accomplishments, challenges and lessons learned

 ACF and Handicap International to come in with recovery and rehabilitation assistance

I. Background:

Typhoon Pablo (International name Bopha) entered the Philippine Area of Responsibility (PAR) on December 2, 2012. It made its landfall in the vicinity of Baganga, Oriental around 4:00 am on December 4 with maximum sustained winds of 175 kph near the center and gustiness of up to 210 kph.

Striking also the majority of Compostela Valley Province, Typhoon Pablo is now known to be one of the biggest disasters to hit the . Moreover, Typhoon Pablo will not be easily forgotten by being one of the first typhoons to hit Compostela Province affecting almost of its 11 municipalities and 249 out of its 267 barangays. These areas severely suffered as these aren’t used to these types of disaster. II. Humanitarian Needs:

The coping with, for the survivors, seemed to be impossible. Destroying vast lands of Table 1: Summary of Statistic Typhoon Pablo Immediate Impact to residences and livelihoods, the typhoon left the Health as of April 30, 2013 survivors with nothing to move forward with. No of Deaths 632 Houses, trees, and even the rocks that were thought No of Injured 856 to be immoveable, were blown away and flushed by Missing 243 the strong winds and rushing waters brought by the heavy rain. Lifelines were interrupted; roads and No of Totally Damage Health 08 BHS Facilities bridges were severely damaged. Health facilities were among the structures that were damaged No of Partially Damage Health 93 BHS Facilities which resulted to disruption of health services. 4 RHUs

Starting off in December 5, 2012 immediately after Typhoon Pablo made landfall, the Provincial Government of Compostela, stood with their commitment to respond and address the needs of the affected residents seeking for help and temporary refuge. Search and rescue for the survivors, providing immediate and life saving care, distribution of food and water and retrieval of dead bodies were the initial response of the government.

Due to the vast destruction brought by Typhoon Pablo, a State of National Calamity was declared in the provinces of Compostella Valley, and in Region XI, Surigao del Sur in CARAGA, Lanao del Norte, Misamis Oriental and Cagayan de Oro in Region X, Siquijor in Region VII and Palawan in Region IV-B.

The declaration of State of Calamity opens the way for international organizations and UN agencies to come in and provide assistance. Many humanitarian sectors entered the chaotic scene of Compostela, bringing help and assistance. Medical team and rescue team from the government, non-government organizations, private sectors, civic organizations, and volunteers flocked working with one goal that is to save lives. For the first two months after Typhoon Pablo made landfall, health services were complementary delivered by the itinerant teams as the local health staff were dealing with a lot of concerns including restoring what they have lost personally and with their health facilities. III. The Response:

a. Coordination

As the situation evolved the Local Government with the help of the UN and non-government organizations facilitated the delivery of humanitarian assistance. Each organization committed to support the Cluster Approach as a response strategy to coordinate and maximize the use of resources. The Provincial Health Office of Compostela Valley Province, as the lead agency for the four clusters (HEALTH, MHPSS, Nutrition and WASH), started to call for cluster meetings supported by its co-lead from the UN agencies. Non-government and the private sector also extended their support to the Cluster Approach. The meeting became the venue for all humanitarian assistance to discuss issues and concerns, identify needs and gaps, and complement each and everyone’s capacity to ensure resources addressed the greatest needs of the community. Cluster meetings were initially held once a week and later became once in every two weeks.

As there was a need to Name of # of Brgys No of No of Brgys No Of Brgy extend assistance to the areas not Municipality Mobile with at least 2 with No being reached during the early part Teams Visits Visit of the response, the mapping of Deployed mobile teams for the month of Compostela 16 21 11 1 February noted that only about 60% 20 18 06 4 of the areas were visited twice a Monkayo 21 46 16 0 month by either the mobile medical 16 39 09 2 team or by the local health staff. Laak 55 12 14 1 Transportation services then through Table 2: Medical Team Coverage the assistance from the provincial December 4, 2012 - February 28, 2013 government and cluster members were used to support the delivery of health services to remote barangays of the Province. Also, certain humanitarian needs were given attention to five priority municipalities as recommended by the provincial government. Compostela, Montevista, Monkayo, New Bataan and Laak, severely affected and hardest hit by Typhoon Pablo, were considered as the priority municipalities for the response.

b. Information Management

Information management as the vital step for the basis in decision making was revitalized through the collaborative effort of all agencies involved in the response. Conforming to the partner’s weekly submission of 3Ws, the commitment and support extended by all local health staff in the Weekly Data Board Monitoring as well as regular attendance of partners to the Cluster Meeting were successfully completed.

The mapping of mobile team deployments and reporting of the status of damaged health facilities and services led by WHO with support from the local health staff and UNOCHA became the baseline information of the cluster to identify next priority areas. It was then when health services and deployment of teams were considered to the GIDA and in areas not visited by the mobile teams. From 60% of areas visited by the mobile team during the first two months it later increased to 80% areas covered.

c. Delivery of Basic Health Services

Delivery of health services in the 31 evacuation centers in Compostela was through the mobilization of the medical teams from the Department of Health, LGUs and non-government organizations; establishment of emergency health stations; and establishment of temporary health stations in the halls for areas with severely damage health facilities. Health services were affected in terms of regularity, frequency, and quality brought by inaccessibility to the area, damage roads and bridges, and damage to health facilities. Medical Outreach by the Compostela Provincial Health Office, PEEMO, and MHOs were given schedules and later on, were supported by the other DOH Regional Health Offices, PHOs, PRC, IOM, and WHO. These medical outreach programs reached barangays previously not visited due to non passable road conditions and sometimes due to security and safety reasons.

Mental Health and Psychosocial Support was given equal importance. The Department of Health with the support from IOM provided Mental Health and Psychosocial Support services to the health workers. CFSI, PRC, Plan International provided Psychosocial Support activities both in evacuation centers and in the community. ACF focused their support to pregnant and lactating women and children under-5 years old.

Reproductive health services in emergencies were set in motion by the UNFPA together with the PHO and local health staff. A total of 2,674 Pregnant and lactating mothers availed of RH Medical Missions covering 97% of their target population. UNFPA however admitted that they have to work hard to increase coverage of the info session related to Gender-Based Violence. Currently only 16% of their target population were being covered.

By the end of February 2013, as reporting system have slowly re-established, the gaps that need to be covered already significantly

Fig 1. Tot al Number of Consult at ions By Municipalit y and Facilit y February 18-April 30, 2013 decreased. Medical services and consultations were

90000 being regularly provided by the local health staff.

80000 70000 From Feb 18-April 30, 2013, 4% of the total 60000 50000 population of the four municipalities with almost 40000 30000 complete data submitted per week was given 20000 10000 medical care at the RHU and BHS (Figure 1). PRC 0 Compostel a M ontevi sta New Bataan Laak also reported to have provided consultation to a total

BHS RHU P opul ati on 9,754 patients and provided transport and referral to 21 patients mostly from the evacuation centers of Compostela, New Bataan and mobile consultation from the municipalities of Montevista, and Monkayo. IOM also reported a total of2, 885 consultations, and assisted referral of 26 patients of their consultation in the established transitional health facilities. Government hospitals in Compostela Valley became the immediate referral facilities of cases from the RHUs and evacuation centers before it is referred to the next higher level of care.

Humanitarian needs however remain. Figure 2. Basic Services Regularly Rendered Per M unicipality Perhaps, it should remain important as much as it Feb 16-April 30, 2013 was in the first days even after all the operations. Laak By giving solution to the non-passable roads of

New Bat aan Compostela, additional coverage of assistance Mont evist a were noted, consultations became more regular at Compost ela the main health facility and barangay health 0 1000 2000 3000 stations. Medical Team from PHO and NGO Vit A AMV OPV Pre Nat al Post Nat al Deliveries complemented delivery of services to the areas making at least 90-95% of the areas covered from 60% initial coverage during the early response phase. Primary Health services at the health facilities such as: medical assistance to the rising vulnerability of the community to any health condition due to unpredictable weather condition especially to GIDA barangays; provision of pre and post natal care; attended/assisted in the deliveries of pregnant women and significant increase in the coverage of basic immunization services to the eligible and vulnerable groups were noted (Figure 2).

d. Disease Surveillance

A few days after Typhoon Pablo landed, Surveillance in Post Extreme Emergencies and Disasters (SPEED) was activated. Responding mobile teams from other Regional Health Offices initiated SPEED reporting. Medical teams from other international and local humanitarian organization were given brief orientation on SPEED reporting by the focal person from CHD XI as they dropped by for coordination and brief orientation of the situation. SPEED reporting then was continuously coming in from two hospitals, four RHUs and five evacuation centers.

From December 6 to April 30, a total of 28,641 consultations of health conditions under SPEED were reported. Twenty seven percent of these consultations were among children five years old and below. Respiratory Infection was predominant leading cause of Fig 3: Top Five Leading Consultations consultations from the five municipalities. by Month This is followed by fever, wounds and Dec 4, 2012 - April 30, 2013 14000 bruises, hypertension and acute watery 12000 diarrhea. Immediate referral of health 10000 conditions like suspect measles, suspect 8000 leptospirosis, suspect acute flaccid paralysis 6000 4000 and other health conditions that need 2000 immediate intervention were always taken 0 cared by the respective health facilities from Dec Jan Feb Mar Apr ARI WBS HBP AWD the RHUs to higher level of care, program managers and by other clusters such as WASH, Nutrition, MHPSS, and CAMP Management for immediate and appropriate interventions. Interventions such as massive measles immunization of children in the evacuation centers, additional installation of WASH facilities, distribution of WASH supplies, intensification of health promotion campaign, immediate investigation and response to any reported communicable health conditions contributed to the continuous decrease of consultations. No outbreak had been reported and no deaths related to any communicable diseases were monitored.

e. Capability Building

Response component included capability building that promotes life saving activities. WHO provided training on SPEED to increase reporting coverage for early detection of outbreaks and immediate provision of interventions. Likewise, WHO further supported CHD XI in the conduct of Training on Community Mental Health Programs for Disaster Response to provide capacity for the local health staff to address psychosocial concerns. IOM also supported DOH in the conduct of orientation for Psychosocial Support for the BHW and Barangay Officials. Plan International together with their local partners provided capability building to the service providers such as DEPEd teachers, Day Care Workers, Parents and Youth Volunteers.

IV. The Rehabilitation

April 2013 saw the initial signs of the so-called new beginning. Repair of damage health facilities as initially taken cared by the LGUs was gaining ground. Rehabilitation of the health centers slowly was taking its shape: the RHU and the Cabinuangan BHS in New Bataan had been completely rehabilitated by first two weeks of April 2013. However, seven barangay health stations in Laak, BHS Pansalan in Compostela, BHS Tubo-tubo and Baylo in Monkayo remained non-functional. And so, the LGUs and DOH, together with the local and international partners remain to work rigidly even in the last days of operation Pablo. The Pablo Response Humanitarian Mission mostly ended on May 2013.

While patiently waiting for the release of the rehabilitation fund from the government, international partners eventually supported the rehabilitation projects either through allocation of Basic Drugs, Medicines and supplies and or repair of the damage health facilities, as well as construction of transitional health facilities.

IOM constructed two transitional health facilities, one in Barangay Andap, New Bataan and one at the relocation site in Compostela. Basic drugs and supplies for these two transitional health facilities were given by the World Health Organization. These were officially turned over to the respective midwives in the area with the presence of the LGU Officials and Municipal Health Officers. IOM also supported the repair of the Staff House of New Bataan RHU and provided partial repair on the damaged roofing of Monkayo RHU.

Table 3: Status of Damage Health Facilities by Municipality

(As of April 30, 2013 Monitoring) Municipality No of Total Pop No. of Extent of Damage Status of Repair Brgys BHS (No) (No)

ND TD PD R PR TR Compostela 16 82,059 16 1 2 13 0 13 2 Laak 55 78,253 45 8 0 37 1 20 12 Montevista 20 41,347 20 7 0 13 0 4 9 Monkayo 23 106,878 21 0 3 18 0 0 18 New Bataan 16 53,231 15 0 3 12 1 10 4 Total 130 361,768 117 16 8 93 2 55 43 ND – No damage TD- Totally damage PD- Partially damage R – Rehabilitated PR – Partially Repaired TR – Temporarily Repaired

Main health centers were also given Inter-agency Supplementary Kits by the UNICEF during the early phase of response while WHO allocated Basic Inter-agency Kits to the RHUs of Compostela, Montevista, Monkayo, New Bataan and Laak. AmeriCares provided medicines and supplies to IOM for their use in their mobile clinics in BHS Ulip, Monkayo, BHS Mangayon, Compostela and BHS Kidawa, Laak.

During the review by the cluster of the existing gaps, ninety three (93) partially damaged barangay health stations needed replacement of their basic drugs, medicines, supplies and equipments. Eight of these were taken cared of by PRC and twenty BHS will also be given BHS basic drugs, supplies and equipment by WHO. As the resources were limited, prioritizations of the BHS out of 93 partially damaged BHS were based on consultation with the respective Municipal Health Officers and on the criteria discussed at the level of the CHD: existing health facility, assigned midwife/human resource, number of population serve and its geographic location (Table 4). Table 4: Priority BHS for Drugs, Supplies and Equipments

Name of Type of Beneficiaries Agency Assistance Municipalities Facility

PRC Basic New Bataan RHU, BHS Panag, San Roque and Bantacan Equipments and Montevista RHU, BHS New Visayas Supplies Compostela BHS Aurora, Maparat, New Osmena, Alegria WHO Basic Drug, Compostela BHS:Mapaca,Ngan, Lagab Medicines Montevista BHS:Camansi, Mangayon, Lebanon, Camantangan Supplies and BHS Balag, Baylo, Haguimitan,Mt Diwata Monkayo BHS: Cabinuangan Bantacan, Camanlangan, Panag, Equipments New Bataan Catipunan Laak BHS: Aguinaldo, Belmonte, Kapatagan,Langtud

V. The Challenges:

The difficulties to reach GIDA Barangays, defaulters, relapses in family planning programs and some non-responders to health services, lack of age- and sex-disaggregated data at LGU level which was necessary to properly identify target beneficiaries and to plan for appropriate interventions, the ongoing fragile security situation in some barangays were among the challenges for both right bearers and service providers. The inadequate knowledge and awareness of some barangay officials and the community affected their participation and interest particularly in the conduct of Reproductive Health Medical Missions. Sustainability in terms of coordination, and collaboration, and completion of rehabilitation phase remains to be seen.

VI. The Impact

Despite the challenges, each and every one recognized that Humanitarian assistance whether it was through a direct or indirect delivery of services, positively brought impact to the lives of the people in Compostela Valley Province. The Cluster Approach helped synchronized plans and activities, facilitated prioritization and addressed needs and gaps. Coordination and collaboration of resources and expertise increased coverage/access to essential health services. Prenatal/antenatal check-ups among the Pregnant and Lactating Women (PLWs) as well as Family Planning FP Counseling to Women of Reproductive Age (WRA) and PLWs lowered maternal mortalities during emergencies. Health promotion activities generated new acceptors for family planning modern method, and increased awareness on preventive and control measures for communicable diseases. Collaboration facilitated resource sharing that addressed the availability of medical supplies at the health facilities. Capability building and technical support assisted the re-establishment of the referral system, increased relevant health information for decision-making and further planning. Advocacy activities conducted enhanced public sector accountability on ensuring delivery of basic health services to include adolescent Sexual and Reproductive Health (ASRH) promoting bottoms-up approach as well as elicited volunteerism among youth in the conduct of RHMMs.

VII. The Recommendations The following recommendations were highlighted by the partners during the exit conference: IOM  Need more outreach programs on psychosocial and health promotion activity especially to the vulnerable group.  Transportation that can access hard to reach areas (GIDA) UNFPA  Adoption of Quad-Cluster approach in order to align all activities for the emergency response  Regular provision of updated list of target clients (PLWs, WRA, Youth, etc. ) on a weekly basis for targeted and precise planning of activities  Full engagement of community health workers on the conduct of Sexual and Reproductive Health Information Sessions  Prioritize the conduct of Adolescent Sexual Reproductive Health (ASRH) activities at the provincial and municipal levels  Full support of the community leaders during conduct of RHMMs and SRHIS WHO  To continue coordination and collaboration strategy with the lead agency  Establish a monitoring system for program implementation and its status  Advocates to partners, stakeholders, donors to align plans and activities that would address priority needs and gaps identified  Cluster Approach needs to be strengthened and sustained at the local level.

ACF  Regular conduct of barangay based Outpatient Therapeutic Program (OTP) for severely wasted cases  Community mobilization in the conduct of activities and delivery of services  Continue support for the pregnant and lactating women and young children VIII. The Conclusion

The Typhoon Pablo Humanitarian Response Missions of some partners have ended. However, this does not mean that there was no more need for further assistance. Communications between the LGUs, DOH, and the partners shall continue for constant and unimpeded recovery for the people. The LGUs, DOH, partners, and the people shall continue to work together to get through the getting over process and finally arrive in completely moved on state.

The people of Compostela Valley Province could not be more grateful for all the help that the humanitarian agencies brought. From gloom, smiles in the face of the people were repainted along with the re-establishment of their homes and basic social services.

With the re-entry of ACF supported by DOH, IOM, and WHO in terms of drugs and supplies for use of ACF Mobile Clinic in GIDA areas and the new partner from Handicap International who came to continue medical assistance and psychosocial support for recovery and rehabilitation, these would definitely bring more hope to the people of Compostela Valley.

By May 2013, there were a reasonably enough supplies of drugs and medicines, regular health services rendered, and hopefully a completely recovered and prepared community.

Table 5: Scheduled End of Mission Health and MHPSS Cluster Members Agency End of Mission

WHO May 31, 2013

Handicap International June 31, 2013

UNFPA June 31, 2013

PRC

 Mobile Teams and Health June 2013 Emergency Stations  Psychosocial Interventions May 2014

IOM May 31, 2013

For Inquiries you may contact, Dr Renato Basanes: 09173034798 or Dr Georgie Arvin Legaspi : 09177200715

PHO Compostela Vallley

Dr Gerardo Medina 09088633163; Julie Villadolid 09276171866 World Health Organization

Annex A

List of Mobile Teams Deployed Per Municipalities December 5- February 28, 2013 Name of Name of Mobile Teams Municipalities

Compostela (21) 1. CHD XI, 2. PHO ComVal, 3. Compostela Valley Prov' Hosp, 4.Lingkod Panginoon, 5. Korean Med Team, 6. UNFPA, 7. CUPA, 8. Malaysian Med. Team, 9. Cebu Doctors, 10. Cotabato Med Group, 11. Davao Med Center, 12. AMHOP, 13. San Miguel Corp, 14. Junior's Pharm., 15. Davao del Norte Convergence Team, 16.GK Manila,Perpetual Clinic, 17. Makati Med Center, 18. SMART, 19. Red Cross, 20. San Pablo College, 21. San Pedro College

Montevista (18) 1. PHO ComVAl, Marsman, 2. Amai Pakpak Medical Team, 3. REACH International, 4. UNFPA, 5. CVPH, 6. HUMA, 7. Caraga Med Team, 8. St Bridget Sisters, 9. Caraga Med Team, 10. AFP 60IB, 11. San Pedro College, 12. Rotarian, 13. Sagip Kapamilya, 14. PHIC Regl Office, 15. Rotarian, Koronadal Medical Team, 16. ARMM Solidarity Team, 17. Sarangani Medical Team 18. AMHOP

Monkayo (46) 1. CHD VI, 2. CHD XI, 3. CHD XII, 4. PHO Davao del Norte, 5. REACH International, 6. Mercy Malaysia, 7. Guerero Charitable Foundation, 8. COPTA, 9. Medical Mission Group Hosp., 10. Medical Group, 11. BF-AFP, 12. Polymedic Hosp of Tagum, 13. Davao Medical Sch Foundation, 14. Kiwanis, 15. Makati Medical Group, 16. Beta Sigma, 17. UP College of Medicines, 18. Petron, 19. San Miguel Corp. 20. ,AFP, 21. Del Rosario Medical Group, 22. Couples for Christ , 23. Alson Medical Team, 24. Medical Specialist Davao, 25. Malaysian Med Team, 26.AMHOP, 27. Rivera, 28. PRC, 29. Gov't, 30. APO Fraternity Medical Team, 31. UNFPA, 32. Ospital ng Makati,Medical Mission Group, 33. Diocese of Tagum, 34. Davao Medical Group, 35. Association of Medical Doctors, 36. Lopoz Med Group, 37. Jun Hinampos Med Group, 38. Cotabato Med Group, 39. SDA Church, 40. Phil Cardinal Doctors, 41. LGU Dinagat, 42. MHO Davao Oriental, 43. MHO M'lang, 44. RHU, 45. Korean, 46. Japanese,HUMA,

New Bataan (39) 1. CHD XI, 2. Davao Regional Hospital, 3. PHO South Cotabato, 4. RHU M'lang, 5. PHO Cotabato, 6. PHO South Cotabato, 7. CHD VII , 8. DOH ARMM, 9. Sakurako Narita, 10. HUMA, 11. San Pedro Hospital, 12. DMSF, 13. AFP, 14. PHIC, 15. Surigao Medical Group, 16. UNFPA, 17. Canadian Medical Mission, 18. Davao Doctos Hosp, 19. PHO ComVal, 20. Makati Medical Team, 21. ABC 5, 22. CARD, 23. Davao Regl Hosp., 24. GMA, 25. SMART, 26. PRC, 27. Bishop Reagan Doctors, 28. Malaysian Gov't Med Team, 29. TSU-THI Med Group, 30. General Baptist Med Team, 31. DepEd, Parish Council, 32. GO Family Med Group, 33. Well of Life Com Dev, 34. Tulunan North Cotabato, 35. San Pedro College, 36. Jz Pharmazone Med Mission, 37. Agusan Medical Team 38. AMHOP, 39.UST Medical Mission

Laak(12) 1. DOH, 2. PEEMO ComVal, 3. DOH ARMM, 4. Mercy Malaysia, 5. Office Cong. Amatong, 6. UCCP, 7. UNFPA, 8. Cornerstone Health Care Ministries, 9. REACH International, 10. Kingking Copper Gold Project, 11. San Agustin Services Inc, 12. 10th ID Velona