SUPPORT FOR RAPID HEALTH ASSESSMENT & RESPONSE STRATEGY
OHANGWENA AND OSHANA REGIONS 19-20 MARCH 2008
Dr. Ferima Zerbo Coulibaly, IST/EHA-NUT, WHO-Zimbabwe Dr Michel Yao, IST/EHA, WHO-Zimbabwe Dr. Desta A. Tiruneh, DPC/WHO-Namibia Mr. Petrus Mhata, EPI Surv. Officer/WHO-Namibia
1 People met
1. Dr Naftal T Hamata, Director of Oshana Region and Coordinator of health emergency activities in the four flood affected regions 2. Dr K. J.J. Kashaija, Principal Medical Officer and Head of Engela district 3. Dr Isabel Ferdinand, Medical Doctor, Engela Hospital 4. Mrs Lina Mampala, Nurse and coordinator of the health emergency response for the region 5. Mrs Mahnaim Shilango, Health information System focal person of Ohangwena region 6. Mrs Josephine Hango, Health Information System focal person of Engela district 7. Nurses of Oshikango, diarrhea treatment center 8. Committee and members of Oshikango relocated people camp in Engela district 9. Mrs Karin Shyagaya, Oshana Regional Management Team (RMT) staff member 10. Mrs Karin Toivo Oshana, RMT staff member 11. Committee and members of Oshakati relocated people camps (Stadium, Oshapala and Ongendiwa Trade center) 12. Dr. J. Vries, Chair person, National Health Emergency Committee 13. Ms L. de Wee, Head, Epidemiology Division, Ministry of Health and Social Services
We would like to acknowledge all the above listed people for their valuable contribution in this work particularly Dr Hamata for his kind assistance and facilitation of our visit to Ohangwena and Oshana regions.
Assessment team with Engela District Hospital Team (Photo: WHO Namibia)
2 Introduction
Since February 2008, Namibia has been facing flooding in his north western and Eastern parts of the country. In rural and urban areas more than 62,000 people have been affected and have lost their livelihood and belongings in variable degree and about 4,000 people are relocated in relocation camps. A previous assessment was done by the Government of Namibia and UNDP and WFP have taken part in this assessment. This assessment was focused on some specific sectors and gave relevant information to make short term decision for meeting the urgent needs of the affected population. The impact of the flood on transport and communication, crops and livestock were well described. Clear and relevant recommendations were made in regards to the different sectors. However, for health services, more information was needed for effective targeting according to specific health needs of each population group (relocated persons, children under five and women). Therefore, to this end, WHO conducted a complementary data collection mission to determine the need for appropriate health support according to age groups, gender and the place of residence.
1. Methodology
An adapted tool (from the Global Health, Nutrition and Water Sanitation and Hygiene (WASH), clusters’ assessment tools) designed for assessment during crisis was used. The tool incorporates public health key aspects and indicators. Besides, health related issues such as water and sanitation, food security and nutrition situation was assessed. Data were collected from 19th to 20th of March 2008 through observation, review of health facility records, district and regional health statistics and interviews with local health workers (head of regional and district health teams, HIS staff, medical doctors and nurses). Community members and people living in relocation sites provided useful information about their living condition. In Ohangwena region only Engela district was visited as it was the only district affected by cholera outbreak. The key findings are presented below followed by general comments, recommendations and suggestions for a health response plan.
3 2. Findings
2.1 Background During our two days’ visit it was still raining. According to the forecast, the two regions should expect some more waves of floods from Angola in a near future, and more rains till the end of the rainy season, i.e. end of May. Regional and district staff in both Ohangwena and Oshana regions are working hard to address the emergency needs.
a. Engela district The district has three relocation centers: Oshikango, Omatunda and Onamunama. - Oshikango relocation center had 301 people with 102 under five children, 152 women between 5 and 40 yrs and 6 elderly persons. This center has no problem of access to health services and has three times a week health outreach services including immunization, mosquito nets distribution, and treatment of minor illnesses and ARV treatment. Seriously sick patients are transported to the district hospital. Every month the Namibian Red Cross Society (NRCS) is supplying to each family about 4 cans of 750g of fish and four bags (10kg/bag) of maize flour. - Omatunda has 107 people and is accessible only by air. These flood-affected people have been without any access to health services for the last two weeks and the district is planning to re-locate them. The number of children and women in this camp is not known. - Onamunama, the number of people is unknown and this center is only accessible through Eenhana district with difficulty. They have access to health services only once a week. There are no sanitation facilities or safe water supply in these last two camps. Also, access to health service is difficult and the above-mentioned three camps are visited once a week. The need for more tents was reported as the number of relocated people is increasing every day.
b. Oshana region Three relocation centers in Oshakati town have been established. These are the stadium center with 1829 people, Oshapala site and Ongendiva Trade Center. People of Ongendiva will move in the near future to another site close to the trade center. In these camps, although most of the people are from towns, some came from rural areas and have lost most of their belongings and food items.
4 2.2 Major causes of death and morbidity within the flood-affected population a. Engela district
Common health problems reported in the relocation camps of Engela were febrile illnesses and flu. From 23rd February to 18th March 2008, 264 cases of diarrhea with 9 confirmed cholera cases and 3 deaths were reported (1.14% CFR: as all diarrhea cases are lumped together, the CFR due to Acute Watery Diarrhea (AWD)/cholera could have been under-estimated) from few facilities around Engela Hospital. Between the 12th and 18th March a total number of 68 patients were admitted in the cholera treatment center (CTC) including 18 under five children, 28 women and 22 men.
Okatope reported four AWD cases but the laboratory results are still pending. An increasing number of diarrhea cases were reported in Odibo Health Center (with 3 confirmed cases of cholera at the time of the visit).
From January to February 2008 amongst the under five years children seen as outpatients, the most common acute diseases were malaria and diarrhea without blood and other respiratory infections. In the same age group, the common cause of deaths for inpatients were diarrhea and pneumonia. Measles immunization coverage was reported to be 83 % (an average). Among adults, diarrhea was quite common and one of the most frequent chronic diseases is HIV with prevalence rate of 25.2% (HIV-sentinel survey-2004) in Oshakati. Data specific to the affected population is not available and data are not disaggregated by age group, gender and place of residence.
b. Oshana region
From January to February 2008 the common acute diseases among under five year children seen in the outpatient department was diarrhea with or without blood, fever and Acute Respiratory Infection (ARI). Malnutrition, Pneumonia, and diarrhea were leading causes of death according to district health statistics. Some cases with AWD were seen in the district but not checked for cholera. According to the RMT staff , respiratory infections are quite commonly seen in the camps. However, data from the camps are not being reported and monitored on a weekly basis, by location and age and sex groups.
5 2-3 Health service provision
a. Engela district
In this district, pregnant women from flood affected and inaccessible areas have been transferred to towns to improved access to antenatal care and delivery services but no social network is in place. The Engela hospital was not accessible by road but it is still functioning and has a unit of diarrhea isolation room with three beds. Moreover, there is a diarrhea/cholera treatment center (CTC) where cholera cases are admitted. The CTC is located about 2-3 Km from Engela Hospital. There were four nurses and one pharmacy assistant at the camp and 11 admitted patients in the tents during the visit. Patients are nursed on the mattresses on the floor. The CTC is visited by a medical doctor on daily basis. Engela district is so far the only one affected by cholera in Ohangwena region. Odibo and Okatope have reported some cholera cases. A concern about the cross border movement with regard to spread of cholera was raised.
The Cholera Treatment Center at Engela (Photo: WHO Namibia)
Four out of the 24 inaccessible outreach points have been re-established but still roughly 80 % of people are not accessible, and the district health authorities have no information about their health status. The inaccessible health facilities were Endahafo, Ogenga and Endola clinics. Health workers are visiting the relocation camps three times a week. The health service package includes, Family planning, Treatment of minor illnesses, immunization, vitamin A distribution, distribution of bed-
6 nets, weight measurements in under 5 years children. No identification system was devised for families in the relocation camps. Care for chronic diseases is still delivered to those who are accessible. The district team however highlighted that it has limited stock of Oral Re-hydration Salt (ORS). Eigth nurses have been assigned to Engela from Oshana; but there is still a need for another 17 nurses.
b. Oshana region
This region has 12 outreach sites where health service provision has been interrupted due to the flood. Outreach health services is provided three times a week in the three relocation camps. The health service package includes: - Family planning, Treatment of minor illnesses, immunization, vitamin A distribution, distribution of bed-nets, weight measurements in under 5 years children.
2.4 Water and sanitation in the relocation camps
Flood water is seen everywhere in the two regions. According to the district team, in Engela, less than 50 % of the household had access to piped water before the crisis. Currently, many taps are under the water aggravating the population access to safe water supply. But the district has enough chlorine tablets. It was reported that most people use surface water such as pond water. In addition, the stagnated water could increase the risk for vector borne diseases (malaria…) In Omatunda and Onamunama (Engel District) there are no sanitation facilities or safe water supply. In Oshakati town, water and sanitary facilities are available but not sufficient for the number of people in the camps. In all relocation camps, people are living in very crowded tents. E.g. in Oshopla 16 Families are staying in one tent of about 40m2 size. This crowded situation could increase the risk of communicable disease outbreaks (measles, diarrhea diseases). The situation in different camps is summarized according to the sites in the table below. In Ohangwena, chlorine tablets are available in health facilities, but most of these facilities are difficult to access. Hence, the district team is not quite sure if communities have access to the purification tablets. The district is planning to make them available in the community using various outlets.
7 Table1. Living conditions in the camps Relocation camps Population Security and Sanitation Clean water Accommodation Engela District 301 people; -No case of injury - Two latrines - Oshikango 102 < 5; 152 - 3 -4 families per - Waste - One tap women; 6 tent disposal elderly - Buy their soap
-Onamunama Population of - 13-15 people per - No latrines -No tap water (information was about 300 tent - No waste -Have chlorine given by the district) people disposal tablets
- No clean water Omatunda 107 people 13-15 people per - No latrines - Chlorine tablets tent - No waste distributed disposal Oshana region - At least 5 - 3 toilets for families per tent men Stadium - At least - Tents are not - 3 toilets for - Have access to 1,829 people waterproof and women clean water some have holes -waste - Robberies disposal reported Oshapala Not available - 16 families per -2 toilets for - Have access to tent the whole clean water camp Ongendiwa Trade Not available - Are well settled - 1 toilet for - Have access to center in the trade center young girls, 1 clean water (about to be moved) for young boys, 2 for adults men, 2 for adult women
SPHERE STANDARD: 20 persons maximum per latrine; 1 water point per 250 persons maximum.
Flooded village in Engela District (Photo; WHO Namibia)
8 In all the camps, new people keep coming and some are not yet registered. The average of toilets is one for at least 150 persons (1 per 20 people required by Sphere standards). People are more likely to use open field for their needs. Tents are crowded in Oshapala and inconvenient in Stadium Camp because of the rain water that is leaking through the roof of the tents. Omununama relocation needs more tents. The need for tents is applicable in all the relocation camps as the number of relocating people is increasing daily. The number of people in the camps is not known to the MOH Officials.
2.5 Food and nutrition Food distribution is done on a monthly basis by the Government or by Namibian Red Cross Society. Nevertheless in all the camps food shortage was raised as a major concern. Each family is receiving food aid that is much lower than its daily allowance of 2,100kcal/day/person and hence must provide for its members to supplement its daily needs. In Oshikango relocation center residents complained about having difficulties to feed young children. Fish seem to be easily available and some families use this alternative to make money and provide food to their family. Many people were seen using mosquito nets for this purpose.
People fishing in flooded water in Engela district (Photo: WHO Namibia)
2.6 Social mobilization It is being done through radio. Messages include education about cholera such as on what is cholera, how does it spread, how to prevent it and on Malaria and hygiene. A leaflet on the use of water purification tablets has been developed and distributed to all health facilities and some demonstrations have been done in communities by volunteers. In fact, 6 volunteers were trained in the Oshikango relocation camp on
9 social mobilization in collaboration with national Red Cross (NRCS) and an NGO called Total Control of Epidemic (TCE) which are members of the regional emergency management unit (REMU). These NGOs and the MOHSS are the institutions involved in social mobilization at regional level. There is a plan to expand the social mobilization activities.
2.7 Coordination There is a permanent emergency coordination team in all the affected regions which has been reinforced lately by the National Government. Meetings are held on a daily basis in the Engela district and weekly at the regional councils, which liaise with the national level. In Engela, the workers complained about having too much workload and multiple responsibilities which is having a negative impact in some aspects of the work such as data management and the follow up the needs of the displaced populations.
3. Summary of finding
Major causes of morbidity were reported to be diarrhea, malaria and ARI mainly among under five year children population. However, no figures were provide to support this statement. Access to health services is completely lost in some areas and very difficult to access in other areas. No medicine and medical supply shortage was reported at all levels. However transport of medical supplies could be a challenge due to the flood. There are no diarrhea kits but IV fluids and antibiotics are sufficient. In most of the camps health care is accessible. But one area that need improvement is health data management in the context of the emergency situation. This includes implementing adequate epidemiological analysis and monitoring to guide response to the cholera outbreak. The case fatality rate of cholera could be higher than what mentioned (1.14%) as all diarrhea cases are lumped together. At district and region levels health information from relocated camps, outreach points or on current cholera outbreak is not being monitored on a weekly basis by age, sex, place of residence (basic epidemiological requirement for such type of emergency). Only cumulative data are reported on cholera outbreak although team later learned that a line-list of diarrhea cases is being sent to national level on a daily basis with out any feedback being sent from national to local level.
It becomes difficult therefore to analyze the pattern of diseases in the camps and among patients seen in the health facilities. Furthermore, although AWD cases are
10 reported in the region of Oshana, no sample has been taken to rule out cholera. The health sector does not have any demographic data disaggregated by age groups and sex in the relocation camps. The surveillance system is not yet adapted to the emergency situation, hence, data is collected and compiled on monthly basis. However there is no problem of completeness and timeliness.
No acute malnutrition screening is done in the relocation camps despite many complaints by residents regarding the difficulty they have in accessing food aid. People are looking for some coping mechanism as fishing to make money to meet their basic needs. The same amount of food aid is provided to each family regardless of the family size and coping capacity of families particularly those who are relocated from rural areas. Living condition in the camps is difficult with more than 200 people per point of water, one toilet for 300 people (aginst 1 per 20 people -Sphere standard). People are likely to use open field, which is a cause of major concern. No soap is distributed and yet tents are over crowded. We may have an increase of respiratory infection amongst children and even adults, an outbreak of measles is likely since the coverage of measles vaccination is lower than the threshold to have protective herd immunity. HIV has a high rate in the region but no prevention activities are rolled out in the camps.
4. Recommendations
• Support is needed for data gathering management and analysis for epidemic prone diseases. Monitoring data on weekly basis will be very critical in guiding the provision of adequate and appropriate health services to the affected population groups. • Screening under-five children for acute malnutrition is essential considering the possibility of food shortage, increased health risk, problem of childcare in the camps and the role of malnutrition as a leading cause of under-five mortality. • Training on severe malnutrition management is necessary in Engela district • Reinforce HIV prevention intervention at least in the relocation camps • AWD cases need to be screened for cholera in all flood affected areas outside Engela. • Outreach service need to be strengthen including immunization (measles mainly) • Coordination need to be strengthened for regular gap analysis and planning
11 • Ensuring safe water supply and proper sanitation in the cholera epidemic context is urgent. There is also a need to provide urgently some more tents as most of the camps are overcrowded. • Cholera treatment center need to be supported, appropriate isolation and hygiene measures were lacking in the CTC visited. • Need to redeploy more health workers as the actual group seems to be overwhelmed.
5. Suggestions for a health response plan
5.1 Objectives To continuously collect and disseminate information on the health situation and strengthen epidemic prone diseases and malnutrition surveillance in the flood- affected districts and camps for displaced persons. To contribute to the provision of health services including outreach services (immunization) and provision of TB treatment and ARV for displaced population, health education related to hygiene promotion and HIV/AIDS and reproductive health package. To supply necessary guidelines and train health professionals for emergency case management and for prompt response to epidemic outbreaks.
5.2 Strategy • The Health Sector aims at restoring access to essential health care for flood- affected populations by ensuring that all the required components for an essential health services are in place, such as qualified health care personnel, medicines, equipment and guidelines. • The sector also aim to prevent death as a result of epidemic outbreaks linked to the flood by improving diseases surveillance and the availability of sufficient medical supplies for a rapid response.
5.3 Specific actions Setting up an effective coordination mechanism at regional level o Regular meeting o Who is doing what and where? o What are remaining gaps? What strategy to address them? Continuous assessment of health conditions and needs.
12 Strengthening epidemiological surveillance of epidemic prone diseases and malnutrition in flood affected areas Strengthening primary health care by supplying essential drugs, deploying health personnel, and strengthening technical skills in the management of disease outbreaks. Making available TB treatment, ARV and PEP kits. Strengthening mobile health services, including immunization, in hard to reach areas. Stockpiling medicines needed for a prompt response to outbreaks. Setting up of the Minimum Service Package (MISP) for reproductive health Setting up health education and sensitization for malaria, diarrhea, HIV/AIDS, ARI and malnutrition prevention. Supporting community networks to educate and sensitize on sanitation. Increasing the coverage of mosquito nets to reduce the risk of malaria. Providing necessary guidelines and supporting minimal training required for response to outbreaks and for the overall health response.
5.3- Expected outputs/results All flood-affected population have access to essential health care. Regular reports (weekly) on health situation of flood-affected people allowing appropriate interventions are available (health bulletin,…) Completeness and timeliness of epidemic prone diseases surveillance system above 80% (proportion of health facilities reporting on time on epidemic prone diseases in all flood-affected areas) Health workers in flood-affected areas are trained for common diseases (diarrhoea, malaria…) case management and reproductive health activities. Medical supplies for basic health care, epidemics response and reproductive health provided and distributed in health facilities. Long lasting insecticide-nets (LLINs) provided with provided mainly to vulnerable population (children and pregnant women). Actors (including volunteers) trained and equipped for health education activities, related to epidemic prone diseases and HIV/AIDS. Regular health information provided to health stakeholders for planning purpose
13 Annex 1: Frame for activity budgeting Activity Quantity Unit cost Total Coordination Meetings Field visit (fuel, Perdiem) Information management Assessment missions Surveillance system: communication, information collection (Tools) Gap filling Medical supplies for PHC including STI treatment and PEP kit ARV + PMTCT Continuity of care for chronic diseases (TB, Diabetes, Hypertension) Cholera treatment center: Beds Tents Diarrhea Diseases kits Immunization Water treatment/purification tabs Water quality control kits Vector control Insecticide Vector control LLIN Staff redeployment (CTC, PHC, surveillance) Health education tools & activities (for HIV/Malaria/Diarrhea, access to treatment & Prevention) Condoms procurement & distribution Capacity building Training Guideline Logistic and transport Transport medical supply Transport for Medical team
14 Annex2: Diarrhea kit content
Product Information Product Description: Diarrhoeal Disease Kit (Inter Agency), COMPLETE For 100 severe cases (cholera treatment unit) and 400 moderate cases (oral rehydration unit)
BASIC MODULE 1. Drugs Quantity Oral rehydration salts (for 1 litre each) 700 Ringer lactate, 1 litre bag/pouch, with infusion set* 80 Doxycycline 100mg tablets, box of 1000 1 Erythromycin 250mg tablets, box of 1000 1 Ciprofloxacin 500mg tablets 1000 NaDCC 1.67g "multipurpose" tablets**, box of 200 6 Cetrimide 15% + Chlorhexidine 1.5%, 1 litre bottle 5 2. Renewable supplies Cannula, IV short, 16G, sterile, disposable 50 Cannula, IV short, 18G, sterile, disposable 100 Cannula, IV short, 22G, sterile, disposable 50 Cannula, IV short, 24G, sterile, disposable 50 Needle, scalp vein, 21G, sterile, disposable 25 Needle, scalp vein, 25G, sterile, disposable 25 Safety box f.used syrgs/needles 5l/BOX-25 1 Bandage, gauze, 8cmx4m, roll 24 Cotton wool, 500g, non-sterile, roll 5 Tape, adhesive, zinc oxide, roll, 2.5cmx5m, roll 20 Compress, gauze, 10cmx10cm, non-sterile/PAC-100 3 Gloves, examination, latex, large, disposable/BOX-100 200 Gloves, examination, latex, medium, disposable/BOX-100 200 Gloves, examination, latex, small, disposable/BOX-100 200 Gloves, surgical, 7.5, sterile, disposable, pair 100 Gloves, surgical, 8.5, sterile, disposable, pair 100 Apron, protection, plastic, disposable 100 Tube, feeding, CH08, L40cm, luer tip, sterile, disposable 10 Tube, feeding, CH05, L40cm, luer tip, sterile, disposable 10 Tube, feeding, CH10, L125cm, conical tip, sterile, disposable 10 Tube, feeding, CH12, L125cm, conical tip, sterile, disposable 10 Tube, feeding, CH16, L125cm, conical tip, sterile, disposable 10 Syringe, feeding, 50ml, luer tip, sterile 10 Syringe, feeding, 50ml, conical tip, sterile 10 Culture swab, Cary Blair, pure viscose tip, peel pouch 10 3. Equipment Scissors, Deaver, 140mm, straight, s/b 5 Forceps, artery, Kocher, 140mm, straight 5 Basin, Kidney, stainless steel, 825ml 5 Tray, dressing, stainless steel, 300x200x30cm 5 Tourniquet, rubber band, 1.8cmx1m 10 Stethoscope, binaural, complete 2 Sphygmomanometer, (adult), aneroid 2 Thermometer, clinical, digital 32-43C 10 Brush, hand, scrubbing, plastic 5 Soap, toilet, bar, approx. 100g, wrapped 2 Bag, body, plastic, 220cm, zipped 5
15 Blanket, survival, 220x140cm 10 4. Documents Information Note (English) 2 First steps for managing an outbreak of acute diarrhoea 20 (10 French and 10 English) Critical steps in decision making for preparedness and response 10 (5 French and 5 English) Assessment of cholera outbreak (English) 2 Guidelines for the control of Shigellosis 5 ORS MODULE Information Note (English) 2 Oral rehydration salts, sachet for 1 litre (4l/patient) 1600 Jerrican, plastic, 20 litres, with tap 4 Ladle, 250ml 4 Cup, 250ml, plastic, graduated 100 Soap 100g, bar 2 First steps for managing an outbreak of acute diarrhoea 4 (2 French and 2 English)
INFUSIONS MODULE Information Note (English) 2 Ringer lactate, 1 litre bag/pouch, with infusion set 720
SUPPORT MODULE Information Note (English) 2 Bucket, plastic, 15 litres, graduated (patient and cleaning) 40 Jerrican plastic with tap, 20 litres (for ORS) 5 Ladle, 250ml 4 Container, plastic, 125l 10 Cup, 250ml, plastic, graduated 40 Chlorine test kit, range 0.1-2.0 mg/l for 100 tests 4 Gloves, cleaning, reusable, large 100
Shelf-life a minimum of 3 years, except for the culture swab which has a 1 year and half Shelf-life.
General remarks for the Basic Module: * The quantity of the Ringer lactate is only for the first 10 severe patients and must be completed by the Infusions Module or local purchase. ** - Drinking water disinfection: 1 tablet per 200 L clean water - General disinfection: (solution of 0.2%) 2 tablets per litre - Hand, skin disinfection (solution of 0.05%) 1/2 tablet per litre
Special Feature: STANDARD DELIVERY TIME: 40 kits Ex-stock. More than 40 Kits 2-4 weeks, from date of Purchase Order to date of Ready for Shipment.
Recommended Shipping Type: Air Shipping Volume (cbm): 5.85/kit; Shipping weight (kg): 1813/kit Inco Terms: FCA Gorinchem, Netherlands
16 Annex 3: Daily reporting form
Ministry of Heath and Social Services Daily Briefing on Health Situation and Activities
Area: …………………………………………… Reporter:……………………………………… Day: …………………………………………….
HIGHLIGHTS (major events to be known (a summary to be developed below)) •
I. GENERAL SITUATION: Main events of interest/concern for health (population affected, displacements, sanitation, water supply…)
II. ANALYSIS & HEALTH CONSEQUENCES:
a) Major health problems (disease outbreaks: epidemiological data: time/trend, area and population affected (age, sex…); health system: situation of Health centers/healthcare, Human resource, supplies…)
b) Health needs of affected populations (services & interventions needs to respond to problems)
III. ACTIONS TO BE TAKEN (in relation or response to the issues mentioned above):
a) Ministry of Health activities (field trips, assessments, gap filling (health services), coordination, information sharing: surveillance & assessments, training, etc.) & requirements (Human resources, material, infrastructure & other logistic required):
b) Other partner actions & Ongoing programmes
IV. COMMENTS (important action points & contraints…)
17 Annex 4: Monitoring matrix of key interventions for an effective health response during crises
Function What need to be done Current status Measures for improving Responsible body the situation 1. Assessment 1.1.Assessment Health needs, health system and monitoring delivery capacity and operational constraints known; information consolidated, arranged and displayed in a manner that facilitates consensus and decisions 1.2.Surveillance and early Priority health threats, warning mainly epidemic prone disease surveillance strengthening, and system's critical capacities monitored regularly with possibility of early warning. 2. Support to 2.1. Health coordination Clear mapping of health coordination stakeholder: who is doing what and where? Information flow and periodicity established. Organized space and time for all health partners to discuss issues, decide action to take and assign responsibilities; mechanisms for follow-up, evaluation and readjustment. Need for all pertinent programmes and stakeholder to participate.
18 2.2.Coordination with Work in all other sectors other sectors geared to the survival and healthy and sustainable livelihoods of the population (water and sanitation…) 3. Identifying and 3.1. Filling the life- Life-threatening conditions filling gaps threatening gaps prevented or promptly addressed, with CFR maintained within international norms 3.2. Filling gaps that are Appropriate means applied critical to effective to improve equitable access delivery of health care to health care in a sustainable way and according to international standards ( e.g. SPHERE), including chronic diseases. 4. Strengthening 4.1.Bulding national National health partners and repairing capacities fully integrated in, and supportive of the delivery of systems and humanitarian assistance building 4.2.Building capacities of International health partners capacities international partners effectively complementing national efforts 5. A strong 5.1. Programme MOHSS’s interventions Ministry Of administration properly administered and accounted for, with no Health & Social rupture in the pipeline; there Services is real-time exchange of (MOHSS) information programme 5.2. Logistic support Require logistic support is provided provided in collaboration with other sector.
19 Health Response to crises
Health Sectorial Group
2-Coordination Strategy
3-Building 3-Filling 1-Assessment Identification Capacities critical of Health for response gaps Sector Priorities & Best Crisis tasks allocation (W3) possible Alert Surveillance Partnerships Immediate Projects Health
Outcomes Medium Projects term
Medium/ Projects Long term
Lesson learnt & Preparedness
W3: Who is doing what and where?
20