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Initial Rapid Health Assessment, BOHOL PROVINCE – Philippines, October 30-31, 2013

INITIAL RAPID HEALTH ASSESSMENTS

EARTHQUAKE - BOHOL PROVINCE – Philippines October 30-31, 2013

Report of 5 November 2013

I. Background information:

An earthquake measuring 7.2 on the Richter scale hit the Bohol Islands at 8:12am on October 15th, 2013. The epicentre was located at two kilometres from Carmen Municipality with a depth of 33 Km but after revision, the USGS estimated the epicentre depth about 57 km. The earthquake was felt in Cebu City, where collapsed buildings were reported. The Pacific Tsunami Warning Centre in Hawaii informed there was no threat of a Pacific-wide tsunami after the earthquake. As of 3.00pm on 25 October, the National Disaster Risk Reduction and Management Council (NDRRMC) reported a total of 3,157,869 persons affected in provinces of Region VI and VII, 211 deaths, 9 people missing, 752 injured people and more than 60,000 displaced families mainly in Bohol, Cebu and Siquijor. NDRRMC estimated the cost of damage at 1,426,542,000 pesos . A State of Calamity was declared for Bohol and Cebu on October 15th, 2013.


A Rapid Joint needs assessment was conducted in Bohol province, involving national and international UN partners on October 17th. The first results reported severe damage to 130 health facilities and partial damage of additional 20 health facilities. The cold chain system was reported to be interrupted, equipment lost or damaged and the routine immunization services suspended. Between October 15th and 29th, 10 suspected measles cases were reported. The Provincial Health Officer initiated measles mass vaccination campaigns in evacuation centres for children below 15 years. BASELINE INFORMATION Table 1. Population, number of barangays and barangays health stations by municipality

Municipality

Population per Municipality (2010 Census Estimation)

# of barangays # of barangay health stations

Average Population per BHS per municipality

Antequera 14,644 21 5 2,929 Bilar 17,420 19 4 4,355 Buenavista 26,972 35 7 3,853 Calape 30,382 33 8 3,798 Carmen 44,016 29 22 2,001 Catigbian 23,800 22 7 3,400 Clarin 19,248 24 24 802 Inabanga 44,198 50 28 1,578 Loon 43,290 67 13 3,330 Maribojoc 18,475 22 8 2,309 Sagbayan 19,787 24 5 3,957 San Isidro 9,360 12 4 2,340 Sevilla 11,515 13 4 2,879 Sierra Bullones 26,926 22 9 2,992 Tubigon 45,323 34 14 3,237 Alburquerque 1,987 11 5 397 Alicia 23,890 15 4 5,973 Anda 16,948 16 6 2,825 Baclayon 18,375 17 5 3,675 Balilihan 17,474 31 5 3,495 Batuan 12,380 15 5 2,476 Candijay 31,807 21 6 5,301 Corella 7,620 8 1 7,620 Cortes 14,878 14 5 2,976 Dagohoy 18,677 15 5 3,735 Danao 18,070 17 4 4,518 Dauis 36,862 12 12 3,072 Dimiao 14,471 35 6 2,412


Duero 17,599 21 6 2,933 Garcia Hernandez 21,734 30 8 2,717 Guindulman 33,002 19 7 4,715 Jagna 32,675 33 33 990 Jetafe 28,409 24 7 4,058 Lila 11,017 18 5 2,203 Loay 16,199 24 5 3,240 Loboc 16,625 28 7 2,375 Mabini 23,634 22 8 2,954 Panglao 26,609 10 6 4,435 Pilar 27,822 21 10 2,782 Pres Carlos P Garcia 25,620 23 4 6,405

San Miguel 22,643 18 5 4,529 Sikatuna 6,462 10 4 1,616 Tagbilaran City 94,143 15 17 5,538 Talibon 60,459 25 9 6,718 Trinidad 28,132 20 5 5,626 Ubay 67,218 44 16 4,201 Valencia 28,604 35 5 5,721 Bien Unido 23,880 15 7 3,411 TOTAL 1,241,281 1109 405

Table 2. Government Health Human Resources

Human Resource Male Female Total HW:population ratio Doctors 31 36 67 1: 18,526 Dentists 8 12 20 1:62,064 Dental Aide 3 9 12 1:103,440 Nurses 17 99 116 1: 10,700 Midwives 408 408 1: 3,042 Nutritionist - 8 8 1:155,160 Nutrition Aide - 8 8 1:155,160 Medical Technologist 5 36 41 1: 30,275 Sanitary Engineer 1 1 1:1,241,281 Sanitary Inspectors 42 82 124 1:51,720 Active Barangay Health Workers 53 7,839 7,892 1:157 Barangay Nutrition Scholars 7 888 895 1:387 Nutrition Coordinator 1 23 24 1:51,720


Table 3

TOP 10 LEADING CAUSES OF MORBIDITY ,YEAR 2012 COMPARED TO PAST 5 YEARS

NUMBER AND RATE PER 100,000 POPULATION 2010 NSO survey

Causes of Morbidity

2012 Past 5 Years Average ( 2007 -2011 )

Number Rate Number Rate 1 Diseases of the Respiratory System (Upper

& Lower) 87032 6794.06 84968 6289.52

2 Essential Hypertension 11038 861.67 7787 579.16 3 Pneumonia 8239 643.17 10242 763.32 4 Diarrheal Diseases / Gastroenteritis 8016 625.76 50990 3767.96 5 Wound, All type 7113 555.27 6076 444.87 6 Kidney / Renal / Urinary Tract Disease 6334 494.46 3730 274.53 7 Diseases of the Stomach and Dudenum 3515 274.39 4049 299.24 8 Fever of unknown origin 3440 268.54 7821 592.65 9 Sytemic Viral Infection 3173 247.70 5396 396.88

10 Diseases of the Skin 2496 194.85 7084 523.81 Table 4

TOP 10 LEADING CAUSES OF MORTALITY ,YEAR 2012 COMPARED TO PAST 5 YEARS NUMBER AND RATE PER 100,000 POPULATION

PROVINCE OF BOHOL Causes of Deaths

2012 Past 5 Years Average

( 2007 -2011 )

Number Rate Number Rate 1 PNEUMONIA, all type 1004 78.38 1006 74.83 2 Diseases of the Heart 804 62.76 1147 85.37 3 CVA, CVD, Stroke 724 56.52 420 30.97 4 CANCERS 418 32.63 629 46.81 5 HYPERTENSION / HYPERTENSIVE 353 27.56 420 31.23 6 CARDIORESP. ARREST / CARDIAC/RESP.

FAILURES 333 26.00 270 19.98

7 RENAL FAILURES 305 23.81 395 29.29 8 LUNG DISEASES 265 20.69 98.6 7.42 SENILITY 265 20.69 111.6 8.28 9 SEPSIS / SEPTICEMIA 247 19.28 124 9.20

10 DIABETIS MELLITUS 214 16.71 224 16.55


Table 5: Routine vaccination coverage (2011) Bohol:

Antigen % DPT3 70.4 OPV3 70 MCV1 (MV) 69.4 MCV2 (MMR) 41.4 TT2+ 57.8 CPAB 55.2 Table 6. Leptospirosis cases and deaths, Week 1-37, 2012 and 2013, Region VII 2012 2013 Cases 99 46 Deaths 4 3 Table 7. Dengue cases and deaths, Week 1-37, 2012 and 2013, Region VII 2012 2013 Cases 11,409 11,356 Deaths 58 38


D. Damaged Public Hospitals and RHU per municipality as of 24 October 2013


II. Methodology

WHO EMT (Emergency Management Team) for Bohol decided on October 28th to send a rapid assessment team to Bohol to assess health structures and services in priority affected municipalities. The team arrived on October 29th and 30th and decided to split into two teams to assess a total of 15 municipalities mainly in the West of the main Island of Bohol which is reported to have suffered most of the damage. The teams were composed of: a. Team 1:

• Ms. Patricia Kormoss – Technical officer EHA – WPRO (team leader) – October 30th • Ms. Astriedley B. Cabinatan – EPI nurse coordinator – CHD region 7 • Ms. Myra Leonora Salvaleon – Newborn Screening Nurse – CHD region 7 • Mr. Peter Vanquaille – EPI consultant – WCO Philippines

b. Team 2:

• Dr. Gerrie Medina – EHA Technical Officer – WCO Philippines • Ms. Machiavillia Luida M Caliao – EPI Nurse Coordinator, PHO Bohol • Ms. Julie Villadolid – Disease Surveillance Focal Person – WCO Philippines • Mr. Bonifacio Magtibay – Environmental Health Officer – WCO Philippines

Team 1 visited following health facilities on October 30-31st:

• Rural Health Units in Balilihan, Catigbian, Sagbayan, Tubigon, Maribojoc, Loon, Antequera and Bohol Provincial Health Office

Team 2 visited the following health facilities on October 30-31st:

• Rural Health Units in Bilar, Danao, Carmen, Buenavista, Inabanga and Clarin municipalities • One evacuation center in Carmen

The Initial Rapid Health Assessment questionnaire developed by the team leader was revised after consultation with the Provincial Health Officer and agreed upon within the team on October 29th, 2013 (see annex). Following areas of concern were looked at:

• Status of the infrastructure of the RHUs • Health services and human resources availability in rural health units using the HeRAMS services

checklist • Health services delivery and health human resource in the Evacuation Centres • Cold chain integrity • Access to and quality of the water supply in health facilities • SPEED concerns

Due mainly to road conditions and time constraints, the Initial Rapid Health assessment was focused on the rural health units of 15 municipalities identified as priority by the Provincial Health Office. Only few Barangay Health Stations were assessed as located far from the RHUs.


III. Main findings

1. Status of Health facility infrastructures: i. The following rural health units assessed are considered totally destroyed :

Sagbayan, Carmen, Maribojoc and Loon

ii. The following Rural Health Units assessed are considered not and/or slightly damaged:

RHU in Tubigon, Bilar, Danao, Inabanga, Clarin municipalities

iii. Reports of partially/fully damaged barangay health stations in the municipalities were given by the medical staff in the RHU and by the Provincial Health Officer. A thorough assessment of those health stations is not possible at this time due to mainly road conditions and time constraints. In principle, if access to the different barangays from the RHU is possible, outreach services could resume even the BHS is damaged.

iv. Constructions of transitional health facilities has started. v. Electricity provision: all RHUs visited have electricity provision from the public grid, except RHUs

in Sagbayan and Loon. Loon RHU under tent has power from the municipal hall. All but 2 RHUs (Tubigon, Antequera) do not have a backup generator in case of emergency. Tagbilaran cold storage room has a manually operated old generator. Fuel for generators is in sufficient supply.

2. Health services availability:

i. The majority of the rural health units are providing essential primary health services, either in the health facility itself (those which have sustained slight or no damage) and or in another building provided to the health staff (such as in Carmen), or in temporary health facilities (tents and/or under shelters covered by plastic sheeting – see below pictures. Although these health services are provided to the affected population, they are often not provided in the best condition: in Sagbayan temporary RHU, no privacy is given nor guaranteed to the pregnant women when consulting the midwives.

ii. None of the temporary RHU have inpatient capacity: patients requiring hospitalisation are transferred either to the closest functional district level hospital or to hospitals in Maribojoc and Tagbilaran city. The referral of patients from BHS to the RHUs and to hospitals is guaranteed by ambulances, private vehicles and/or motorcycles with the support of the LGU and barangay officials.

iii. Since the earthquake, the screening of acute malnutrition (MUAC) within children below 5 years are generally not done at RHU nor are the supervisory visits for outreach activities of Community Management of Acute Malnutrition programme. The out- & inpatient treatment of severe acute malnutrition is not available. SPEED has reported few consulations of acute malnutrition in some RHUs and hospitals.

iv. The majority of the laboratory activities have been interrupted in the damaged health facilities as equipment were destroyed by the earthquake: the early detection of dengue, malaria and TB cases is not performed.


v. Although the midwives are reporting on duty, the antenatal, essential intra-partum & newborn and post-partum services are reduced and/or are not provided in the temporary RHU and birthing centres. Before the earthquake mothers were delivering at the RHUs and at selected BHSs and in the birthing centres. However, since the earthquake there is an increase in home deliveries done by skilled attendant.

vi. Detection of gender-based violence has been interrupted in most of the RHUs. vii. Most of the non-communicable diseases are detected at the RHU: reports from medical staff are

indicating an increase in hypertension cases since the earthquake. viii. Mental health care and psychological first aid is the main services lacking and/or non-existing

before the earthquake. The majority of the health care workers and some of the IDPs that were interviewed are requesting support.

ix. The medical drugs and material supplies availability at health facility is adequate. However some of the health facilities are requesting additional drugs for respiratory infection and fever. Some RHUs need storage capacity (tents). Suppliers are the DoH, CHD, LGU, private donors and some international agencies.

x. The early warning system SPEED has been activated in all assessed RHUs with the exception of Inabanga. At least 2 staff from each RHU have been trained on SPEED. Validation of data is being done at the provincial level. In most instances, consulations done at the RHUs, evacuation centers and barangay health station are being consolidated and reported as one by the RHU as the reporting facilities. Measles surveillance is carried out, including daily reporting (7 suspected measles cases were reported between 1 and 15 of October.) No deaths from measles have been reported. Challenges remain on the regularity of reporting for disease surveillance. No outbreaks have been reported.

3. Status of health services and health human resource concerns in ECs As of 30 October, there are 376 ECs in Bohol with 17,763 families/89,291 persons. The teams were able to visit only a few ECs. Most of the interviewed IDPs are willing to go back at their place of origin and life under tented

shelters. Health staff from the RHUs regularly (from once a week to daily) visit ECs within their

municipalities to provide medical consultations. However, barangay health workers or barangay nutrition scholar took charge in the daily monitoring of any health related concerns.

4. Cold chain integrity and immunisation services

a. Condition of cold chain equipment i. The physical condition of the Cold Chain equipment is remarkably good in most RHUs except in

those that were severely damaged (Sagbayan, Maribojoc and Loon). Some equipment can still be recovered and tested for proper functioning. It has to be said though that health staff is afraid to enter the severely damaged structures for fear of aftershocks.

ii. Some of the RHUs don’t have voltage regulators. Voltage regulators are observed in PHO Tagbilaran to protect all equipment from power fluctuations.

iii. Vaccine carriers were observed left in the rubble of severely damaged RHUs. Some of the equipment was recuperated by the assessment team.


iv. Although it must be accepted that in times of emergencies, not all systems and equipment will be properly set up and used, it is observed that some of the refrigerators are not well maintained and not properly loaded according to WHO standards which is an indicator that staff is not properly oriented in basic cold chain management.

b. Condition of vaccines and diluents v. Vaccines were lost due to severe damage in RHU Sagbayan and Loon.

vi. Vaccines were discarded after 5 days in Maribujoc and Antequera while some of the VVMs must have not reached stage 2 of the VVM (Vaccine Vial Monitor) therefore they could have still been used. In health staff’s mind though, they were not used because they had been in the earthquake and damaged by temporarily break in the cold chain

vii. Vaccines in the other RHUs were recuperated and were still potent as indicated by the heath sensitive monitors (VVMs)

viii. PHO is currently replenishing the routine vaccines so immunization services can continue. ix. Most of the diluents observed (in damaged RHUs and operational RHUs) were in the cold chain.

However, some packs of diluents were also discarded along with its antigen. x. In 1 RHU, Some of the vaccine and diluents discarded were disposed of in syringe disposal boxes

along with used syringes and placed outside the health center accessible to the public xi. As temperature monitoring is not done like before the disaster in most RHUs (twice a day)

vaccine inside the fridge may be at risk for either freezing or warming up.

C. Condition, availability and need of ancillary products xii. . 50% of the RHU's assessed have damaged cold chain equipment and vaccines. 10% of the

vaccine needs have been filled by DOH while the remaining 40% is planned by DOH for replenishment through PHO. There remains the gap of filling in the urgent need of cold chain equipment

xiii. Waste boxes have been seen in the rubble of the RHUs and have been partly recuperated by the assessment team

xiv. Some safety boxes are observed to be used for disposal of discarded vaccine and disposed of along with used syringes.

xv. It has not been observed in all RHUs how used syringes are disposed of but the safety boxes were generally in good use and proper disposal of used syringes was generally observed. It seems that most RHUs dispose of their medical and immunization waste in a site usually behind the health centre. In at least 2 RHUs it was observed that this was done in a correct way (in a concrete vault in the ground)

xvi. Probably due to the surge in emergency materials, storage of ancillary products is not in ideal condition at the cold storage – warehouse facility at the PHO in Tagbilaran.

c. Situation of staffing and continuation of services

All staff of all RHUs has reported for duty after the earthquake, even staff being affected themselves. This shows the dedication and motivation to continue primary health services including immunization program

xvii. Except for Sagbayan and Antequera, all RHUs visited have resumed the weekly routine immunization services. (Balilihan, Catigbian RHUs conduct outreach to all the BHSs. Sagbayan RHU has not yet resumed routine services while Antequera is disrupted as they are waiting for vaccine delivery. Maribojoc and Loon are providing services in the relocated centres but cannot yet conduct outreach services.


xviii. At the time of the assessment, information is not yet available on which RHU’s have conducted mass measles (MMR) vaccination campaign in the evacuation centers (EC) and what was the target group (reported to be the < 15 y old) and number of children immunized.

xix. Vaccines are adequately available to continue routine immunisation – even for Sagbayan (PHO teams going every Wednesday for immunisation)

xx. Vaccines conditions ( VVMs beyond stage 2) are good in Tagbilaran, Buenavista, Inabanga and partially/fully damaged in Clarin, Maribojoc, Loon and Antequera.

xxi. Health staff expressed the need for vaccine carriers in general, but for some RHUs, the need existed prior to the earthquake.

5. Access to water supply and quality control in health facilities

i. Various government and non-government agencies are providing assistance to WASH in different municipalities. Based on records, interviews and actual observation, these groups are as follows: DOH regional offices; Officer of Bohol Governor; Office of the mayor of all municipalities/city. LWUA; Manila Water; Oxfam; UNICEF; Singapore NGO; Philippine Red Cross; Mercy-Malaysia

ii. Water supply systems operated by Water Districts and Municipal Waterworks, although with reported damages in pipe network and deep wells, were found functional. In all municipalities visited, water refilling stations played a key role in providing drinking water with high quality.

iii. Other assistance to augment water supply is the provision of water treatment units and water bladders as provided by Manila Water, LWUA, Philippine Red Cross, Office of Bohol Governor, Office of Cagayan de Oro City Mayor, Armed Forces of the Philippines. DOH provided water containers, chlorine solutions, and chlorine tablets.

iv. RHUs are equipped with water-sealed toilet facilities with handwashing lavatory, except Carmen and Sagbayan where the RHU building is not functional. In Sagbayan, temporary latrines (4 cubicles) are being constructed near the damaged RHU and municipal hall.

v. The PHO has the capacity to test bacteriological quality of water supply using a water laboratory. But due to the high demand and immediate results needed, portable water test kits are needed. In the seven RHUS visited, only Carmen has an acceptable level of residual chlorine (0.4 ppm) in piped water. LWUA treated water has 0.3 ppm. Others have below 0.3 to 0 pm.

vi. Acute watery diarrhea has been observed to be increasing based on SPEED report. A total of 180 consultations of acute watery diarrhea were reported from 26 october to 2 November 2013. About 33% of these consultations were among children below five years old. Around 35% of the total consultations were reported from the municipality of Maribojoc seen at the Rural Health Unit (60/180) and in Maribojoc Community Hospital (3/180). There was 30% increase of AWD consultation noted in Maribojoc on this reporting period as compared to 20-26 October 2013. Other municipalities that reported significant number of acute watery diarrhea consultations were from Carmen (16%), Buenavista (6%) and Danao (5%).

vii. Due to limited time in conducting the assessment, only RHUs and few evacuation centers were assessed. Assessment was not done on existing LGU or community water supply systems, toilet facilities and point of use of water disinfectant in the areas visited.


Key Recommendations

1. Status of Health facility infrastructures

a. Health facility structure – and infrastructure

For the assessed 15 rural health units i. It is recommended to cordon off all severely damaged health structures and prevent entry from

the public as still hazardous substances and equipment are present inside the buildings. ii. It is further recommended to evacuate, if at all possible, all infrastructures, furniture,

equipment that can still be salvaged. iii. All severely damaged structures have to be assessed by the government for its possible

demolition. Rebuilding, rehabilitation or relocation needs to be according to international “earthquake proof standards”

iv. All partial, minor and non-damaged health structures should undergo a rapid visual screening by teams of national and international specialists to assess the possibility of applying retrofitting techniques for strengthening structural elements of the buildings.

v. It is recommended that every RHU has an autonomous emergency backup power supply through minimum 6 KVA generator for refrigerator(s), priority medical devices and emergency lighting.

vi. It is recommended that all health structures should have priority to have electricity through the grid if the power lines are being restored after an emergency

For non-assessed Rural Health Units, Hospitals and Barangay Health Stations

v. It is recommended that all hospitals should be assessed structurally and service/surge vi. It is recommended that identified affected BHS to be assessed along with outreach services

2. Health services availability

a. Access to and utilization of Health services i. It is recommended to carry out a thorough assessment of the reported affected Barangay

Health Stations in order to have a clearer picture on the access to and utilization of essential health services in the municipalities.

ii. Discussion should be held with the Provincial health authorities to determine where health facilities should further be supported and where the set-up of temporary health facilities (tents) should be done as soon as possible.

iii. Further support should be provided to the provincial health authorities and Rural Health unit in terms of drugs and medical supplies storages. The Provincial Health Officer made an official request to WHO for additional pharmaceutical storage capacities.

b. Sexual and Reproductive Health iv. It is recommended to further collaborate with the provincial health authorities and UNFPA for

better understanding of the sexual and reproductive health service delivery and availability of reproductive health kits, material and equipment. Particular attention should be given to providing increased privacy during the consultation. Additional tents should be distributed for this purpose.


d. Non communicable diseases v. It is recommended to carry out a thorough assessment on the health services delivery for

chronic health conditions as a relatively large proportion of the vulnerable population are elderly who will need further support.

vi. Mental health and psychosocial support should receive priority attention as there is an important lack of these services both at health facility level and at community level. It is also recommended to provide MHPSS to medical professionals as health workers themselves have been affected. - Mental Health and Psychosocial Support

a. Immediate: (a) Identify victims who needs MHPSS services; (b) Victims (including health professionals of the affected areas) should receive MHPSS services in order to be able to cope and deal with the issues caused by the earthquake and its consequences. Interventions could be made individually or in groups; (c) Provide special clinical support (debriefing, medication) in psychiatric clinical cases.

b. Long term: (a) MHPSS Training for health workers in the affected areas (Psychological First Aid, How to deal with traumatic situations, etc). (b) Continue to provide MHPSS services and support for victims; (c) Monitoring the patients and their psychological cope development after some months.

e. Child Health vii. It is suggested that further collaboration with the provincial health authorities and UNICEF

should be enhanced on nutrition programme as most of the services are currently neither provided at health facility level or community level.

e. Communicable diseases viii. It is recommended to carry out an in-depth assessment on the laboratory service availability in

the affected municipalities in order to guarantee adequate and early detection of communicable disease outbreak.

ix. Furthermore, it is highly recommended to carry out Crash Course training on SPEED to increase reporting coverage. Prior to the earthquake only the Municipal Health Officer and the Public Health Nurse received the SPEED training.

3. Status of health services and health human resource concerns in ECs

i. It is recommended to further analyse the IDP situation and the establishment of evacuation

centres in the affected municipalities in order to assure to these vulnerable groups access to health services.

4. Cold chain integrity and immunization services

a. Condition of cold chain equipment i. A special recovery team should try to rescue and salvage some cold chain equipment (fridges,

ice boxes, vaccine carriers and ice packs) from the rubble in the severely damaged RHUs. All equipment should be properly tested before usage.

ii. Try to maintain as good as possible all CC equipment for proper functioning. Especially the refrigerators as they are the lifeline to the children and people.

iii. Keep freezer compartments ice free, check all icepacks for leakage. iv. Keep as much as possible food and beverage out of the EPI fridge as temperature may rise with

frequent opening of the refrigerators


v. PHO cold chain equipment in Tagbilaran needs urgent maintenance, revisions and cleaning of the interior compartments of fridges and freezers.

vi. MR-OPV SIA 2014 will be an excellent opportunity to orient immunization health staff in basic cold chain management

b. Cold Chain equipment needed / requested v. The list from 2 teams of cold chain equipment needed / requested needs to be consolidated and

assessed by DOH / PHO and health partners and decided to send what’s readily available and to procure what’s not

c. Condition of vaccines and diluents vi. Even some of the vaccines have VVMs that have not reached stage 3 from some of the damaged

RHUs, it is recommended to discard them, even they are theoretically still potent as RHUs and PHO don’t have the capacity to test the vaccines. This is also important for the level of confidence of the health workers towards the service they provide to the public.

vii. MR-OPV SIA 2014 will be an excellent opportunity to orient immunization health staff in basic vaccine management, including emergency procedures

viii. Diluents do not have to be stored in the fridge but should be kept at 2 to 8 degree C just 12 to 24 hours before reconstitution. This to avoid overload of the refrigerators.

d. Situation of staffing and continuation of services ix. It is essential to get the correct consolidated information from the PHO on how many children

(and what age group (< 15 y?)) are already vaccinated for measles (MMR) by the different RHUs before any further mass immunization intervention would be advised to be planned province wide.

x. As routine MMR coverage remains low (generally below 70%) there is an opportunity to advocate for higher attendance of the routine program by conducting a short & sharp social mobilization campaign in all ECs to advocate for the routine immunization program at the RHUs and operational BHSs or outreach programs.

xi. Resume outreach immunization services to the barangays as soon as all necessary vaccines and equipment is available and accessibility permits. If BHS is not safe to work in, services can be given in other public or open-air locations

xii. As at least 30% of the target population is missed in the MMR routine immunization program, this indicates that the outreach program is not fully reaching all targets. This may be due to various factors but the given emergency situation provides an opportunity to catch up with community leaders and religious leaders who may be displaced along with their populations in the evacuation centers

xiii. Many NGOs are currently active in the ECs and could be approached to help with social mobilization campaigns to promote the routine immunization program.

5. Access to water supply and quality control in health facilities

a. Immediate Solution:

i. The increasing cases of diarrhea suspects suggests that water quality of drinking water is declining. Despite availability of water, its quality is becoming questionable due to lack or inadequate chlorination and even poor maintenance of drinking water storage. To immediately address this concern, chlorine disinfectant should be used at the point of use particularly in areas where water systems are not chlorinated or with below standard level of chlorine residual. There is a need to coordinate with UNICEF and DOH to ascertain WHO assistance for this item.


ii. Bacteriological water quality of water refilling stations has to be verified.

iii. Portable water test kits should be made available to regularly test the quality of water supply. Priority parameters that should be measured are residual chlorine and bacteriological quality.

iv. Portable water test kits should be made available to regularly test the quality of water supply. Priority parameters that should be measured are residual chlorine and bacteriological quality.

v. A Local Drinking Water Quality Monitoring Committee as required by the Sanitation Code has to be organized, activated, and trained on water quality monitoring to ensure that water quality is monitored and an action is provided if there are findings in water quality.

b. Long-term solution: vi. Damaged water supply systems are starting to recover and could stabilize in three months’

time. However, water quality maintenance is observed as a need. Training on water safety planning for waterworks system should be conducted to come up with the development and implementation of water safety plan in priority water supply systems.

Loon RHU - External & internal structural damage on pillars, beams, walls, ceiling at the entrance

Sagbayan RHU - exterior and Interior damages

Catigbayan RHU – Interior and Infrastructure damaged

Antequera RHU – Birthing centre. External structural dam on pillars and walls

Balilihan RHU - new wing interior damaged structure

Catigbayan RHU - entrance used as consultation room

Sagbayan Temporary RHU – under plastic seeting

Evacuation Centre in the Caligbian municipality

Sagbayan – Evacuation Centre behind the temporary RHU

Sagbayan Temporary RHU – national NGO Querra

Loon temporary RHU - EPI fridge in tent

PHO Tagbilaran- Cold storage room operational

Loon temporary RHU under tent: working cold chain

Sagbayan – Philippine’s Red Cross water supply and chlorination

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