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MODULE TITLE

INTER-REGIONAL TRAINING COURSE ONPUBLIC HEALTH AND EMERGENCY MANAGEMENT IN ASIA AND THE PACIFIC

RECOVERY AND RECONSTRUCTION

ROLE OF THE HEALTH SECTOR

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Learning Objectives

By the end of this course, the participant should be able to:

• Describe health needs, risks and services in disaster recovery and reconstruction

• Discuss processes for recovery and reconstruction of health services and infrastructure within the larger context of community recovery and reconstruction plans

• Discuss the opportunities presented for health risk reduction and health systems capacity development during disaster recovery and reconstruction

• Describe the roles of an HEM in managing health in disaster recovery and reconstruction

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Disaster Recovery

Recovery “... focuses on how best to restore the capacity of the government and communities to rebuild and recover from crisis and to prevent relapses. In so doing, recovery seeks not only to catalyze sustainable development activities, but also to build upon earlier humanitarian programs to ensure that their inputs become assets for development.”

(source: United Nations Development Program 2001)

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Q&A

What are the factors in recovery and reconstruction that might provide opportunities for long-term capacity development?

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Warning Indicators(Flash Points)

WARNING PHASE

Months / Weeks / Hours

EMERGENCYPHASE

Days / Weeks

MitigationPreparedness

Search & Rescue

Emergency Relief

Rehabilitation

Reconstruction

Ongoing Development

Rapid / Detailed Assessment

SuddenImpact

Rehabilitation / Recovery

Many Months

TIME

AC

TIV

ITY

12

34 5

Emergency Response and Recovery

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Health Roles in Managing Risks Over Time

stagetime-frame

general needs health needs

immediatefirst 24 hours

search and rescueevacuation / shelterfoodwaterpublic information system

first aid

triage

primary medical care

transport / ambulances

acute medical and surgical care

emergency communication, logistics and reporting systems (including injury and disability registers)

short-term

end of first week

securityenergy (fuel, heating, light, etc.)environmental health services for:•vector control•personal hygiene•sanitation, waste disposal etc.

emergency epidemiological surveillance for Vector Born Disease, Vaccine Preventable Disease, Diseases of Epidemic Potential

control of disease of public health significance

control of acute intestinal and respiratory disease

care of the dead

general curative services

nutritional surveillance and support (including micronutrient supplementation)

measles vaccination and Vitamin A

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Health Roles in Managing Risks

stagetime-frame

general needs health needs

medium term

end of first

month

protection (legal and physical)employmentpublic transportpublic communicationspsychosocial services

(re) establishment of the health information system

restoration of preventive health care services such as EPI, MCH, etc.

restoration of priority disease control programmes such as TB, malaria, etc.

restoration of services of non-communicable diseases / obstetrics

care of the disabled

long term end of 3 months

educationagricultureenvironmental protection

reconstruction and rehabilitation

specific training programmes

health information campaigns / health education programmes

disability and psychosocial care

conclusion compensation / reconstruction

evaluation of lessons learned

restitution / rehabilitation

revision of policies, guidelines, procedures and plans

prevention and preparedness

upgrade knowledge and skills, change attitudes

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From Response to Recovery and Reconstruction

If there is no clear cut boundary between responses and recovery processes… this means:

Don’t wait, think ahead!

Build on the momentum of response to anticipate longer-term recovery and reconstruction.

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Long-term Health Considerations for the Recovery Process

Psychosocial

Concurrent problem due to disaster: decrease in mental health services, increase in incidence of common mental health problems• Psycho physiological• Behavioral• Emotional• Cognitive

Emergency health care system addresses acute cases and initiate long-term plan for community- based psychological interventions.

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Long-term Health Considerations for the Recovery Process

Emergent and Re-emergent illness• Monitoring for delayed / ongoing health impacts• Surveillance for potentially emergent and re-emergent

endemic diseases or areas

Environment• Clean-up, hazard reduction and environmental management

of the incident site

Housing• Permanent Accommodation

Access to regular Services• Resettlement and / or Repatriation

Worst possible plan is to resettle

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Health Recovery and Reconstruction Within Community Recovery and Reconstruction Plans

Community recovery and reconstruction addresses essential infrastructure and services:

• Building and permanent installations living

• Energy

• Water

• Food

• Waste disposal

• Education

• Health

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HEALTH - A Systemic approach

It is crucial to consider ‘health’ in recovery and reconstruction as a system, operating in

collaboration with other systems.

A systemic approach to health draws attention to:• Facilities and infrastructure• Health care resources (medicines, PPE, supplies,

etc)• Financial resources• Human resources

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HEALTH - A Systemic Approach

A systemic approach to health enables:

1. Adequate strategies• Understanding and enhancement of capacity of health

system to meet the health needs of population • Understanding of and mitigation of system’s main

vulnerabilities• Understanding and filling of gaps in system - for instance,

inclusion of surge capacity considerations

2. Appropriate allocation of resources throughout the health care system

3. Lessons learned from disaster in own or other countries to be incorporated into health system recovery and reconstruction

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Principles of Health Recovery Plans

1. Look at the big picture

2. Be country-owned and backed by political commitment

3. Ensure community participation• People begin almost immediately to re-house themselves

and re-establish their social and economic networks after a disaster - build upon, don’t supplant community initiatives!

• People have good ideas of what they want to do to rebuild their lives - take their views into account when planning for recovery!

4. Take into account the overall context and the changes in this context (political, economic, social and military)

5. Establish partnership with ALL key stakeholders

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Principles of Health Recovery Plans

6. Use a ‘zoom approach’ (medium / long-term time frames, with short-term cycles)

7. Assess the functional health system elements of the affected community in relation to the community’s health needs

8. Develop and formalise arrangements for the effective management of the recovery process

9. Facilitate the rehabilitation and improvement of affected infrastructures as quickly as possible

10.Facilitate the recovery of affected individuals (physical, social)

11.Ensure general understanding of planning process and programme (agencies, authorities and communities)

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Principles of Health Recovery Plans

11.Describe organisational networks and structures appropriate to recovery process (different types and scale events)

12.Be reviewed on a regular basis

13. Incorporate performance indicators and measurable results into the plan, in order to readjust the strategy to the outcomes.

14.Set out appropriate resourcing arrangements

15.Define responsibility for the range of specific services to be provided

And… ALWAYS CONSIDER LONG-TERM CAPACITY DEVELOPMENT AND RISK REDUCTION!

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Recovery, Capacity Development and Risk Reduction - Some Examples

• Reducing population vulnerabilities improving access to basic resources reducing exposure to disease vectors and

pests. improving knowledge of health risks and

mitigation strategies

• Improving factors affecting public health housing, water supply, sanitation, food safety,

nutrition, dietary security, personal hygiene.• Developing health system capacities

stronger, better located & equipped facilities better training for staff addressing systemic weaknesses

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Recovery Planning - Baseline Questions

what? vulnerabilities, available capacities & resources, support

who? target group & beneficiaries

how much / many? needs and limitations

who? responsible, involved, support,

where? co-ordination lines - (coverage, prevent duplication of services) overlapping of subdistricts

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Recovery Planning - Baseline Questions

how & when? appropriate response, reactive and / or proactive

how long? continuity & sustainability - (training, supervision, ownership, integration, financing), reconciliation, resettlement.

what type? policy, guideline or good will.

why? understand Root Issues and what is being done to address them?

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Recovery Planning - Health Assessment

• Identify new vulnerability to future disasters or make existing vulnerability worse.

• Failure to recover, or partial recovery, can make people more vulnerable.

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Guidelines for Delivery of Recovery Services 1

• maximise the flow of information

• make programs that enable the affected persons to actively participate in programs which affect their future

• maximise the use of local resources, groups and individuals (local suppliers and services)

• ensure effective liaison (recovery teams, volunteer resources and CBO’s).

• encourage practice that allow for self-determination and community involvement in restoration planning

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Guidelines for Delivery of Recovery Services 2

• make use of the existing structures, resources and local formal and informal networks

• ensure recovery workers are given ongoing support, debriefing, relief and rest

• aim at keeping families together (evacuation, temporary accommodation or resettlement)

• plan withdrawal of external recovery resource whilst ensuring continuity of the recovery process

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Roles of the Recovery Manager

• Ensure

appropriate strategies are in place

maximum community involvement

immediate & long-term individual and community needs

• Facilitate

acquisition, allocation of material

• Identify

staff and financial resources

• Promote

planning at all stages of the emergency cycle.

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Tasks of the Recovery Manager

• organise and manage resources, staff and systems.

• advocate (behalf of the affected community) with government departments voluntary agencies, the wider community, Business. other organisations

• liaise and consult (if necessary, coordinate) participating agencies, groups, authorities in order to achieve the most effective and appropriate recovery

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Tasks of the Recovery Manager

• provide information

• mediate where conflicts occur.

• develop relationships

• be partially distanced from the immediacy of the event to provide guidance overall recovery process establishing priorities anticipate future requirements

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THANK YOU