ninth inter-regional training course on public health and emergency management in asia and the...

NINTH INTER-REGIONAL TRAINING COURSE ON

PUBLIC HEALTH AND EMERGENCY MANAGEMENT IN ASIA AND THE PACIFIC

PHEMAP 9

HEALTH ASSESSMENTS

module 9

MODULE 9 HEALTH ASSESSMENTSPHEMAP 9

2

Learning Objectives

By the end of this module, the participant should be able to:• Discuss the role of the Health Emergency Manager in

Health Assessment• Discuss the purpose of Health Assessments including

the need for phased assessments corresponding to the different phases of health emergencies

• Describe the components of a Rapid Health Assessment tool and the process of conducting health such assessments

• Discuss the benefits and problems associated with health assessment processes, methods and technologies


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Group Activity

• Work in groups to discuss the data sheet handout. It is data from a recent earthquake in an Asian country.


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Earthquake August 2009 Red Province

COUNTY/ DISTRICT AREA (km2) HOUSEHOLDS

BASELINE POPULATION

PEOPLE KILLED

PEOPLE INJURED

PEOPLE HOMELESS

HOSPITAL BEDS

Dragon 2869 46500 160500 15000 50000 100000 1600

Tiger 4083 35880 105400 15000 5000 15000 1000

Lion 3216 81270 248000 5000 10000 80000 2400

Total 163650 513900 35000 65000 195000 5000

Questions:as a manager, what are your observations on this data ?as a manager, what does this data tell you about what you need to do ?

Additional questions:how many children under 5 ?how many pregnant women ?how many elderly ?

how much food do these people need ?how much water do these people need ?

how many doses of measles vaccine are needed ?how many deaths can you expect every week ?


5

Group Activity

• Work in groups to design the outline of a Rapid Health Assessment form for local staff to use in the scenario you have been assigned.

• The form is one that must be designed to collect information that can be submitted within 48 hours.

• At the end of the session, groups will work to revise and present their forms.


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The Purpose of Assessments

Q&A:

What is the purpose of conducting assessments in emergencies?


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The Purpose of Assessments

To give decision makers information that will allow them to make timely and appropriate interventions to:

• save lives

• minimise injury and illness

• prevent escalation of the emergency (increased

severity)

• prevent spread of the emergency to other areas

• support response and recovery planning


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Phased Assessments

• One assessment cannot collect all the information needed to manage all the phases of response, recovery and reconstruction

• Additional assessments are needed to determine the priorities and targets for immediate response, early relief and recovery, and longer-term recovery and reconstruction

• BUT to enable effective decision-making and to avoid duplication and ‘assessment fatigue’ coordination is crucial.


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Health Assessments are part of the HIS

Assessment is the first step in a continuous information gathering process that includes:

• Assessments of damage and analysis of needs (of the population and the responding agencies)

• Emergency Reporting system Morbidity and Mortality reporting (by age, sex,

location and cause of death) Surveillance of communicable disease, injury,

nutritional status, water quality and disability Ongoing monitoring of the effectiveness of

relief services (health and non-health activity reports)

• Evaluation of the operation


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Health Needs Assessments (DANA, RHA)

Reporting + SurveillanceHospitals cough + feverClinics and Health Centers diarrhea + feverLaboratories headache + feverPHC Programmes: rash + fever

nutrition myalgia + feverIMCI - epi, ari, cdd etc other fever

water and sanitation malnutrition <5svector control trauma, disability

MCH, safe motherhood DEP, VBD, VPD, DPHS, PUCD

? workload ? investigation

expected needs unexpected needs? enough supplies ? new supplies

? enough staff ? new staff? referral system working ? new referral system

institution focus disease focus

are we meeting the needs?

dailydaily


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Common Approach to Assessment Methodologies

• Methodologies should be based on standard health indicators

• Health assessments should take account of health status of population before the disaster

Health indicators can be used in Health Emergency Management for:

• Assessing disaster impacts and needs

• Monitoring and evaluating programme implementation and outcomes


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A Policy on Assessments

• Defines the general purpose of assessments Defines the data to be collected

• Defines the classification of victims• Defines the classification of damage

• Defines the format for the collection

• Defines the reporting schedule

• Defines the assessment roles and responsibilities of agencies and departments in preparedness and response

• Defines the knowledge and skills needed for assessments


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The All Hazards Approach and Assessment

• 80% of what we do in emergencies is generic – we do it for every emergency – the all hazards approach No need to wait for field information to do this

• 15% is specific to the hazard Much can be done before field data is available

but an assessment is needed to provide the quantitative data

• 5% is unique to the event – the people, the place and the time The assessment will provide all of this data


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Disaster Management is:80% generic 15% specific 5% uniqueto all disasters to the hazard to the event

1. Operational OrganisationEOC/command and control systems earthquake timecoordination mechanisms large numbers of trapped and injured placecommunications systems large numbers of homeless and displaced weathertransport and traffic management systems large numbers of dead and missinglogistics and supplies systems geographyassessment and reporting systems dead, injured and missing staff climateinformation systems and media management damaged critical infrastruture/resources (hospitals, vehicles)resource mobilisation/tracking systems loss of water, gas, electricity, phone, transport, fuel networksdonated supplies/foreign teams management systems loss of road, sea, air, rail infrastructure / access security

2. Response Operations politicssearch and rescue long period of Search/Rescue, victim extraction economyevacuation high demand for FA, stretchers, triage, medical transport governancemass casualty management high demand for beds, surgery, blood products, referralmanagement of dead and missing many wound infections, amputations, tetanus, dust inhalation emergency management capacitysecurity and traffic control high demand for orthotics, prosthetics, disability, dental logistics capacitytemporary shelter, clothing and utensils demand for specialised spinal and head injury care disposal of inappropriate donationsemergency water, sanitation and energy high demand for temporary shelter, food, utensils, stoves,emergency food / cooking supplies water, energy, clothing, tents, blankets leadershipemergency public and environmental health high demand for psychosocial support of victims and staff solidarityemergency engineering and public works severe disrupiton of public health services morale

3. Recovery Operations low risk outbreaks of communicable diseases corruptionlifelines variable demand for medicines and equipment crime / lootingcurative and public health care (acute/chronic injury care - high, infectious disease - low, lootingeducation potentially unstable chronic disease - medium)agriculture medium risk contamination of water and soil compensation claimstrade and commerce medium risk fertiliser, chemical, sewerage and gas leaks/spills insurance claims

4. Rehabilitation and Reconstruction urban fires, explosions ownership disputespeople contaminated, infested and unsafe foods property disputesproperty increased vector breedingservices high demand for debris clearance and disposal foreign assistancelivelihoods foreign teamsenvironment loss of livelihoods, markets, distribution networks

THIS IS WHAT WE PLAN FOR ….


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Multi-sectoral assessments


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Damage Assessment and Needs Analysis (DANA)

A multi-sectoral, team activity that uses standard protocols to collect data that is analysed to define:

• the causative factors of problems what needs to be done?

• the extent of the problem how much of which resources are needed?


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Damage Assessment and Needs Analysis (DANA)

• the likely trends for how long?

• constraints (climatic, geographic, political, social, logistical, organisational etc.)

• priorities and targets over the relief and recovery period


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Group Activity

Work in your groups to answer the following questions:

• What are the benefits of the health sector being involved in a multi-sector DANA?

• What can be some constraints to a multi-sectoral approach?


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Which Information?

The basic needs:foodwatershelterenergy / fuel

securityacute medical carehygiene and sanitation etc.

The population:demography, culture, geography, climatebaseline causes of morbidity and mortality

The support systems:information flowslogisticscoordinationcommunicationresource flows


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Pre-assessment Information

• any existing demographic information

• any existing national, provincial or district emergency profiles

• local risk assessments

• local capacity assessments

• inventory of resources and deficits

• maps

• directory of local staff and experts (government and NGO)

• lists of emergency materials and supplies

• logistics arrangements for emergencies

• standing orders and administrative guidelines


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Why Assess Damage?

• Guides the setting of relief priorities: Needs caused by damage:• Direct needs e.g. treat the injured – will the

damages affect this?• Indirect needs – caused by damage e.g.

loss of access to water supply Function and safety issues –– can a service be

delivered, is a building safe (building “triage”)• Evacuate or not ?• Can people access the service?• Repair or provide a temporary service?

• Guides planning for repair, rebuilding and reconstruction


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Factors Determining Damage and Needs

• the vulnerabilities of the affected communities and of different individuals and groups within those communities

• the readiness of response agencies

• the gaps in essential resources, including logistics capacities

• the impact, extent and duration of the hazard


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General and Health Needs

Vector Born Disease, Vaccine Preventable Disease, Diseases of Epidemic Potential, Diseases of Public Health Significance, Potentially Unstable Chronic Disease)

Stage Time-frame General Needs Health Sector ResponsibilitiesImmediate first search and rescue safe extraction, resuscitation and first aid

24 evacuation / shelter triage and transport system

hours food primary medical care

water detoxification / decontamination

public information system acute medical and surgical care (first line and referral)

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

Short term end of security emergency epidemiological surveillance for VBD, VPD, DEP, DPHS

first week energy (fuel, heating, light etc.) treatment and control of cases of VBD, VPD, DEP, DPHS, PUCD

environmental health services: strengthen blood banks and laboratories (diagnosis, confirmation, referral)

* vector control strengthen burns, spinal / head injury, orthotics / prosthetics, dental services

* personal hygiene strengthen referral system - curative, mental health and obstetric services

* sanitation, waste disposal etc. nutrition surveillance and support (including micronutrient supplementation)

dead and missing (emergency measles vaccination and Vitamin A)

Medium end of protection (legal and physical) (re) establishment of the health information system

term first month employment restoration of preventative health care services such as EPI, MCH, etc.

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

public communications restoration for services of non-communicable diseases / obstetrics

psychosocial services care of the disabled (mental and physical)

Long term end of education reconstruction and rehabilitation

3 months agriculture specific training programmes

environmental protection 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 and practices


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Categories of Information

The assessment involves the collection of two key categories of information:

• Analysis of the needs of the victims Immediate needs arising from the situation Future needs arising from damage / disruption

to services / infrastructure

• Analysis of the damage to: Critical resources Critical infrastructure and fixtures Critical services


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Information on Victims

A report describing the impact of a hazard will provide:

• Number of casualties• killed; injured; sick; disabled;• by age, sex, location and probable cause of

death

• Number of affected

• total affected; severely affected; critically affected;


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Classification Based on Severity

The following criteria are used to describe the severity of the impact on people:

• affected

all those living within the geographical area involved

• severely affected

those who have lost one or more of their lifelines

• critically affected

those who have lost all of their lifelines

OR who have been displaced i.e. those totally dependent on others to support them


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Critical Services - Basic Needs and Lifelines

Basic needs are the minimum requirements needed for the survival of the affected population (also called “pre-requisites for health”).

Q&A:What are the basic needs for survival of a population?


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Critical Services – Basic Needs and Lifelines

Basic needs for survival:

• water

• food

• shelter (and clothing in cold climates)

• energy (fuel)

• (acute medical care)


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Lifelines are services that are needed to deliver the basic needs.

Q&A: What lifelines can you identify that would enable the meeting of these basic needs?


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Critical lifelines:

• Utilities (water, electricity, gas) – sources and networks

• Communications systems

• Transport networks (air, sea, road)

• Distribution systems


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First priority of the government:

To restore lifelines and meet basic needs


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Assessing Facilities and Services

For each facility or service in the affected area, the assessment grades function according to a pre-defined scale:

For example:

• destroyed / no function possible

• more than 50% reduction in capacity

• less than 50% reduction in capacity

• undamaged / full function


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Health Assessments


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What is a Rapid Health Assessment?

“collection of subjective and objective information in order to measure damage and identify those basic needs of the affected population that require immediate response”

Rapid Health Assessment protocols for emergencies, WHO, 1999


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Public Health Consequences of Disasters

• temporary population displacements

• increased numbers of deaths and injuries

• new cases of disease and disability

• exacerbation of and increased numbers of cases of psychological and social behaviour disorders

• food shortages and nutritional deficiencies


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Public Health Consequences of Disasters - cont.

• environmental disruption causing hazards – vectors, waste management, sanitation

• destruction of infrastructure

• disruption to routine health services

• disruption to routine disease surveillance and control services

• diversion of capital investment funds to emergency relief and the rehabilitation or reconstruction of essential infrastructure


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Emergencies and Health

VULNERABILITIES

CAPACITIES

EMERGENCY

INDIRECT IMPACTS

DIRECT IMPACTS

HEALTH RESPONSE search and rescuefirst aidtriagemedical evacuationprimary care disease surveillance and controlcurative careblood bankslaboratoriesreferral systemspecial units (burns, spinal) evacuation centresshelterwaterfood and nutritionenergysecurity environmental healthprimary health care care of the deadpsychosocial caredisability care recoveryreconstruction

ASSOCIATED FACTORS Climate / weather / time of dayLocationSecurity situationPolitical environmentEconomic environmentSocio-cultural environmentMorale, solidarity, spiritCompetence, corruption

Damageand

Needs

Community


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Objectives of Rapid Health Assessments

Collection objectives

• identify existing and potential public health needs

• identify gaps and problems in meeting urgent medical needs

• assess existing and potential environmental risk factors

• assess resource and logistics needs

• identify managerial, coordination and organisational gaps, overlaps and problems


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Objectives of Rapid Health Assessments

Analysis objectives

• set priorities for response / relief

• set priorities for information dissemination and communication

• identify resources needed to meet priorities – external and internal

• identify additional information needs for the response and for planning recovery and reconstruction


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Questions Answered by a Rapid Health Assessment

• Is there an emergency or not?

• What is the existing response capacity?

• What decisions need to be made?

• What information is needed to make these decisions?

• What are the sources of that information?


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Categories of Information

The assessment involves the collection of three key categories of information:

• Analysis of the damage to: critical resources critical infrastructure and fixtures critical services

• Analysis of the needs of the response agencies immediate needs arising from the situation future needs arising from damage / disruption to services

/ infrastructure• Analysis of the needs of the victims

immediate needs arising from the situation future needs arising from damage / disruption to services

/ infrastructure


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Rapid Health Assessment task

The first task is to assess functioning of all the health facilities in the area (hospitals, clinics, laboratories, warehouses, blood banks, administration):

a. Staff – dead, injured, missing, absent

b. Access – can staff / people reach the facility

c. Buildings – damages, safety, loss of electricity / gas / water, loss of fuel (diesel)

d. Supplies and equipment damaged or lost, including vehicles


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Rapid Health Assessment tasks - cont.

The next task is to assess needs arising from loss function :

a. Temporary services needed?

b. Repairs needed?

c. Replacements needed (staff and materials)?


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Rapid Health Assessment tasks - cont.

The next task is to assess urgent health needs of the population:

a. Overview of actual and potential causes of morbidity and mortality, and numbers of cases

The final report will make recommendations on:

a. Resource needs

b. Personnel needs

c. Management and organisational needs

d. Logistics and communication needs


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Use the Coordination Mechanism

It is not necessary to go to the field to collect detailed information from other sectors

At the daily coordination meetings, reports and assessments from other sectors are shared – these can be sent as ANNEXES to health sector reports

The Emergency Reporting System should take over from assessments as soon as possible


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Planning a Rapid Health Assessment

• Set the assessment objectives, team skill needs and time frame

• Collect the data: reviewing existing information inspecting the affected area interviewing key people carrying out a rapid survey

• Analyse and interpret the findings

• Issue orders and instructions

• Disseminate the report and communicate the findings


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Preparing for an Rapid Health Assessment

• What information should I collect before going to the field?

• What collection methods are appropriate given: the specific context of the emergency, and weather, security, time, logistics, technical,

cultural constraints?

• What will be the main sources of information? Is an interpreter needed?


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Preparing for an Rapid Health Assessment - cont.

• What is the composition of the team and the role of each team member?

• What are the security, logistics and communication needs of the team?

• What equipment to take – maps, contact information, forms, specimen bottles, paper / pens, personal items


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Q&A

• Does your country have a policy and guidelines, protocols, standard forms for Rapid Health Assessment?

• Are people trained in health assessment?

• What are the common weaknesses of rapid health assessments?


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Rapid Health Assessment: Common Mistakes

• No policy or guidelines on assessment

• No standard collection formats

• No training in assessment skills

• Different sectors use different terms and methods

• Data cannot be consolidated

• Too much irrelevant/duplicate data collected

• Too much time taken – accurate is better than precise

• Those collecting the data don’t know how it will be used and don’t have the opportunity to improve the assessment system


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Rapid Health Assessment - Common Mistakes

The biggest mistake in forms used by the health sector is that they focus too much on collecting (unavailable or unreliable) morbidity and mortality data rather than health sector function information


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Resources for planning assessments


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WHO


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What is Available in the EHA Webpage?

• Short introduction with objectives

• Sitrep Template

• Instructions

• Reference Values


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Reference Values


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Activity

Based on what you have just learned, work in your groups to review and revise the form you developed in the first exercise


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Q&A

Is it possible to develop one single form that covers the assessment needs for all possible emergencies?


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Health Sector Assessments by Hazard Class

1. Natural Hazards• focus first on recording damage to health sector,

then on the needs of the health facilities to restore some function, then on the meeting needs arising from actual and potential causes of morbidity and mortality

2. Technological Hazards• focus on capacity to meet the needs arising from

the actual and potential causes of morbidity and mortality


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Health Sector Assessments by Hazard Class

3. Biological hazards• focus on capacity to meet the needs arising from

the actual and potential causes of morbidity and mortality

4. Societal Hazards• In conflict - focus first on recording damage to

health sector, then on the needs of the health facilities to restore some function, then on the meeting needs arising from actual and potential causes of morbidity and mortality

• In other situations - focus on capacity to meet the needs arising from the actual and potential causes of morbidity and mortality


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Different Needs, Equal Opportunities

Differences between individuals and groups can lead them to having different types and degrees of need(s), which might have to be met in different ways.

Examples of differences between individuals and groups: • Age• Sex/gender• Wealth• Social status, caste• Geographic location• Legal status• Ethnicity, race• Religion


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Recap: the Purpose of Assessments

To give decision makers information that will allow them to make timely and appropriate interventions to:

• save lives

• minimise injury and illness

• prevent escalation

• prevent spread

• support recovery planning


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Advantages of a Standard Template

• prepared for the people who need to use the information (managers, decision makers)

• controls what kind of information is collected standardised protocols for data collection standardised terminology, technologies,

methods and procedures enforces “Zero” reporting

• facilitates preparation of consolidated reports

• facilitates rapid analysis and dissemination


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Disadvantages of a Standard Template

• prepared by the people who need the information those collecting the information have no input

into design

• controls what kind of information is collected non standard information cannot be included

• standardises the terms used qualitative information might not be captured


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Needs Assessment and Programme Monitoring

Assess resources and Assess health status

infrastructure (morbidity, mortality, nutrition) Programme Indicators

Is there damage to health sector infrastructure?

1water, sanitation, waste, shelter, food supply and nutrition services in place / meeting needs

Is there damage to health sector resources?

Is there a major health problem? NO

2curative, preventative, promotional and rehabilitative services in place / meeting needs

Is there damage to lifelines? 3

situation specific preventative actions being taken – vector control, measles vaccination, vitamin A, public awareness, antenatal care etc

YES YES 4 guidelines issued and being followed

Can the health system cope? YES 5

reporting and surveillance systems for injury, disease, nutrition, water quality, vectors, food safety, mental health, disability in place

Can the community cope? 6referral systems in place, including laboratories, psychosocial, chronic diseases and disability care

NO 7essential drugs and equipment available, appropriate and sufficient

strengthen existing services/ organise temporary services

8management, logistics, security and communications systems in place / meeting needs

Mobilise additional resources 9 staff safety, information, training needs being met

Seek expert advice 10community health information / health education needs being meet

Organise epidemiological studies and surveys

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plans for rehabilitation and reconstruction address issues of equity, access, coverage and risk reduction


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Health Needs Assessments (DANA, RHA)

Reporting + SurveillanceHospitals cough + feverClinics and Health Centers diarrhea + feverLaboratories headache + feverPHC Programmes: rash + fever

nutrition myalgia + feverIMCI - epi, ari, cdd etc other fever

water and sanitation malnutrition <5svector control trauma, disability

MCH, safe motherhood DEP, VBD, VPD, DPHS, PUCD

? workload ? investigation

expected needs unexpected needs? enough supplies ? new supplies

? enough staff ? new staff? referral system working ? new referral system

institution focus disease focus

are we meeting the needs?

dailydaily


76

Learning Objectives

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

• Discuss the purpose of Health Assessments including the need for phased assessments responding to the different phases of health emergencies

• Describe the components of a rapid health assessment tool and the process of conducting health assessments

• Discuss the benefits and problems associated with health assessment processes, methods and technologies

• Discuss the role of the Health Emergency Manager in Health Assessment


77

THANK YOU

ninth inter-regional training course on public health and emergency management in asia and the...

Documents

health assessmentsphemap

health assessments module

purpose of health assessments

public health

health assessment processes

health emergency manager

health needs assessments

rapid health assessment