Health Sector Resources for Disaster

8/13/2019 Health Sector Resources for Disaster

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What is a Disaster?WHO defines Disaster as an occurrence that causes damage,economic disruption, loss of life and deterioration of health andhealth services on a sufficient scale to warrant an extraordinaryresponse from outside the affected community of area of effect.

Disasters happen when the forces of a hazard (an extremedisruptive event) impact on vulnerabilities (physical & socio-economic) and overwhelm the ability of the affected community tocope on its own.

Disaster = Hazard X Vulnerability

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Community Coping Capacity

Remember not all communities are at risk of every type of disaster, but every community is at risk of some particular disaster.


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Top 10 most important disaster bynumber of killed in 2007s

Event Country People KilledCyclone Sidar,November

Bangladesh 4234

Flood, July August Bangladesh 1110

Flood, July-September India 1103

Flood, August Korea Dem. P. Rep 610

Heat wave, July South Europe and theBalkans

567

Flood, June July China P. Rep. 535

Earthquake, August Peru 519Cyclone Yemyin, June Pakisthan 242

Flood and Landslides,June

Pakisthan 228

Flood, July India 225

Total 9373Source:Annual Disaster Statistical review,CRED,Belgium


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List of Natural Disasters (Recent Past)Disaster PlaceCyclone, 1997, 1999 Gujarat, Orissa

Flood, 2000, 2004,

2005,2007,2008

Assam; Bihar; WB; Gujarat;

Orissa; Uttaranchal; TamilNadu; MaharashtraEarthquake, 1997; 1999;2001;2004; 2005

Maharashtra; MP; UP; Gujarat; Andaman & Nicobar; J&K

Landslide, 2004 Kashmir; Shimla, Northeastregion

Tsunami, 2004 South IndiaHeat Wave, 2004 Delhi, Haryana, UP, Punjab


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Impact

Two billion people face health threatsbecause they are at risk of or exposed to

crisis conditionTwenty million people or 50 countries areactually in crisis

Sixty Five percentage (65%) of Epidemicreported worldwide occur in complexEmergencies.


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IMPACT: The larger picture

Human lives

Livestock, other animals

Private property

Livelihoods

Municipal infrastructure

Power/telecommunicationsinfrastructure

Health/ education assets

Gujarat earthquakeestimate:

US$ 3189 Million

Direct losses

Export/ import

Agricultural output

Industry/ services output

Remittance income

Fall in earning potential(due to disability,trauma etc.)

Unemployment

Health hazards


US$ 635 Million

Indirect losses

Long-term development

Overall investmentclimate

Funds reallocation

Community migration/relocation


US$ 2097 Million

Tertiary losses


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Mortality due to natural hazards inIndia

Name ofCountry

Deaths caused by naturaldisasters

Natural disasters mortalityratio (per 100,000 deaths)

India1991-1995

1996-2000

2001-2005

2006 1991-1995

1996-2000

2001-2005

2006

20,727 28,605 48814 698 47 63 103 7

Source: ESCAP Statistical Yearbook for Asia and the Pacific 2007:

http://www.unescap.org/stat/data/syb2007/


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Damaged caused by Mass casualtyEvents due to Natural Disasters in India

Year People affected( Lakh)

Houses &buildings,partially ortotallydamaged

Amount ofpropertydamage/loss(Rs Crore)

1998 521.7 1563405 0.72

1999 501.7 3104064 1020.97

2000 594.34 2736355 800.00

2001 788.19 846878 12000


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How vulnerable we are?

In India, more than 80% geography

exposed to major and localizednatural hazards with 53% earthquake,

27% draughts, 12% Floods and 8%cyclones probabilities.


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Country vulnerability profile-at a glance

Andhra Pradesh -8 Madhya Pradesh -15

Arunachal Pradesh-8 Maharashtra-6

Assam -17 Manipur -3

Bihar -4 Meghalaya -1

Chhatisgarh -5 Mizoram-(Data not available)

Delhi -2 Nagaland -5

Goa -2 Orissa -6

Gujarat -7 Punjab -11

Haryana -6 Rajasthan-(Data not available)

Himachal Pradesh -8 Sikkim -4

Jammu & Kashmir -3 Tamil Nadu -6

Jharkhand -2 Tripura -4

Karnataka -6 Uttar Pradesh -27

Kerala -11 Uttaranchal -2

West Bengal -5

Vulnerability analysis of 27 states & 184 districts:
http://www.nidm.net/Multiplehazards3_Assam.asphttp://www.nidm.net/Multiplehazards1_Andhrapradesh.asphttp://www.nidm.net/Multiplehazards15_Madhyapradesh.asphttp://www.nidm.net/Multiplehazards2_Arunachalpradesh.asphttp://www.nidm.net/Multiplehazards16_Maharashtra.asphttp://www.nidm.net/Multiplehazards3_Assam.asphttp://www.nidm.net/Multiplehazards17_Manipur.asphttp://www.nidm.net/Multiplehazards4_Bihar.asphttp://www.nidm.net/Multiplehazards18_Meghalaya.asphttp://www.nidm.net/Multiplehazards5_Chhatisgarh.asphttp://www.nidm.net/Multiplehazards6_Delhi.asphttp://www.nidm.net/Multiplehazards20_Nagaland.asphttp://www.nidm.net/Multiplehazards7_Goa.asphttp://www.nidm.net/Multiplehazards21_Orissa.asphttp://www.nidm.net/Multiplehazards8_Gujrat.asphttp://www.nidm.net/Multiplehazards22_Punjab.asphttp://www.nidm.net/Multiplehazards9_Haryana.asphttp://www.nidm.net/Multiplehazards10_HimachalPradesh.asphttp://www.nidm.net/Multiplehazards24_Sikkim.asphttp://www.nidm.net/Multiplehazards11_Jammukashmir.asphttp://www.nidm.net/Multiplehazards25_Tamilnadu.asphttp://www.nidm.net/Multiplehazards12_Jharkhand.asphttp://www.nidm.net/Multiplehazards26_Tripura.asphttp://www.nidm.net/Multiplehazards13_Karnataka.asphttp://www.nidm.net/Multiplehazards27_Uttarpradesh.asphttp://www.nidm.net/Multiplehazards14_Kerala.asphttp://www.nidm.net/Multiplehazards28_Uttaranchal.asphttp://www.nidm.net/Multiplehazards29_Westbengal.asphttp://www.nidm.net/Multiplehazards29_Westbengal.asphttp://www.nidm.net/Multiplehazards28_Uttaranchal.asphttp://www.nidm.net/Multiplehazards14_Kerala.asphttp://www.nidm.net/Multiplehazards27_Uttarpradesh.asphttp://www.nidm.net/Multiplehazards13_Karnataka.asphttp://www.nidm.net/Multiplehazards26_Tripura.asphttp://www.nidm.net/Multiplehazards12_Jharkhand.asphttp://www.nidm.net/Multiplehazards25_Tamilnadu.asphttp://www.nidm.net/Multiplehazards11_Jammukashmir.asphttp://www.nidm.net/Multiplehazards24_Sikkim.asphttp://www.nidm.net/Multiplehazards10_HimachalPradesh.asphttp://www.nidm.net/Multiplehazards9_Haryana.asphttp://www.nidm.net/Multiplehazards22_Punjab.asphttp://www.nidm.net/Multiplehazards8_Gujrat.asphttp://www.nidm.net/Multiplehazards21_Orissa.asphttp://www.nidm.net/Multiplehazards7_Goa.asphttp://www.nidm.net/Multiplehazards20_Nagaland.asphttp://www.nidm.net/Multiplehazards6_Delhi.asphttp://www.nidm.net/Multiplehazards5_Chhatisgarh.asphttp://www.nidm.net/Multiplehazards18_Meghalaya.asphttp://www.nidm.net/Multiplehazards4_Bihar.asphttp://www.nidm.net/Multiplehazards17_Manipur.asphttp://www.nidm.net/Multiplehazards3_Assam.asphttp://www.nidm.net/Multiplehazards16_Maharashtra.asphttp://www.nidm.net/Multiplehazards16_Maharashtra.asphttp://www.nidm.net/Multiplehazards16_Maharashtra.asphttp://www.nidm.net/Multiplehazards2_Arunachalpradesh.asphttp://www.nidm.net/Multiplehazards2_Arunachalpradesh.asphttp://www.nidm.net/Multiplehazards2_Arunachalpradesh.asphttp://www.nidm.net/Multiplehazards15_Madhyapradesh.asphttp://www.nidm.net/Multiplehazards1_Andhrapradesh.asp


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Disaster Management CycleEmergency Response

Post-disaster: recovery

Preparedness

Prevention/Mitigation

Reconstruction

Rehabilitation

Response/Relief

Pre-disaster: risk reduction

Disaster

Emergency Response

Post-disaster: recovery

Preparedness

Prevention/Mitigation

Reconstruction

Rehabilitation

Response/Relief

Pre-disaster: risk reduction

Disaster

Opportunity for development

ResourceMapping


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Strategies For Disaster Management

Supporting and enabling mechanisms for the districts andstates.

Early warning & communication systems.

Coordinated, timely and effective response.Involvement of NGOs, Corporate and private sectors .

Time Bound Action Plan for Earthquakes, Floods & Cyclones.

Pro-active participation at the regional andinternational level.


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Effects of natural disasters on health

Effect Earthquakes

High winds(W/out

flooding)

Tidal waves /flash floods

Slow-onsetfloods Landslides

Volcanoes / Lahars

Deaths Many Few Many Few Many Many

Severe injuriesrequiringextensivetreatment

Many Moderate Few Few Few Few

Increased risk ofcommunicablediseases

Potential risk following all major disasters (Probability rises with overcrowding anddeteriorating sanitation)

Damage tohealth facilities

Severe(structure

and

equipment)

Severe Severe butnot localized

Severe(equipment

only)

Severe butlocalized

Severe(structure

andequipment)

Damage to watersystems Severe Light Severe Light

Severe butlocalized Severe

Food shortage(may occur due to

economic and logisticsfactors)

Common Common Rare Rare

Major populationmovements

Rare (may occur in heavily damagedurban areas Common (generally limited)


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Health Issues after a Disaster

Appropriate handling of the deadInjury and disability

Psychosocial problemsWater and Environmental sanitationCommunicable DiseaseReproductive and child health issues

Sustaining key health care delivery functions,including medicines and critical medical suppliesImmunizationCoordination


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Health events subsequent to a disaster

Medical Emergencies

Trauma, Burns, Drowning, Snake bite, Electrocution

Mass casualty management

Public Health Emergencies Water-borne diseases Vector- borne diseases Zoonotic Droplet- infections Direct contact (skin) Sexually transmitted diseases Psycho social disorders


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Health events that may lead to disaster

Epidemics

MeaslesDiarrhoeal diseasesVector borne diseasesMall Nutrition

Non communicable disease events

Traffic / Transportation AccidentsMass scale nutritional deficiency disorders

Biological warfare / Bio-Terrorism

PlagueAnthrax

Hemorrhagic-Ebola, MarburgGenetically engineered organisms


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How to Deal the Health Issues

after a Disaster ?


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A need for contingency planning

Two Components :

1) Logistics Planning Inventory of resources(existing + required)

2) Technical Planning Investigations, treatment,control


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Health sector resources required for

emergency management Budgetary provisionTrained PersonnelMedical care/ FacilitiesLaboratory support

Equipment and suppliesField teamsImmunizationVector controlCommunicable Disease Surveillance

Environmental sanitationTransportCommunicationCommunity participationExternal aidProper guidelines


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Where are these resources

AvailableCommunity levelBlock levelDistrict levelState levelCentral levelExternal AgenciesPresently India does not require any external support tohandle any disaster but in some situation the countrymay look for technical support to bridge the immediateneed.

Government


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Preparedness

1. Hazard mapping/ vulnerability mappingMapping of infrastructure facilities

Risk assessment of facilitiesInventory of equipments & suppliesManpower

2. Preparedness & Contingency Planning3. Hazard Mitigation & Vulnerability Reduction4. Capacity building for coping5. Integration with Development Planning


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Hazard mapping/vulnerable

mapping1.Mapping of health facilitiesRisk assessment of health facilities

Inventory of equipments & suppliesLaboratory facilitiesBlood Banks

2. Mapping of Human resources Specialists, para-medical and support staff

Training - content, methodologyMotivation

3.Mapping the Private Facilities Types of Health facilities Trained health care professionals Ability to render the health care need during emergency Motivation


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Hazard mapping/vulnerable

mapping cont Mapping the Communications facilities:

-Independent system like the army or the

police? Strengthening the existing system?-Ham radios, satellite communication,telephone and mobile connectivity etc.-Linking all health care facilities .

Mapping the Transportation facilities: Ambulance, vans, Public transport etc


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Resource mapping at village/GPlevel

Health workers ( ANM/MPW(M)/Village health nurse) at village/GPlevel can play vital role in health resource management duringemergency with active involvement of community. They should beinvolved in -Development of the Village health plan / village contingency planand formation of village level task force for different activities withactive participation of local community and volunteers.Mapping the infrastructure facility (School/Community centres/villagelibrary etc)Listing out the Drug Distribution Centre, Fever Treatment Depot,CBO health facilities, if any.Maintaining the stock of the health inventories and supplies and

putting request to the PHC if there is a difference between demandand supply.Preparing a roster of trained health personnel in the village/GP andits catchment area who can provide /facilitate the health services inemergency.Listing out the drinking water sources in the area


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Resource mapping at village/GPlevel cont.

Maintaining and updating the data bases of important telephone andmobile numbers Ambulance, Police, health centres, PWDs and also theofficials who can be immediately contacted in disaster.Listing out the communication facilities available in the village/GP -personal vehicles, Auto , trucks, minibuses, motor cycles etc.Ensuring that in the catchment area each village has its contingencyfund.Ensuring that village community are trained in early warning system. Preparing the database of the vulnerable population i.e. women, children,elderly, pregnant ladies, disable persons and people required specialneed .Sensitize the community about their vulnerability and inform them aboutthe health care facilities available at the sub centre and nearby healthcenter. Disseminate the health message, distribute IEC/educational leafleton dos and dont during disasters. NB: The community have the ability to cope up with the disaster to some

extent till the external assistance reaches them. - Making them awareabout their vulnerability and building their capacity are crucial fordisaster management and resource mobilization.


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Resource Mapping at Block/District level:

Though Block Development Officer (BDO) and District Collector is the overallcoordinating authority for disaster management at block and district levelrespectively. For Health Sector the responsibility lies with the Block Medical Officer(BMO) and Chief Medical Officer (CMO).

Preparing the block/District health sector contingency plan.Hazard mapping/ Vulnerable mapping.

Health Resources Mapping block/district as a whole listing out the health facilitiesboth govt. and non govt. sector( NGO run facilities, Nursing home etc), blood banks,accident and trauma management centers. Database of health personnel - specialists, medical officers (both govt. and nongovt.) paramedical staff, Health workers/ANMs etc.CMO to maintain a data base of specialists and medical officers of its adjacentdistricts.Listing the transport facilities- Ambulance, vehicles with govt, private/NGO.Listing the mobile health units available in the district.Proper logistic management ( Drugs/vaccines/equipments)Listing the drinking water facilitiesMaintaining and updating the contact details of line departments like- PHED, PWD,Revenue, agriculture, education, Social Welfare, Police station and fire station etcand coordinate with them .


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Resource mapping at state level

The Relief Commissioner is the overall coordinator for disaster mgt. ForHealth Sector the responsibility lies with the Director, Health services

Preparing state level health sector contingency plan.Consolidate the district level Hazard mapping/ Vulnerable mapping

data.Development of Health sector Guidelines in consultation with centralauthority.Health Resources Mapping at state level listing out the healthfacilities both at govt. and non govt, medical colleges, charitablehospitals, medical research institutes.Database of health personnel - specialists, super specialists, medicalofficers both at govt., non govt.Listing the mobile health units available in the stateListing the transport facilities- Ambulance, vehicles with govt,private/NGO.Proper logistic management. Update the database of NGOs/INGOs working in the state and assesthe types of health related assistance can be expected from themdurin emer enc


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Resource mapping at Central level

The Ministry of Home Affairs/ NDMA is the overall coordinating authorityof

disaster management at central level. For Health Sector theresponsibility lies

with the Director, Emergency and Medical Relief, MoH&FW.Preparing the national level health sector contingency planConsolidate the state level Hazard mapping/ Vulnerable mapping data.Developing standard guideline or tool to asses the risk of the facilitiesfor different types of disastersBuilding bylaw and standard code for types of health resourcesneeded for different types of disasters.Provide need base training to health personnel both at state andcentral levelsMobilize the emergency fund, drugs, and technical experts to theaffected states during disasterData base on important specialty facilities, technical experts andresearch institutes.Database of UN agencies/ INGOs to asses the possible health


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Coordination for resource mobilization

Health relief assistance should be made available inconsultation with designated officials coordinatinghealth-related humanitarian assistance.

Observe procedures for communication,coordination, and supervision established byauthorities.

Needs-assessment must be carried out promptly bynational health/state authorities to mobilize theresource.

GIS mapping of the health resources need to bemade available for effective resource mobilisation.(This need to be done before hand)


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Coordination for resource

mobilization cont Govt to analyse the strength and weakness of theinterventions and to inform donors the need.

Donors not to compete with each other to meet thevisible needs of an affected areas and make optimaluse of resources.

Emergency assistance should complement and not

to duplicate.


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Issues regarding resourcemobilization

Pre hospital care Pre hospital care andmass causality management rarely exist in

civilian sectorHospital organizations Multipleagencies/Hospitals work in

isolation/emergency and criticaldepartments are inadequate/Lack ofhospital disaster management plan


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Issues regarding resource

mobilization.cont. Poor logistic management:Limited medical supply.No stock pile for surge capacity.

Tedious Procurement procedure.Poor inventory and supply chain management.

Inadequate trained manpower:

Shortage of specialists, nurses and technicians.The vacant positions of basic specialists areprofound in vulnerable district/ block level healthfacilities and CHCs


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mobilization Cont Inadequate Blood bank facilitiesHuge training load :

Doctors at district/ sub-district level have to be trainedon the basic and advance life support.

Limited numbers of doctors trained on mass causalitymanagement at district level.

Nurses have to be trained on managing masscasualty incidents and primary health carefunctionaries and community workers on MedicalFirst Responders


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mobilization cont

Majorities of hospitals dont have a

disaster management planMost of the hospitals are incapable ofmanaging mass causality


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Capacity Development a

Priority Area:Capacity Development in the health sectoris a priority area.

Disasters can only be tackled in anappropriate way if there is an adequateavailability of skilled manpower supported

by essential material logistics andinfrastructures


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Capacity Development a Priority

Area: Cont Human Resource:

There is shortage of anesthetists, neurosurgeons,psychiatrists, orthopaedic surgeons,

doctors, nurses, paramedics and technicians.

Gap in human resources are much more profound in

district/ taluka/and community health care hospitals

For mass casualty management mobilization of humanresource from neighboring districts/states/centredepending upon the magnitude is the preferred strategy.


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Area: Cont Material Logistics: State run hospitals have limited medical supplies and thereis no stockpile for surge capacity.

There is a need to strengthen medical inventory and supplychain management.

The national medical resource inventory needs to benetworked with various state medical inventories.

Newly created districts need appropriate health carefacilities.

The health care facilities at district levels need up gradation.


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Area: Cont Training and Education:

Need to evolve the training module and educationcurriculum for up gradation of mass casualtymanagement skills for doctors, nurses paramedicsat district levels, on basic and advanced life-supportsystems.Need to evolve standardized training modules fordifferent medical responders/community members atthe vulnerable areas.Education about the basic medical practices formanagement of mass casualties is required to bedeveloped at school and college level.Regular mock exercises are required to beconducted at the hospitals at least twice a year.


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Area: Cont Community Preparedness:

Community members are usually firstresponders, though their effectiveness becomelimited during disaster situations due to lack ofknowledge.Community education and awareness aboutvarious disasters and lists of Dos and Donts .

NGOs and Private Voluntaryorganisations(PVOs) need to be involved incommunity education and sensitization.Conducting regular mock exercises fordeveloping resilience in the community.

Health Sector Resources for Disaster

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