Nepal - WHOPAGE 1 *Availability of accurate information on health facilities’ statusfrom seriously...

*Availability of accurate information on health facilities’ status from seriously affected sites is a major challenge for the MoHP

HEALTH CLUSTER BULLETIN # 2 11May 2015

Nepal Earthquake Health Cluster Bulletin No. 4

18 – 26 May 2015

5.6 MLLION AFFECTED

2.8 MILLION DISPLACED

0 REFUGEES

21952 INJURED

8673 DEATHS

HIGHLIGHTS HEALTH SECTOR

It has been a little over a month since the first earthquake hit Nepal on 25 April, and response has transitioned towards: 1) operations in Districts and Village Development Committees (VDCs); and 2) early recovery and reconstruction. Health cluster partners continue to support the response and recovery operations along four strategic lines:

LEAD: WHO, as health cluster lead, supporting the MoHP to coordinate response in districts, to address public health needs of the affected population;

PREVENT: working in support of the MoHP to prevent outbreaks through early detection and effective response;

TREAT: supporting health facilities to treat priority diseases, including ensuring that health supplies and essential medicines reach the most in need, such as those in the most inaccessible districts;

REBUILD: supporting the rebuilding of the health system to ensure key public health needs of the affected population are addressed to prevent further aggravation of the compromised health status. Also, incorporating DRR and applying a ‘build back better’ approach to ensure more resilient health systems in the future.

170 HEALTH CLUSTER PARTNERS

5.6M TARGETED POPULATION

MEDICINES & SUPPLIES

>20 TONNES OF MEDICINE DISTRIBUTED

>28 TONNES OF MEDICINE IN IN-COUNTRY STORAGE

PUBLIC HEALTH FACILITIES

392* COMPLETED DAMAGED

531 PARTIALLY DAMAGED

HEALTH ACTION

103686 CASES TREATED

31707 ADMISSIONS

EWARN

32 - 40 SENTINEL SITES

FUNDING $US

21.4 % FUNDED

$41M REQUESTED

Situation update

Up to 26 May, just a little over a month after the first earthquake of 7.8 on the Richter scale struck Nepal on 25 April, followed by a 7.3 magnitude on 12 May and numerous aftershocks, the MoHP is reporting that there has been 8673 earthquake-related deaths and 21952 injuries. Of this amount, eight health workers and 10 FCHVs have lost their lives, 75 have been injured and two remain missing.

The Ministry of Health and Population’s (MoHP) Early Warning and Response System for epidemic-prone diseases (EWARS) show a generally stabilizing trend in numbers of outbreak prone diseases in the 14 severely affected districts. No major outbreaks have been reported to date.

Numbers of FMTs continue to decline, with the transitioning of the response to recovery phase. According to MoHP sitrep dated 26 May, 33 FMT are presently active in earthquake-affected districts and just about 100 FMTs have completed their task and left the country. At the same time, many of the over 900 damaged public health facilities in the 14 highly impacted districts have instituted temporary measures, normally through the use of tents, to permit their functioning in the short to medium term, while more permanent repairs are effected.

The Minister of Health and Population briefed the international community on the devastating earthquake and its impact in a side event on 20 May, during the Sixty-Eighth Session of the World Health Assembly (WHA) that took place in Geneva 18–26 May 2015.

The National Planning Commission is presently leading the post-disaster needs assessment (PDNA) process on behalf of the government. Health partners including External Development Partners are supporting this process in the areas of health, nutrition and water, sanitation and hygiene (WASH).

Total deaths: 8673 Table 2.1: Number of deaths and injuries reported by districts

SN Districts Total Health Workers ** FCHVs**

Deaths* Injured* Deaths Injured Missing Deaths Injured Missing

1 Sindhupalchowk 3438 1568 1 11 - 5 3 -

2 Kathmandu 1219 7830 3 4 - 2 2 -

3 Nuwakot 1061 1324 1 4 - 1 - -

4 Dhading 732 735 1 6 - - 1 -

5 Rasuwa 596 771 1 9 2 1 - -

6 Gorkha 440 952 - 2 - - 1 -

7 Kavre 318 952 - 12 - 1 - -

8 Bhaktapur 333 2101 1 - - - - -

9 Lalitpur 182 3052 - - - - - -

10 Dolakha 168 643 - 10 - - - -

11 Makwanpur 33 229 - 1 - - - -

12 Ramechhap 39 133 - - - - - -

13 Okhaldhunga 20 61 - 5 - - - -

14 Sindhuli 14 228 - 4 - - - -

Total 8593 20579 8 68 2 10 7 0

Other districts 80 1373 - - - - - -

Grand Total 8673 21952 8 68 2 10 7 0

Note: NA = Not available

Source: *Disaster Risk Reduction Portal, MoHA (as of 26th May 2015; 05:00 pm); ** DHO/DPHO, MoHP

For number of deaths and injured please visit: http://www.drrportal.gov.np/

Districts in the spotlight

Each week, the health cluster bulletin will zoom in on needs and health action in the most affected districts. This week, we take a closer look at the health situation in Sindhupalchowk and Rasuwa, two of the worst impacted districts.

http://www.drrportal.gov.np/

Sindhupalchowk

Health risks, priorities, needs and gaps

The second earthquake of 7.3 magnitude on 12 May had its epi-center in Sindhupalchowk district.

According to the MoHP Sitrep of 26 May, this is also the district that experienced the highest number of earth-quake related deaths (3438). Earthquake related injuries numbered 1568.

Most recent data from the MoHP shows that of the 82 public health facilities in the district, only six are presently functional; 65 are completely damaged and 11 are partially damaged.

Graphs depicting trend in cases of acute watery diarrhea, fever, and acute respiratory infections (ARIs) as per data obtained from the MoHP’s Epidemic-prone diseases Early Warning and Response System (EWARS) are shown below:

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During the reporting period, a rapid response team (RRT) mobilized to investigate to a suspected diarrhoea outbreak in Gumba VDC, Sindhupalchowk found and treated 12 cases of amoebic dysentery. Sporadic cases of diarrhea and dysentery were also reported from Selang, Sipa Pokhara, Thokarpa Shikharpur and Chautara VDCs. A RRT was mobilized to Selang which had the largest numbers reported, but no outbreaks were identified. In the above encounters, the DHO with the support of partners treated all sporadic cases, conducted health education campaign, and addressed any water and sanitation issues identified.

MoHP has set up a Casualty Triage Desk at the Airport to triage critical patients brought by the air route, perform basic initial symptomatic management, and refer them to the public hospitals or the temporary hospitals operated by foreign medical teams (FMT) as appropriate. Sindhupalchowk is the district with the highest number of patients processed by the desk – 281 of the 443 casualties triaged and referred from the desk up to 26 May 2015.

The continuity of maternal and child health care services is a major concern. At least fifteen of the district’s twenty-two maternity clinics are reported to have had collapsed. However, up to 26 May, 13 were reportedly back up and running.

A rapid assessment of vaccines, supplies and cold chain in the 14 most highly impacted districts, conducted by MoHP’s Child Health Division with support from WHO, has found that 70 VDCs/municipalities in the district have continued routine immunizations. Ten have stopped, possibly due to damaged facilities or lack of road access. Sindhupalchowk was the only district where there were concerns over the cold chain status and safety of vaccines.

According to the DHO, during a WHO/Child Health Division field visit on 19 May, there was a lack of temporary vaccine carriers, as well as problems with vaccine storage, in light of challenges with electricity supply. WHO and UNICEF are providing support to address these issues.

Health Cluster Action

The health cluster mechanism, led by the DHO with co-leadership from WHO has been established for the district. Meetings are ongoing as well as mapping of partners and activities.

Nine foreign medical teams are currently complementing the delivery of health care services in the district. Of these, Czech Republic, Japan Red Cross, Norwegian Red Cross, and Thailand are supporting the four temporary field hospitals presently operational in the district.

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WHO is supporting the DHO in disease surveillance and overall coordination as well as ensuring the continuity of essential services, including maternal and child health care services with the help of UNFPA and UNICEF. WHO is presently enhancing logistic capacity of its field presence in the district, to ensure the relevant and appropriate support is provided to the DHO and partners to avoid any roadblocks, especially in delivery of supplies and equipment.

Health partners in the district are working to restore maternity clinics and health care facilities demolished by the quake. The focus is on replacing the damaged maternity clinics with temporary arrangements to restart delivery of services immediately. One Heart, for example, is presently rehabilitating four birthing centers.

Women in outlying areas of the district, unable to access facilities are being airlifted to maternity clinics at the Norwegian Red Cross Field hospital in Chautara and a Japanese Red Cross Society health care facility in Melamchi.

WHO together with Child Health Division of MoHP, UNICEF, Population Services International (PSI) and Save the Children visited Sindhupalchowk district to field test a readiness assessment for Integrated Management of Neonatal and Childhood Illnesses (IMNCI) and child health services. During the visit, the team also engaged with Female Community Health Volunteers (FCHVs), who are integral players in the IMNCI readiness assessment, to provide sensitization on the process, as well as to distil their experiences, challenges, and recommendations.

To support the revitalization of primary health care services in the district, WHO together with World Food Programme (WFP), UNFPA, UNICEF, International Medical Corps, and International Organization for Migration (IOM) are supporting the MoHP to install Medical Camp Kits, to act as temporary primary health care centres until more permanent structures are erected.

Rasuwa

Health risks, priorities, needs and gaps

According to the MoHP, as of the 26 May, earthquake related deaths and injuries in the district numbered 596 and 771 respectively. Just over a quarter of the total 163,339 patients seen through outpatient departments (OPD) across the 14 highly impacted districts up to 15 May, were in Rasuwa (43,446). This is the highest of the 14 districts.

Information from the MoHP Sitrep of 26 May also indicates that of the 19 public health facilities in the district, only one is functional; 15 have been completely damaged and three partially damaged.

Graphs depicting trend in in cases of acute watery diarrhea, fever, and acute respiratory infections (ARIs) as per data obtained from the MoHP’s Epidemic-prone diseases Early Warning and Response System (EWARS) are shown below:

There is a pressing need related to the packaging and distribution of health supplies and equipment from the district headquarters to more isolated locations, before the landslides and road blockages anticipated during the monsoon season.

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The earthquake has affected most of the health workers in the district. Providing support for their recovery, including psychological support, is an important component of response and recovery efforts.


There is presently one temporary field hospital in the district, in Dhunche, which is operated by the Canadian Red Cross. Trekmedic, from Australian, is the other FMT supporting health care delivery services in the district. A recent visit by representatives from the MoHP/FMT Coordination Cell to the Canadian Red Cross operated field hospital in the district found that it is offering excellent services and is well coordinated with the DHO.

Save the Children is working on providing medical commodities, food and shelter to health workers as soon as possible.

To support the revitalization of primary health care services in the district, WHO together with World Food Programme (WFP), UNFPA, UNICEF, International Medical Corps, and International Organization for Migration (IOM) are supporting the MoHP to install Medical Camp Kits, to act as temporary primary health care centres until more permanent structures are erected.

Since the first earthquake of 25 April, a total of sixteen health cluster partners have provided varying types of support to the health response in the district.

Public health risks, priorities, needs and gaps

Communicable diseases

Monitoring of four syndromic diseases (acute respiratory infections, acute watery diarrhea, acute bloody diarrhea, and fever of unknown origin) continued through the MoHP’s Epidemic-prone diseases Early Warning and Response System (EWARS). The MoHP with support of WHO continues to work on improving data quality and data management in the system, both at central level with HEOC and at district level with sentinel hospitals.

Information on rumors or other alerts of suspicious episodes and clusters of diseases in the 14 most highly affected districts, is collected within the EWARS through media scanning, communication with peripheral health facilities, community leaders, foreign medical teams, and WHO surveillance medical officers, as well as daily telephonic follow up with districts health offices by Epidemiology and Disease Control Division, Department of Health Services. Rapid response teams (RRTs) and health facilities also remain on alert for potential outbreaks. During the reporting period, suspected diarrhea outbreaks were reported from Sindhupalchowk (see details above in district spotlight section), Dolakha and Nuwakot districts.

o Following a report to DHO Nuwakot on 21 May of cases of diarrhea in an internally displaced population (IDP) camp in Betrawati VDC, Qatar Red Crescent and Singapore Red Cross were mobilized and treated the approximately 48 cases, 23 of whom were under 5 years old. Symptoms have resolved and no new cases or deaths have been reported on subsequent follow up visits. The camp has approximately 400 persons.

o Local health workers verified a media rumor of diarrhea in Nandu VDC, Dolakha. Eight cases of mild diarrhea were detected and treated.

In Dhading district, 18 cases of chicken pox reported from Chainpur VDC were all treated by the RRT.

Four cases of tetanus in adult males, including two deaths, were reported from one hospital in Kathmandu. WHO provided 100 vials of Injection Tetanus Immunoglobulins to MoHP’s Logistic Management Division (LMD), 50 vials of which were subsequently handed over to Teku hospital.

China Medical Team (CMT) and National Public Health Laboratory (NHPL), on 2 May, set up a joint laboratory which can conduct 53 tests for common infectious diseases, drinking water, food, etc., with a testing capacity of around 100 samples per day. Up to 23 May, 354 samples had been

collected and tested (245 water samples, 5 food samples, 47 stool samples, 56 throat swab samples, 1 blood sample) from Kathmandu, Bhaktapur, Lalitpur, Gorkha, Dhading, Sindhupalchowk, and Kabhrepalanchowk districts.

o Laboratory reports of nine of ten stool samples from the above batch, collected from Sindhupalchowk, Dhading, Kathmandu and Gorkha, have shown no bacterial growth. Only one, from Dhading district, showed growth for Salmonella.

In Nepal, Tuberculosis (TB) remains an ongoing public health burden. To ensure the effective management of TB cases and continuation of its services, starting 20 May, Nepal’s National Tuberculosis Centre (NTC) conducted a post disaster rapid assessment of the National Tuberculosis Program. It included a rapid assessment of the functionality and structural damage of DOTS and microscopy centers in the 14 most affected districts, as well as guided interviews with one TB health worker and two multi-drug resistant (MDR) TB patients living in temporary camps

o 281 of the 779 DOTS in the 14 most affected districts were completely damaged by the earthquake and at least 256 suffered partial damage. At least 353 of the damaged facilities are presently functioning from temporary tents.

o At least 27 of the 120 microscopy centres, which were functional before the earthquake, are presently non-functional.

o NTC has identified the following key areas of action from the guided interview analysis: addressing living conditions of TB patients in temporary camps; increasing patient access to infection control measures and DOTS- through patient centered approaches; minimizing stigma and providing psychosocial support.

With logistical support from WHO, the NTC rapid response committee has also started tracing TB patients in the 14 most affected districts, with a priority to reach those with Drug Resistant TB (DR TB), In relation to the impact of the earthquake on the continuation of Anti-TB Treatment (ATT):

o At least 517 of the 698 TB patients enrolled in ATT on 24 April have continued ATT after 25 April.

o At least 134 of the 151 DR TB patients enrolled in ATT on 24 April have continued ATT after 25 April.

Trauma and injury

The injury and rehabilitation sub-cluster has been mapping community based rehabilitation services and local capacity for rehabilitation. The organizations that have already been conducting outreach in villages into which injured people have been discharged from district hospitals have noted a number of post-operative infections. This confirms the need for community level follow up to prevent long term disabilities and complications.

Step Down / Rehab Beds have been identified in a number of districts. However there are still notable gaps in Dolakha, Dhading, Ramechhap and Rasuwa. Hence, patients from these districts who require intensive rehabilitation are, for now, being transferred to step down units inside Kathmandu, or Green Pastures in Pokara.

There is a need for step down facilities in Kirtipur, in the Kathmandu Valley, where nine Orthoplastic Surgeons are currently doing 10-12 cases a day.

There are some specialities for which support will need to be sought from outside of Nepal, such as the orthotic technician required by Spinal Injury Rehabilitation Center (SIRC). However, the injury and rehabilitation sub-cluster is reiterating that there are adequate physiotherapists in Nepal, and if needed, organisation involved in rehabilitation should be focusing on recruiting Nepalese physiotherapists.

According to the International Organization of Migration (IOM), there are few tents available on an as needed basis, to support injured patients’ shelter needs on discharge.

Child health

MoHP’s Child Health Division with support from WHO assessed the capacity of the 14 highly affected districts to carry out routine immunization work. Most of the districts are in a position to resume routine immunization, despite the severe damage in the physical infrastructure. The cold chain in most of the districts is intact and vaccines are safe except in Sindhupalchowk district. WHO in close coordination with Logistic Management Division and UNICEF is working to make generators available and revitalize the cold chain system.

Reproductive health

The Reproductive Health (RH) sub-cluster has indicated that among the immediate RH priorities for the response are rehabilitating damaged birthing centers; ensuring safety and wellbeing of female health workers, particularly those living in damaged houses; and, providing confidential counseling sessions for women at risk, where they can talk about domestic violence, sexual, physical and mental abuse and other personal problems.

Functionality of health facilities and availability of essential services

MoHP, as of 26 May, has indicated that a total of 923 public health facilities, predominantly village health posts, are totally or partially damaged in affected districts. The capacity of those facilities to deliver services has been severely impacted due to damaged infrastructure, the shortage of medical supplies, and the heightened demand for post trauma and injuries care.

Services continue to be supplemented in the short term, by field hospitals in six districts, as well as mobile national and foreign medical teams. According to the MoHP, 9 of the 20 originally established field hospitals were still providing service, as at 26 May.

There is an immediate need to revitalize the destroyed primary health care centres especially ahead of the rainy season and the expected road cut off due to landslides as well as to ensure continued support to MoHP for the management of trauma and injuries cases.

Availability of health staff

The MoHP, as at 26 May, has indicated that there are health human resources needs in 38 Village District Committees (VDCs), in four of the 14 most affected districts (Gorkha, Ramechhap, Rasuwa, Sindhupalchowk) Personnel are needed for up to six months. Doctors, nurses, health assistants, and paramedics are in greatest need.


Health cluster coordination

The MoHP continues to lead the health cluster with co-leadership from WHO. The national level cluster meetings continue to be held twice per week - Monday and Friday.

Operational health cluster meetings have also continued in a number of districts, including Sindhupalchowk, Gorkha, Dhading, Nuwakot, Kavrepalanchowk, Dolakha and Rasuwa led by senior MoHP officials, with co-leadership from WHO. The three health sub-clusters - Mental Health, Injury and rehabilitation, and Reproductive Health - as well as the Foreign Medical Team Coordination Cell also continued regular meetings. However, with the reduction in numbers of FMTs, the MoHP is planning to combine the FMT Coordination Cell meeting with the regular cluster meeting.

In order to ensure a coordinated and predictable response, WHO is also supporting the health clusters at national and sub-national levels to map who the partners are responding in the health sector, what type of support they are providing, where, and for how long. Four updates of the 4 Ws have already been completed, but although improvements have been noted, there continues to be particular challenges to obtain information at the level of the Village Development Committee (VDCs).

Health cluster partners are presently participating in a process to revise the health component of the Flash Appeal for this emergency. It is being updated to cover the six months period until September 2015.

Communicable Diseases

WHO has supported the MoHP to develop a framework for a District Contingency Plan on Preparedness and Response to Diarrheal Diseases. This framework is presently being reviewed and adapted by DHO and partners, according to the realities, needs, and capacity existing in their respective districts.

China Medical Team (CMT) has prepared four technical notes, one each on Post-Earthquake Cholera, Hepatitis E, Measles, Typhoid Fever/Paratyphoid Fever Surveillance and Outbreak Response in Nepal in 2015.

Assessments

Assessments of the health care needs of the affected population are ongoing by the MoHP and health partners. Among the most recently:

WHO published an Initial Public Health Risk Assessment and Interventions document. The purpose of the assessment is to provide all health sector partners, including professionals of local and national authorities, non-governmental organizations (NGOs), donor agencies and United Nations agencies currently working with populations affected by the emergency in Nepal, with up to-date technical guidance on the major public health threats faced by the affected population.

WHO also published the Rapid Hospital Needs Assessment Report, with the results of assessments at 34 hospitals between 29 April and 3 May.

Nepal’s National Tuberculosis Programme has circulated a Preliminary Report of the Post-Disaster Rapid Assessment of the National Tuberculosis Program conducted within the past two weeks.

The above assessment reports can be accessed at https://www.humanitarianresponse.info/en/operations/nepal/health

Support to health service delivery

According to data from the MoHP, Foreign Medical Teams now number 33 active and registered with the government working in the earthquake-affected districts. The team consists of a total of 871 persons including 294 doctors and 274 nurses. About 8 – 10 will stay long term and be integrated into health systems projects/program, while others will continue to work in large type 2 field hospitals replacing critical infrastructure in the short term. The Government reiterated during the 25 May meeting of FMT Coordination Cell that there is no need for additional FMTs from outside Nepa, barring special cases in which bilateral arrangements have been developed with the MoHP.

Source: MoHP/FMT Coordination Cell

MoHP has also mobilized a total of 47 National Medical Team in 12 of the most affected districts i.e. Bhaktapur, Dhading, Dolakha, Gorkha, Kathmandu, Kavre, Lalitpur, Makwanpur, Nuwakot, Ramechap, Rasuwa and Sindhupalchowk.

International Medical Corps’ First Responders have provided a total of 3,286 primary health care consultations via mobile medical units (MMUs) in four districts—Bhaktapur (152), Kathmandu (55), Gorkha (1957) and Dhading (1122).

https://www.humanitarianresponse.info/en/operations/nepal/health

MoHP with support of health cluster partners is applying a four pronged strategic approach to guarantee continuity of health care services delivery:

o Supporting DHOs to re-establish normal activities: In this regard, over the next three months, the following FMTs will support district hospitals as follows: Rasuwa (Canadian Red Cross), Kathmandu Valley (Cuban Medical), Gorkha (IMC is replacing Swiss Team -SDC), Ramechhap (MDM Spain), Nuwakot (Bhutan Army is being replaced by MSF France and Qatar Red Crescent), and Sindhupalchowk (Norwegian Red Cross) Dolakha (Charikot - Nepalese Army for a few more days, and discussions are presently underway for their replacement in the longer term; Jiri - Nick Simmons Institute);

o Ensuring availability of step down facilities to lighten the workload of the District Hospitals (see section below on Trauma and Injury Care).

o Supporting hard to reach areas/VDCs with longer term placement FMTs: Gorkha, Aarughat (MSF France); Dolakha – 13 northern VDCs (MSF); Sindhupalchowk, Marming (Humedica). Need for additional placements are presently being assessed. Ongoing presence of FMTs will be valuable in these regions into the near future.

o Supporting revitalization of primary health care services - the Medical Camp Kit (MCK).

Revitalizing Primary Health Care Services – the Medical Camp kit More than 70% of public health posts (HPs) and (PHCs), often serving/reaching small populations in different difficult to reach areas in districts, have been partially or totally destroyed in the 14 highly affected districts. A large part of the work of health cluster partners in support of the MoHP is about the restoration of primary health care services from these destroyed health posts and public health centres. These facilities are important for delivery of primary health care (including ante-natal care, safe delivery and neonatal care), as well as, prevention of any

disease, and the point of delivery for early treatment of various conditions the affected persons may be experiencing in the aftermath of the earthquake.

A rapid response approach to getting these facilities up and running is key to revitalizing health services – prior to any other effort in early recovery and reconstruction. This is being done through a complete package of tented facilities with essential medicines and supplies package – the MCK (Medical Camp Kit) -, a temporary measure, to begin primary health care services in the worst affected areas of the districts before the monsoon begins.

WHO with support from World Food Programme (WFP) has assembled ten of the Medical Camp Kits from a Staging Area in Bharatpur. These first ten of the fifty MCKs, which will be established, will be installed in Sindhupalchowk, Dhading, Gorkha, Rasuwa and Dolakha by the first week in June. By the end of June, it is expected that all of these MCKs will be set up in the highly affected districts, to act as temporary health posts during the rainy season. UNFPA, UNICEF, International Medical Corps, and International Organization for Migration (IOM) are also collaborating on this effort.

Provision of essential drugs and supplies

UNICEF dispatched a total of 40 tents, 24 emergency health kits (basic units) and 600 blankets to hospitals and DHOs in Lalitpur, Kathmandu, Dolakha, Kavre, and Dhading, to provide primary health care and life-saving maternal, new born and child health for a population of 24,000 persons over a period of three months.

Under a new partnership with Nepal Public Health Association and Centre for Public Health Development, UNICEF is establishing 22 shelter homes adjacent to district hospitals and in the periphery of 11 of the most affected districts (2 per district), to ensure that pregnant women with complications, postnatal mothers, newborns, and under-five children, who have been left homeless have a safe place to stay after being discharged from a hospital. 44 tents, 440 blankets, 22 emergency health kits, 440 family hygiene and dignity kits, and 330 long lasting impregnated mosquito nets (LLINs) were dispatched to these 11 affected districts. The shelter homes primarily target 46,500 mothers with new-borns.

Good Neighbours International handed over medicine worth US$ 17,275.93 to Gorkha DPHO.

Project HOPE, which provided medical care support in the Kathmandu Valley and Dolakha, between 2 – 21 May, has donated medical supplies and medications as requested by MoHP, and anticipate at least $11 million in total donated items. 5 shipments have cleared customs with delivery to MoHP warehouse, and at least 3-4 additional shipments are expecting in the near future.

Arbeiter-Samariter-Bund Deutschland e.V.(ASB), through the Dhelikhel University Hospital, is handing over one Emergency Health Kit (Supplementary and Basic) to its satellite health centre in Lamosangu, Sindhupalchowk.

Since 22 May, AmeriCares working with WHO and MoHP has delivered a shipment of over 21tonnes of health equipment and supplies, including IV solutions, wound care, first aid and orthopaedic supplies, and chronic care medicines. Efforts are also underway to deliver a shipment of assorted medicines and supplies, PPE items (masks, gloves), wound care, first aid and orthopaedic supplies, worth over $5 million. It is expected to arrive in Kathmandu 30 May.

Since 19 May, WHO has delivered over 8 tonnes of health equipment and supplies to various MoHP facilities, including hospitals, and partners in earthquake affected areas. Among the items delivered were 47 IEHK Basic Kits, five surgical kits and 8 tents of varying sizes. To date, WHO has distributed over 20 tonnes of essential health equipment and supplies.

MSF is sending 3-4 months’ worth of medicines and supplies to 13 northern most VDCs in Dolakha before the monsoon season.

Trauma and injury care

The injury and rehabilitation sub-cluster has drafted a rehabilitation strategy highlighting immediate, medium and long-term needs and priorities. The strategy is being consulted at cluster and sub cluster levels, including MoHP and Ministry of Women, Children and Social Welfare. The final strategy will be incorporated into the MoHP’s Health Sector Rehabilitation and Reconstruction Plan.

Handicap International (HI) operates a hotline 12 hours per day, which provides advice and signposting to rehabilitation services, including outreach and assistive devices. HI also accepts requests for assistive devices – crutches/wheelchairs etc. through this Hotline number.

International Organization of Migration (IOM), which has been supporting referrals onwards from hospital (80% to step down and 20% home) has established a nine hour per day hotline for patient transport and step down within Kathmandu.

UK-EMT has provided amputee clinical specialist physiotherapists, and spinal cord injury specialist physiotherapists and occupational therapist to build capacity of local staff in SIRC and HI. The training is also being made open to Nepalese rehabilitation staff from all other partner organizations through the coordination of the Injury and rehabilitation Sub-cluster.

ReSurge International is engaging specialist orthoplastic physiotherapists to build capacity at Kirtipur hospital. These specialists will also be available to support other organizations’ identified training in this specialty area.

The sub-cluster continues to map partners and match capacity against the needs, and to establish step down transit shelter for the post rehabilitation care. Already, it has identified a number of large step down facilities with rehabilitation and nursing services in the Kathmandu Valley, as well as several smaller locally led facilities. The main centres include: Cuban FMT at Kirtipur, Anandaban Hospital (Lalitpur) and Spinal Injury Rehabilitation Center (Bhaktapur). Green Pastures in Pokhara will accept complex rehabilitation patients, including spinal cord injury patients from the west of the country, while Hospital & Rehabilitation Center for Disabled Children

(HRDC) are accepting referrals for children requiring inpatient post-operative support or rehabilitation. Nepal Youth Foundation is also operating a step-down facility for people with injuries.

MSF is supporting Nepal Orthopaedic Hospital, Jorpati, which currently has 200 patient capacity, with potential to operate 50 step down rehabilitation beds.

IMC has opened a step down/rehab facility at Gorkha District Hospital to enable patients to return to their district for care. It will be able to receive referrals of patients needing in-patient rehabilitation, but wishing to return to the district level. This field post-op unit has cared for a total of 15 patients to date.

HI is providing a fixed point center with (x2) physiotherapists in Trishuli, Nuwakot, (alongside the Bhutanese FMT whilst they are present), and also have a physiotherapist working with Norwegian Red Cross in Sindupolchowk.

Injury and rehabilitation sub-cluster is working on a simple flow chart to help tertiary hospitals identify an appropriate facility for each patient based on his/her needs.

Reproductive Health

A separate Adolescent Sexual Reproductive Health (ASRH) working group has been formed under RH Sub-cluster to ensure that ASRH issues are adequately integrated within the overall RH response.

National RH protocols and other technical documents have been uploaded to the HeOC website for use by partners. This includes a one page checklist to guide partners, including FMTs, on providing RH services, according to the Minimal Service Package (MISP).

UNFPA supported DHO Sindhuli to organize a RH camp and distribute 232 dignity kits, 50 insecticide treated nets and blankets in Hariharpurgadhi, one of the most affected VDCs, where 70% of the 720 houses have been seriously damaged. The camp provided sexual and reproductive health (SRH) services and psychosocial first-aid to more than 700 pregnant and recently delivered women.

UNFPA has provided equipment, instruments, drugs and supplies adequate to provide SRH services for 13,500 direct targeted beneficiaries for 3 months to seven districts – Dolakha, Nuwakot, Sindhuli, Kavre, Kathmandu, Lalitpur, Sindhupalchowk, and Rasuwa. This is in addition to the equipment, instruments, drugs and supplies previously provided to reach 1 million affected populations.

UNFPA together with FPAN and ADRA have to date, conducted 26 mobile RH outreach sessions in six districts (Kavre, Rasuwa, Makwanpur, Lalitpur, Kathmandu and Bhaktapur), reaching over 4000 girls, women, and men with SRH services.

In Dhading and Rasuwa, HC3/USAID have been conducting ongoing activities to raise awareness on SRH issues, including danger signs during pregnancy, childbirth and postpartum period, through peer educators, local radio stations, and distribution of print materials.

Mental health and psychological support, non-communicable diseases

The health and protection clusters have intensified collaboration on issues of mental health and psychosocial support, and have agreed on coordination of related functions - community psychosocial support will be addressed by the psychosocial technical working group under the protection cluster and clinical mental health care under the health cluster.

The mental health sub-cluster finalized a tool for community workers/ lay psychosocial staff to identify people with severe mental health problems to facilitate referral to clinical mental health care.

The government has decided to deploy a five member MHPSS team (Psychiatrist, Psychologist, Paramedic and two volunteers) to the highly affected districts, to provide much needed MHPSS services in a coordinated manner. Already teams have been deployed to Dhading and Nuwakot

Psychiatrist Association of Nepal (PAN) has been sending psychiatrist from Kaski, Chitwan, and Rupandehi districts (not among the 14 highly impacted) to Gorkha, to provide mobile psychiatrist services to the affected population. They have plans to eventually establish a help desk/permanent presence in Gorkha and Lamjung.

International Medical Corps has supported 14 psychosocial first aid (PFA) trainings though local implementing partners in Kathmandu and Dhading, reaching 253 people to date. An additional 144 people in Gorkha District, Sirdibas and Uhiya VDCs, have been reached with community-based Pyschosocial Support (PSS) messaging on stress management & positive coping mechanisms.

Water, sanitation and hygiene and environmental health

Kathmandu District Public Health Office (DPHO) together with WHO carried out rapid WASH assessments, including water quality monitoring, in health care facilities (HCFs) in different parts of Kathmandu Valley, including Dahchowk, Dharmasthali, Goldhunga and Sitapaila. On the request of respective DHOs, WHO is also supporting WASH intervention in 15 HCFs in outskirts of the Kathmandu Valley.

WaterAid Nepal in coordination with MoHP Epidemiology and Disease Control Division and Child Health Division is presently distributing one million aqua tablets and hygiene message flyers in earthquake affected communities. Six key hygiene promotion messages have also been broadcasted from nine local radio stations in Bhaktapur, Kavre, Kaski, Nuwakot, Dolakha, Sindhupalchowk, and Gorkha. WaterAid Nepal has also distributed 3000 hygiene kits to earthquake victims through partners in districts.

The National Health Education Information Communication Center (NHEICC) has been finalizing a post–earthquake communications plan. The plan seeks to communicate health risks with communities directly affected by the earthquake in the 14 most affected districts, by focusing on interpersonal communications, dissemination of information and community mobilization through community volunteers, including frontline health workers and civil society organizations, for the six months period, May-October 2015. It outlines the needs, stakeholders/audiences, strategic approaches, proposed activities to be implemented in the six months period, and mechanisms for carrying out monitoring and evaluation. The health communication working group (NHEICC and partners, including Suaahara, Health for Life, JHU, Save the Children, UNICEF and WHO) that supported drafting of the plan is presently preparing training materials for orientation session with frontline health communicators at the district level. The working group has already developed key health messages which will be displayed in temporary shelter sites in the 14 most affected districts.

Nepali-English brochures and posters on post-earthquake hygiene have been developed by CMT. Up to 23 May, a total of 18800 brochures and 250 posters have been distributed to earthquake affected communities

Training of health human resources

Between 30 April and 23 May, China Medical Team trained 1011 health personnel (including clinical health workers, public health personnel, teachers and community volunteers) in laboratory tests, specimen collection, field disinfection, surveillance of infectious disease, health promotion, post-disaster psychological assistance etc. Training methods included lectures (605 personnel) and on-the-spot demonstration and learning (406 personnel).

Plans for future response

The response has transitioned towards two aspects: 1) operations in districts and VDCs; and 2) early

recovery and reconstruction. In this regard, health cluster priority activities over the next four months

include:

Consolidation and standardization of assessments, ensuring the coverage of areas beyond district

headquarters in consultation/coordination with MoHP and External Development Partners;

Support to health service delivery with focus on restoration of Primary Health Care services,

through the provision of medical supplies, tents and rehabilitation support;

Provision of essential drugs and supplies, ensuring distribution of the medicines/supplies from

DHO to peripheral units;

Ensure that priorities such as reproductive health, mental health, and child health are coordinated

and addressed;

Strengthen the communicable disease control and surveillance

Funding status of action plan

Funding requirements:

The first Strategic Objective of the UN Flash Appeal is to prevent increased morbidity and mortality and outbreaks of communicable diseases, and provide immediate access to health services. The Health Cluster component of the Flash Appeal plans to respond to the most urgent health needs of 4.2 million people. The revised funding requirements for the Health Cluster amount to US$ 42 million.

Funding partners:

As at 27 May 2015, the health component of the flash appeal is 21.4% funded. Health Cluster’s humanitarian response to the Nepal earthquake has received support from the following contributors: Australia, Estonia, Finland, Friends of UNFPA, Italy, Japan, Netherlands, Norway, the Russian Federation, and UN Central Emergency Response Fund, Switzerland, Thailand, World Health Organization

Health Cluster 4Ws Partners

170

Baglung

Plan International

Bhaktapur

Adara Development

Alliance of International Doctors

AmeriCares

Bowberos Chidos Sin Frouleros (Foundation Madrazo)

Buddhist Tzu Chi Foundation

Child Workers in Nepal

Corps Mondial de Secours

Deutsche Gesellschaft fuer Internationale Zusammenarbeit (GIZ) / HSSP

Finnish Evangelical Lutheran Mission

Handicap International (HI)

Helen Keller International

Indian Medical Association

International Medical Corps

International Planned Parenthood Federation

Korea Disaster Relief Team

Nepal Disaster and Emergency Medicine Center

Nurse Teach Reach Inc.

Pakistan Medical Team

Population Service International / Nepal

Reach Out Worldwide

SOS Himalaya

United Nations Childrens Fund

United Nations Population Fund

World Health Organization

Chitawan

China

Shapla Neer

Save the Children

Dhading

Adara Development

AmeriCares

CBM International

China Medical Team

Clarion



GNHA

GOAL Global

Government of Bihar

Health Communication Capacity Collaborative

Himalayan Health Care


International Nepal Fellowship

Jhpiego

John Snow Research and Training Institute

King George Medical College

Medical Teams International

MSF Belgium

New York City Medics

Pompiers Humanitaines Francais


Red Cross Society of China

Save the Children

Seikh Mujib Medical University (Nepali doctors)

Singapore

Terre des Hommes - Hospital and Rehabilitation Centre for Disabled Children

United Mission to Nepal



Dolakha

Acts World Relief - Beth Israel Deaconess Medical Center Disaster Medical Fellowship

Canadian Red Cross


Compassionate hands for Nepal + Natan

GNHA

India Army


Maharastra Team

Medical Service Center/All Nepal Progressive Public Health Association

MSF Belgium

Plan International



World Neighbors

Gorkha

Adara Development

Aides Actions Internationales Pompiers + Action Pompier Pour lUrgence Internationale

Canadian Medical Assistance Teams

CARE

China Medical Team

COMMUNITY ACTION NEPAL

Doctors Worldwide

FAIRMED


Good Neighbors International

HANDS

Humanity First

Indian Air Force



International Organization for Migration

INTERSOS-OPPORTUNITY VILLAGE


Marie Stopes International

MountainChild

MSF Belgium

MSF France

MSF Spain

Save the Children

SWISS AGENCY FOR DEVELOPMENT AND COOPERATION




World Vision Nepal

Kabhrepalanchok

Adara Development

America Nepal Medical Foundation

AmeriCares

Bangladesh Association of Physical Medicine and Rehabilition

Bharatiya Jain Sanghathan

CBM International

Centre for International Studies and Cooperation

ChildFund International

China

China Medical Team

Dhaka Community Hospital


GNHA



Iri Shinkwang Presbyterian Church

Japan International Cooperation Agency

KPIM

Medical Help World

Plan International


Royal Melbourne Hospital

Save the Children

Special Medical Team of University of Debrelev

Sri Lanka Army

Terapanth Professional Forum

Terre des hommes (Tdh), Lausanne, Switzerland

UK EMT



USA Medical Emergency Response Team


World Neighbors

Kaski


Kathmandu

Adara Development

Ama Foundation

AmeriCares


China Medical Team

Chinese Army Medical Team (Chengdu)

Cuban Medical Brigade


FAIRMED


Gift of the Givers

Global Medics

Global Outreach Doctors

Government of Karnataka



India Army

Indonesia Medical Team

Indonesia-Civilian (Indonesia-BNBP)

International Charitable Public Foundation for Children in Disasters and Wars




Interplast

Israel Medical team

Japan Ground Self Defense Force

Japanese Military

Karisz usar and Medical Rescue team

Karuna Foundation Nepal


Mercy Malaysia

National Medical Rescue Team

Nepal Kidney Foundation Team

Netherlands Rescue Team

NITTE University

Physicians Across Continents


Project Hope

Shapla Neer

Singapore Army

Taiwan International Health Action

Taiwan Root Medical Peace Corps

Team for chirayu

Team for TUTH

UK EMT



Vicente Sotto Memorial Medical Center-2


Khotang

Save the Children

Lalitpur

Adara Development

Al-Khair Foundation

AmeriCares

Bangladesh Medical Team


China

China Medical Team


Good Neighbors International

Gwangji-Metrocity Medical Relief Team



Human Care Foundation

Indian Army




Samaritans Purse International Relief

Thai Army




Lamjung


Save the Children

World Vision Nepal

Makawanpur

Acts of Mercy

CBM International




Save the Children



Narayan

Ama Foundation

Nuwakot

Adara Development

Bhutan Army Team

Chosum University Hospital, Hope Tree and Kwangju Metropolitan City


Doctors for You

Fida International

GOAL Global



Italy Civil Protection

Jhpiego


MSF Spain


Qatar Red Crescent

Save the Children


Vicente Sotto Memorial Medical Center-1


Okhaldhunga



Parbat


Parsa


Ramechhap

Del Mundo Medicos

Good People International


Metropolitan Manila Development Authority

Save the Children



Rasuwa

Canadian Red Cross


GOAL Global

Health Communication Capacity Collaborative

Helen Keller International/Mayo Hospital Lahore

Human Outreach Project


Karuna Foundation Nepal

MSF Holland

Save the Children

Trekmedic

UK EMT

UK Fire and Rescue Service USAR




Sankhuwasabha

Save the Children

Sindhuli


Save the Children



World Vision Nepal

Sindhupalchowk

Adara Development

AmeriCares

Canadian Military DART

CARE

CBM International

Centre for International Studies and Cooperation


ChildFund International

China Medical Team

Crises Relief Singapore

Czech Medical team

Disaster Medics

Emergency Team Poland

FAIRMED

Fida International


GNHA


Haridwar Shanti Kunj

Heart to Heart International

Humanitarian Medical Assistance

Humedica

IMA

International Medical Relief


Israel Forum for International Humanitarian Aid

Japan Disaster Relief Medical Team

Japanese Red Cross Society


Korean Red Cross

Magna Children at Risk

Malteser International

Medcins Du Monde

Medical Teams International

Miral welfare foundation

MSF Holland

National Medical Organization

New Era

Nick Simons Institute

Norway Red Cross

Norwegian Seismic Array

NPO Tokushukai Medical Aid Team

One Heart World Wide, Nepal

Population Services International Nepal

Plan International

Remote Area Medical

Root Peace International Corp USA/Taiwan Root International Peace Corp

Rotary Club of East Calcutta

Save the Children

Team Rubicon

Terre des hommes (Tdh), Lausanne, Switzerland

The Johanniter International Assistance

Transcultural Psychosocial Organization Nepal


USA Medical Emergency Response Team


World Neighbors

World Vision Nepal

Tanahun


Contacts:

Dr Edwin Salvador, Health Cluster Coordinator

[email protected] ; 9801010010

Support to District Coordination:

Gorkha: Dr Anand Joshi, [email protected]; 9801123160

Sindhupalchowk: Dr Rajan Rayamajhi, [email protected]; 9801123157

Rasuwa: Dr Dipesh Shrestha, [email protected]; 9858023245

mailto:[email protected]




Nepal - WHOPAGE 1 *Availability of accurate information on health facilities’ statusfrom seriously...

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