Inter-departmental co-ordination and Community support aspects for the effective management of Disasters

1. ManagementManagement
ofof
Health & Medical IssuesHealth & Medical Issues
inin
DisastersDisasters
Dr S.J.GandhiDr S.J.Gandhi
Deputy Director (Epidemic)Deputy Director (Epidemic)
Commissioerate Of HealthCommissioerate Of Health
Services, GandhinagarServices, Gandhinagar

2. Seven Fundamental Terms in Risk ManagementSeven Fundamental Terms in Risk Management
A Logical Framework of TerminologyA Logical Framework of Terminology
HazardHazard
AnyAny potentialpotential threat to publicthreat to public
safety and / or public healthsafety and / or public health
RisksRisks
TheThe potentialpotential consequencesconsequences of hazardof hazard
interacting with communityinteracting with community
EmergencyEmergency
AnyAny actualactual threat to publicthreat to public
safety and / or public healthsafety and / or public health
VulnerabilitiesVulnerabilities
Factors which determine the type andFactors which determine the type and
severity of those consequencesseverity of those consequences
DisasterDisaster
AA civil emergencycivil emergency in which thein which the
humanitarian needs arehumanitarian needs are
beyond local capacity to meetbeyond local capacity to meet
those needs i.e. the responsethose needs i.e. the response
and recovery operation mustand recovery operation must
be managed at the nationalbe managed at the national
and/or international leveland/or international level
Readiness for ResponseReadiness for Response
A determinant of the severity andA determinant of the severity and
manageability of those consequencesmanageability of those consequences
CommunityCommunity isis people, property, services, livelihoods and environmentpeople, property, services, livelihoods and environment i.e. thei.e. the
elements exposed to hazardselements exposed to hazards

3. DefinitionsDefinitions
A Hazard is a Human-made or Natural Danger that causes damageA Hazard is a Human-made or Natural Danger that causes damage
to people , property and the environmentto people , property and the environment
A Risk is the Potential for something to go wrong or for somethingA Risk is the Potential for something to go wrong or for something
harmful to occurharmful to occur
Vulnerability is the potential to be easily hurt or harmedVulnerability is the potential to be easily hurt or harmed
Capacity is an ability to cope up with a difficult situationCapacity is an ability to cope up with a difficult situation

4. HazardsHazards
There are 4 classes of hazardThere are 4 classes of hazard::
1.1. Natural hazardsNatural hazards
2. Technological hazards2. Technological hazards
3. Biological hazards3. Biological hazards
4. Societal hazards4. Societal hazards

5. A Community Consists of 5A Community Consists of 5 Elements:Elements:
1.1. TheirTheir propertyproperty (infrastructure, possessions and assets; public,(infrastructure, possessions and assets; public,
private and cultural)private and cultural)
2.2. TheirTheir servicesservices (government and non-government, commercial and(government and non-government, commercial and
voluntary)voluntary)
3.3. TheirTheir livelihoodslivelihoods (urban and rural, formal and informal)(urban and rural, formal and informal)
4.4. TheThe peoplepeople
5.5. TheirTheir environmentenvironment (air, water and soil; urban and rural, built and(air, water and soil; urban and rural, built and
natural)natural)

6. COMMUNITY RISKSCOMMUNITY RISKS
COMMUNITY RISKSCOMMUNITY RISKS are proportional toare proportional to
HAZARDSHAZARDS
xx
VULNERABILITIESVULNERABILITIES
____________________________________________________
READINESS FOR RESPONSEREADINESS FOR RESPONSE

7. VulnerabilitiesVulnerabilities
are:are:
Factors which determine how much riskFactors which determine how much risk
Higher vulnerability increases the risksHigher vulnerability increases the risks
arising from a specific hazard in a specificarising from a specific hazard in a specific
community, or in sub-sections of thatcommunity, or in sub-sections of that
community.community.

8. Indicators of VulnerabilitiesIndicators of Vulnerabilities
EachEach element of communityelement of community can be described in termscan be described in terms
of its vulnerabilities:of its vulnerabilities:
– peoplepeople
– propertyproperty
– servicesservices
– livelihoodslivelihoods
– environmentenvironment

9. Indicators of Vulnerabilities (for people)Indicators of Vulnerabilities (for people)
• Access to health care
• Measles vaccination
coverage rate
• Under 5 nutrition rate
• Under 5 mortality rate
• Access to safe water
• Access to sanitation
• Access to adequate
housing
• Access to regular
source of income
• Female literacy rates

10. Critical Services – Basic Needs andCritical Services – Basic Needs and
LifelinesLifelines
Basic needs for survival:Basic needs for survival:
– waterwater
– foodfood
– shelter (and clothing in cold climates)shelter (and clothing in cold climates)
– energy (fuel)energy (fuel)
– (acute medical care)(acute medical care)

11. ConsequencesConsequences
– injury (mental and physical)injury (mental and physical)
– disease (mental and physical)disease (mental and physical)
– secondary hazards (fire, disease etc.)secondary hazards (fire, disease etc.)
– contamination of the environmentcontamination of the environment
– displacementdisplacement
– breakdown in securitybreakdown in security
– damage to infrastructuredamage to infrastructure
– dead and missingdead and missing
– breakdown in essential servicesbreakdown in essential services
– loss of propertyloss of property
– loss of income …loss of income …

12. Public Health Consequences of DisastersPublic Health Consequences of Disasters
• temporary population displacementstemporary population displacements
• increased numbers of deaths and injuriesincreased numbers of deaths and injuries
• new cases of disease and disabilitynew cases of disease and disability
• exacerbation of and increased numbers of cases ofexacerbation of and increased numbers of cases of
psychological and social behaviour disorderspsychological and social behaviour disorders
• food shortages and nutritional deficienciesfood shortages and nutritional deficiencies

13. Public Health Consequences of Disasters -Public Health Consequences of Disasters -
cont.cont.
• environmental disruption causing hazards – vectors,environmental disruption causing hazards – vectors,
waste management, sanitationwaste management, sanitation
– destruction of infrastructuredestruction of infrastructure
– disruption to routine health servicesdisruption to routine health services
– disruption to routine disease surveillance and controldisruption to routine disease surveillance and control
servicesservices
– diversion of capital investment funds to emergencydiversion of capital investment funds to emergency
relief and the rehabilitation or reconstruction ofrelief and the rehabilitation or reconstruction of
essential infrastructureessential infrastructure

14. Health Services in EmergenciesHealth Services in Emergencies
– Mass casualty management – first aid, triage,Mass casualty management – first aid, triage,
transport, pre-hospital care, in-patient care, posttransport, pre-hospital care, in-patient care, post
care follow-upcare follow-up
– Management of the dead and missingManagement of the dead and missing
– Environmental health (water and sanitation,Environmental health (water and sanitation,
shelter, health care waste management,shelter, health care waste management,
environmental pollution)environmental pollution)
– Psychosocial servicesPsychosocial services
– Reproductive healthReproductive health
– Communicable disease control measuresCommunicable disease control measures
– Feeding and nutritionFeeding and nutrition
– Health information and communicationHealth information and communication

15. Health Sector Role in Relief
Health Assessment Surveillance Systems Organisation and Management
Structural damage and loss Community, hospital and laboratory Public information/media
Staff/equipment damage and loss Public and private Guidelines and protocols
Organisation and management needs Injury Referral systems
Access and logistics needs Communicable diseases Emergency reporting system/HIS/MIS
Programme needs: Water quality Management of the dead/forensics
Acute medical/clinical care Nutritional status Supplies and equipment
Surveillance and Laboratories disability Logistics, transport and communications
Communicable Disease Control mental health Human resources
Mental Health non communicable diseases Professional information and education
Prerequisites for health vectors Research
Medical Care Communicable Disease Control Prerequisites for Health
Acute primary care/obstetrics Diseases of Epidemic Potential Shelter, energy, water and sanitation
Care and treatment of injured Vaccine Preventable Diseases Environmental health
Care and treatment of disability Vector Borne Diseases Nutrition and food supply
Care and treatment of chronic disease Diseases of Public Health Significance Health promotion/information
Reporting System
Preparedness building the capacity to do ALL of the above Surge Capacity for:
Response using AVAILABLE surge capacity
scaling up health services
restoration of essential services (repair/replace)
reconstruction

16. Challenges in HealthChallenges in Health
Emergency ManagementEmergency Management
– Lack of legal frameworks, policies, guidelines,Lack of legal frameworks, policies, guidelines,
protocolsprotocols
– Lack of evidence base for policy developmentLack of evidence base for policy development
– Pressure from the public and mediaPressure from the public and media
– Emergency situations are dynamic and inEmergency situations are dynamic and in
such situations, information is scarce, volatilesuch situations, information is scarce, volatile
and often not sharedand often not shared
– Multiple health effects of hazardsMultiple health effects of hazards

17. Challenges in HealthChallenges in Health
Emergency ManagementEmergency Management
– Multiples agencies involved - inter / intra-Multiples agencies involved - inter / intra-
sectoral, public / private, national /sectoral, public / private, national /
internationalinternational
– Difficulty in coordinationDifficulty in coordination
– Planning is not coordinated within andPlanning is not coordinated within and
between sectorsbetween sectors
– Plans do not exist or have not been testedPlans do not exist or have not been tested

18. Challenges in HealthChallenges in Health
Emergency ManagementEmergency Management
– Lack or mismatch of resourcesLack or mismatch of resources
– Inappropriate donationsInappropriate donations
– Response and recovery actions are doneResponse and recovery actions are done
without needs assessmentswithout needs assessments
– Opportunities for enhancing risk reduction areOpportunities for enhancing risk reduction are
lost during recovery and reconstructionlost during recovery and reconstruction
– Lessons from disasters are notLessons from disasters are not
institutionalisedinstitutionalised
– Lack of best practicesLack of best practices

19. HEALTH ISSUESHEALTH ISSUES
WATER & SANITATIONWATER & SANITATION
There was a breakdown of the water and sewerageThere was a breakdown of the water and sewerage
system.system.
HUMAN REFUSE GENERATIONHUMAN REFUSE GENERATION
Relatives of injured people defecated / urinated in theRelatives of injured people defecated / urinated in the
open, in spite of deep trench latrines.open, in spite of deep trench latrines.
BIOMEDICAL WASTE DISPOSALBIOMEDICAL WASTE DISPOSAL
Amputated limbs and other biomedical waste was disposedAmputated limbs and other biomedical waste was disposed
off by burning.off by burning.

20. SOCIAL ISSUESSOCIAL ISSUES
DISPOSAL OF DEAD BODIESDISPOSAL OF DEAD BODIES
The police was entrusted with the task ofThe police was entrusted with the task of
identification, photographing and cremation / burial ofidentification, photographing and cremation / burial of
the dead bodiesthe dead bodies..

21. ADMINISTRATIVE PROBLEMSADMINISTRATIVE PROBLEMS
COLLAPSE OF THE CIVIL HEALTH COMMAND AND CONTROLCOLLAPSE OF THE CIVIL HEALTH COMMAND AND CONTROL
STRUCTURESTRUCTURE
MH Bhuj whose role was to supplement civil resources had to serve as theMH Bhuj whose role was to supplement civil resources had to serve as the
first responder.first responder.
STRUCTURAL DAMAGE TO HOSPITALSTRUCTURAL DAMAGE TO HOSPITAL
Patient care including surgery had to be carried out in the open under tentPatient care including surgery had to be carried out in the open under tent
cover.cover.
LACK OF COMMUNICATIONSLACK OF COMMUNICATIONS
No serviceable telephone / satellite phone available at mh bhuj during the first 72No serviceable telephone / satellite phone available at mh bhuj during the first 72
hrshrs
NO WATER OR ELECTRICITY SUPPLY INITIALLYNO WATER OR ELECTRICITY SUPPLY INITIALLY
Generator sets became functional by 3 hrs post impact Water was provided throughGenerator sets became functional by 3 hrs post impact Water was provided through
water- bowsers.water- bowsers.

22. ADMINISTRATIVE PROBLEMSADMINISTRATIVE PROBLEMS
HAPHAZARD INDUCTION OF CIVILIAN HEALTH PERSONNEL INTOHAPHAZARD INDUCTION OF CIVILIAN HEALTH PERSONNEL INTO
THE DISASTER AREATHE DISASTER AREA
Personnel were inducted without adequate planning, briefing andPersonnel were inducted without adequate planning, briefing and
preparation. They were not self contained.preparation. They were not self contained.
LOGISTICS MANAGEMENT OF MEDICAL SUPPLIESLOGISTICS MANAGEMENT OF MEDICAL SUPPLIES
Influx of medical supplies was not necessarily need based. Difficulties wereInflux of medical supplies was not necessarily need based. Difficulties were
encountered in sorting out necessary items, accounting and storageencountered in sorting out necessary items, accounting and storage
ABSENCE OF LAUNDRY SERVICES INITIALLYABSENCE OF LAUNDRY SERVICES INITIALLY
Laundry services affected due to shortage of water and damage to theLaundry services affected due to shortage of water and damage to the
washing point. Soiled linen could not be washed, disinfected and reused.washing point. Soiled linen could not be washed, disinfected and reused.
SHORTAGE OF TENTSSHORTAGE OF TENTS
No tents authorized to MH Bhuj on establishment. Tents had to be procuredNo tents authorized to MH Bhuj on establishment. Tents had to be procured
from the local formation.from the local formation.
DOCUMENTATIONDOCUMENTATION
Adequate documentation of the massive influx of casualties was not possibleAdequate documentation of the massive influx of casualties was not possible
with the existing resources.with the existing resources.

23. PATIENT CARE DIFFICULTIESPATIENT CARE DIFFICULTIES
SHORTAGE OF HOSPITAL BEDS AND LINENSHORTAGE OF HOSPITAL BEDS AND LINEN
MH Bhuj is a 99 bed hospital with a 25 bed crisis expansion capability. WithMH Bhuj is a 99 bed hospital with a 25 bed crisis expansion capability. With
the large influx of casualties it ran out of hospital beds, mattresses and linen.the large influx of casualties it ran out of hospital beds, mattresses and linen.
Patients had to be treated on the ground.Patients had to be treated on the ground.
SHORTAGE OF OPERATING ROOM EQUIPMENT, INSTRUMENTS,SHORTAGE OF OPERATING ROOM EQUIPMENT, INSTRUMENTS,
LINEN & DISINFECTANTSLINEN & DISINFECTANTS
The capacity of the operating rooms was overwhelmed by the number of theThe capacity of the operating rooms was overwhelmed by the number of the
casualties.casualties.
CROWD CONTROLCROWD CONTROL
Relatives of casualties demanded immediate attention from the limitedRelatives of casualties demanded immediate attention from the limited
number of medical / paramedical personnel. They broke cordons andnumber of medical / paramedical personnel. They broke cordons and
barged into treatment / operating areas, interfering with prioritization andbarged into treatment / operating areas, interfering with prioritization and
provision of care.provision of care.

24. PATIENT CARE DIFFICULTIESPATIENT CARE DIFFICULTIES
CASUALTYCASUALTY
EVACUATION TOEVACUATION TO
OTHER HOSPITALSOTHER HOSPITALS
Inadequate number ofInadequate number of
stretchers especiallystretchers especially
special stretchers forspecial stretchers for
transporting patients withtransporting patients with
spinal injuries.spinal injuries.
Data Collection Methods and
Profiling during emergencies
Inter-State Meeting on
“Gujarat Earthquake: Health Sector
Perspectives”
06-09 November 2001

25. INFORMATION MANGEMENTINFORMATION MANGEMENT
Lack of communications.Lack of communications.
Assessment of the magnitude of the disasterAssessment of the magnitude of the disaster
impact was not available.impact was not available.
Information on health facilities for redistribution /Information on health facilities for redistribution /
evacuation of patients was not available.evacuation of patients was not available.

26. Rapid Assessment- Team compositionRapid Assessment- Team composition
Public health expert/ EpidemiologistPublic health expert/ Epidemiologist
ClinicianClinician
MicrobiologistMicrobiologist
Environmentalist/entomologistEnvironmentalist/entomologist

27. SPHERESPHERE
Based on Two Principles:Based on Two Principles:
(a) Relieve and minimize human suffering arising out of calamity and conflicts(a) Relieve and minimize human suffering arising out of calamity and conflicts
(b) Affected community has a right to life with dignity and hence a right to(b) Affected community has a right to life with dignity and hence a right to
receive assistancereceive assistance
SPHERE initiative was launched in 1997 by a group of Humanitarian NGOs,SPHERE initiative was launched in 1997 by a group of Humanitarian NGOs,
the Red Cross and Red Crescent movement –the Red Cross and Red Crescent movement –
By framing Humanitarian CharterBy framing Humanitarian Charter
By formulating minimum standards to be applied and achieved in areasBy formulating minimum standards to be applied and achieved in areas
affected by all types of Disastrous situations in terms of Five key factorsaffected by all types of Disastrous situations in terms of Five key factors
(water supply and sanitation, nutrition, food aid, shelter and health(water supply and sanitation, nutrition, food aid, shelter and health
services)services)
At present an Expert Group is working on the strategies of applyingAt present an Expert Group is working on the strategies of applying
Sphere standards in Indian context and how best they can beSphere standards in Indian context and how best they can be
modified to be applicable in current state of affairsmodified to be applicable in current state of affairs

28. Humanitarian CharterHumanitarian Charter
Based on the principles and provisions of InternationalBased on the principles and provisions of International
Humanitarian Law, International Human Rights Law,Humanitarian Law, International Human Rights Law,
Refugee’s Law & Code of Conduct of International Red CrossRefugee’s Law & Code of Conduct of International Red Cross
etc. during disaster reliefetc. during disaster relief
It asserts the Human rights of people affected by natural orIt asserts the Human rights of people affected by natural or
man-made disaster situations like armed conflicts, civil strifeman-made disaster situations like armed conflicts, civil strife
and other political emergencies –to have protection, availand other political emergencies –to have protection, avail
assistance to survive and live their life with dignityassistance to survive and live their life with dignity
It also pertains to Legal responsibilities of the states andIt also pertains to Legal responsibilities of the states and
warring parties to provide above services to the people underwarring parties to provide above services to the people under
crisis situationcrisis situation
If they are unable or unwilling to do so, they are obliged toIf they are unable or unwilling to do so, they are obliged to
allow Humanitarian Organizations to provide humanitarianallow Humanitarian Organizations to provide humanitarian
assistance and protectionassistance and protection

29. Sphere standards alsoSphere standards also relate to the operational framework andrelate to the operational framework and
accountability aspects of service providersaccountability aspects of service providers
In all situations priority would be meeting the urgent survivalIn all situations priority would be meeting the urgent survival
needs of people affected by disastersneeds of people affected by disasters
Ascertain their basic human right to life with dignityAscertain their basic human right to life with dignity
In all contexts , disaster response should support and/orIn all contexts , disaster response should support and/or
complement existing government services in terms of structure,complement existing government services in terms of structure,
design and long term sustainabilitydesign and long term sustainability
Providing valid information regarding availability and ensuringProviding valid information regarding availability and ensuring
accessibility to support services by all groups in a non-accessibility to support services by all groups in a non-
discriminatory manner as per their specific needs has to be co-discriminatory manner as per their specific needs has to be co-
coordinated by continuous dialogue with Local Administrativecoordinated by continuous dialogue with Local Administrative
AuthoritiesAuthorities

30. Key Vulnerable Groups:Key Vulnerable Groups:
WomenWomen
Children (age<18 yrs.)Children (age<18 yrs.)
Older people (age > 60 yrs.)Older people (age > 60 yrs.)
People with HIV/AIDSPeople with HIV/AIDS
Ethnic MinoritiesEthnic Minorities
Cross- cutting Issues:Cross- cutting Issues:
Gender groupsGender groups
Isolated groupsIsolated groups
Malnourished groupsMalnourished groups
Sensitive IssuesSensitive Issues
ExploitationExploitation
AbductionAbduction
Recruitment into fighting forcesRecruitment into fighting forces
Sexual violenceSexual violence
Lack of opportunity to participate in decision makingLack of opportunity to participate in decision making
Most harmful effects in such a situation will be felt by ChildrenMost harmful effects in such a situation will be felt by Children
and young peopleand young people

31. Gender Issues will always remain in Focus and priorityGender Issues will always remain in Focus and priority
Even the assessment teams should be framed up with equal participation byEven the assessment teams should be framed up with equal participation by
Female MembersFemale Members
Protection and Protection Assistance are two separate issues and NGOs canProtection and Protection Assistance are two separate issues and NGOs can
certainly help in providing assistance to Local Authoritiescertainly help in providing assistance to Local Authorities
HIV/AIDS plays it’s role in the way that as the Pandemic matures and moreHIV/AIDS plays it’s role in the way that as the Pandemic matures and more
people die , communities would be left with disproportionate number ofpeople die , communities would be left with disproportionate number of
children, orphans and older people- which require special attention andchildren, orphans and older people- which require special attention and
relief programs may be modified accordinglyrelief programs may be modified accordingly
Environmental Issues:Environmental Issues:
The physical, chemical and biological environment in which affected people areThe physical, chemical and biological environment in which affected people are
living in should not be subjected to over-exploitation, pollution andliving in should not be subjected to over-exploitation, pollution and
degradationsdegradations
NGOs also have to ensure their political clearance, fulfill their visa requirementsNGOs also have to ensure their political clearance, fulfill their visa requirements
and should have sufficient financial, human and material resources of theirand should have sufficient financial, human and material resources of their
own before they enter into above ventures.own before they enter into above ventures.

32. General PrinciplesGeneral Principles
Affected people’s capacities and available resources should be assessedAffected people’s capacities and available resources should be assessed
Identify gaps in essential servicesIdentify gaps in essential services
Support inherent skills of local populationSupport inherent skills of local population
No single sector can be planned and considered in isolationNo single sector can be planned and considered in isolation
Share the findings of assessment with local populationShare the findings of assessment with local population
Allow people to comment upon ongoing relief measuresAllow people to comment upon ongoing relief measures
Plan outreach services for specific groups identifiedPlan outreach services for specific groups identified
Disaster Response Programs should support and complement existingDisaster Response Programs should support and complement existing
services and local institutions in terms of structure and designservices and local institutions in terms of structure and design
Such activities should be sustainable after the external assistance stops andSuch activities should be sustainable after the external assistance stops and
should be framed after due local consultations and approvalsshould be framed after due local consultations and approvals
Host populations extending support to displaced populations should beHost populations extending support to displaced populations should be
consulted and where appropriate the developments in disaster reliefconsulted and where appropriate the developments in disaster relief
activities should also lead to a sustainable improvement in the livelihoods ofactivities should also lead to a sustainable improvement in the livelihoods of
the host populationthe host population

33. Hygiene PromotionHygiene Promotion
Much depends upon effective exchange of information betweenMuch depends upon effective exchange of information between
people and service providers- should jointly list out risk factorspeople and service providers- should jointly list out risk factors
It is in addition to good sanitation and water suppliesIt is in addition to good sanitation and water supplies
Risk Factors: improper excreta disposal, use and maintenance ofRisk Factors: improper excreta disposal, use and maintenance of
toilets, lack of hand-washing with soap, unhygienic storage of watertoilets, lack of hand-washing with soap, unhygienic storage of water
and unhygienic storage and preparation of foodand unhygienic storage and preparation of food
Form water and sanitation committees made from members fromForm water and sanitation committees made from members from
various sections of community and half (50%) should be femalevarious sections of community and half (50%) should be female
membersmembers
Even such committees may be encouraged to manage water points,Even such committees may be encouraged to manage water points,
public toilets and washing areaspublic toilets and washing areas
This will ultimately sustain the efforts for a long long timeThis will ultimately sustain the efforts for a long long time

34. Water SupplyWater Supply
Average water use for drinking, cooking and personal hygiene in anyAverage water use for drinking, cooking and personal hygiene in any
household is at least 15 Liters per person per dayhousehold is at least 15 Liters per person per day
The maximum distance from any household to the nearest water point isThe maximum distance from any household to the nearest water point is
500 meters500 meters
Queuing time at a water source is no more than 15 minutesQueuing time at a water source is no more than 15 minutes
It takes no more than Three minutes to fill a 20-liter water containerIt takes no more than Three minutes to fill a 20-liter water container
Water sources and systems are adequately maintained so as to have aWater sources and systems are adequately maintained so as to have a
consistent and continuous water supplyconsistent and continuous water supply
Generally ground-water sources are preferred , as they require no treatmentGenerally ground-water sources are preferred , as they require no treatment
People living with HIV/AIDS require extra water for drinking and personalPeople living with HIV/AIDS require extra water for drinking and personal
hygienehygiene
Requirements for Livestock and Agriculture crops have to paid attentionRequirements for Livestock and Agriculture crops have to paid attention
especially in drought situationespecially in drought situation
People affected by emergency situation have increased vulnerability toPeople affected by emergency situation have increased vulnerability to
communicable diseases and their water requirements are more than normalcommunicable diseases and their water requirements are more than normal
situationssituations

35. Water Supply….Water Supply….
Excessive Queuing will result inExcessive Queuing will result in
(1) reduced per capita water consumption(1) reduced per capita water consumption
(2) increased consumption from unprotected water sources(2) increased consumption from unprotected water sources
(3) resulting in availability of less time for other survival tasks(3) resulting in availability of less time for other survival tasks
In urban areas it may be necessary to supply water into individualIn urban areas it may be necessary to supply water into individual
buildings to ensure that toilets continue to functionbuildings to ensure that toilets continue to function
All users need to be informed when and where water will beAll users need to be informed when and where water will be
availableavailable
Important Quality Indicators:Important Quality Indicators:
(1) There are no faecal colliforms per 100 ml at the point of delivery(1) There are no faecal colliforms per 100 ml at the point of delivery
(2) Free Residual Chlorine 0.5 mg per Liter(2) Free Residual Chlorine 0.5 mg per Liter
(3) Turbidity is below 5 NTU(3) Turbidity is below 5 NTU

36. Water Supply….Water Supply….
Faecal colliforms Bacteria (>99% of which are E. Coli ) are anFaecal colliforms Bacteria (>99% of which are E. Coli ) are an
indicator of the level of human/animal waste contamination in waterindicator of the level of human/animal waste contamination in water
Animal excreta is not as harmful as human excretaAnimal excreta is not as harmful as human excreta
Disposal of Children Faeces requires more attention as they areDisposal of Children Faeces requires more attention as they are
more dangerous than those of the adults because-more dangerous than those of the adults because-
(1) In children excreta related infections are on a higher side(1) In children excreta related infections are on a higher side
(2) Children lack antibodies(2) Children lack antibodies
People have to be educated for the consumption of ChlorinatedPeople have to be educated for the consumption of Chlorinated
water- in terms of health advantageswater- in terms of health advantages
If the safe water does not taste good-people will continue to drinkIf the safe water does not taste good-people will continue to drink
from unsafe water sources- thereby putting their health at riskfrom unsafe water sources- thereby putting their health at risk

37. Water Supply….Water Supply….
Each household should have minimum two containers of 20 LitersEach household should have minimum two containers of 20 Liters
capacity to ensure continuous availabilitycapacity to ensure continuous availability
Water collection and storage containers should have narrow necksWater collection and storage containers should have narrow necks
At least 250 gms. of soap should be available per person per monthAt least 250 gms. of soap should be available per person per month
If soap is not available-use alternatives like ash, clean sand , sodaIf soap is not available-use alternatives like ash, clean sand , soda
or various plants for washing and scrubbingor various plants for washing and scrubbing
At Communal Bathing facilities- sufficient cubicles should beAt Communal Bathing facilities- sufficient cubicles should be
available separately for men and women groups and should beavailable separately for men and women groups and should be
used appropriately and equitablyused appropriately and equitably
At Communal Laundry facilities one washing cubicle is available perAt Communal Laundry facilities one washing cubicle is available per
100 persons100 persons
Ensure private laundering facilities for women to wash and dry theirEnsure private laundering facilities for women to wash and dry their
undergarments and sanitary clothsundergarments and sanitary cloths

38. Excreta DisposalExcreta Disposal
Safe disposal of excreta creates the first barrier to excreta related disease,Safe disposal of excreta creates the first barrier to excreta related disease,
helping to reduce transmission thro’ direct and indirect routeshelping to reduce transmission thro’ direct and indirect routes
People need to provided with adequate no of toilets, sufficiently close theirPeople need to provided with adequate no of toilets, sufficiently close their
residential premises to allow them rapid, safe and acceptable access at allresidential premises to allow them rapid, safe and acceptable access at all
times of the day and nighttimes of the day and night
Parameters:Parameters:
(1) one toilet per 20 persons(1) one toilet per 20 persons
(2) toilets segregated for men and women(2) toilets segregated for men and women
(3) adequately cleaned and maintained(3) adequately cleaned and maintained
(4) not more than 50 meters away from their dwellings(4) not more than 50 meters away from their dwellings
(5) children Faeces are disposed off immediately(5) children Faeces are disposed off immediately
At times of disasters it may necessary isolating parts of the system, whichAt times of disasters it may necessary isolating parts of the system, which
are still working, re-routing of pipes, installing portable toilets and usingare still working, re-routing of pipes, installing portable toilets and using
septic tanks and containment tanks – which are regularly desludgedseptic tanks and containment tanks – which are regularly desludged

39. Excreta Disposal…..Excreta Disposal…..
During the initial phase of disaster mark-off an area to be used asDuring the initial phase of disaster mark-off an area to be used as
defecation field or for trench latrinesdefecation field or for trench latrines
Consult public-educate them on health benefits of using toilets and helpConsult public-educate them on health benefits of using toilets and help
them to maintain toilets and keep them cleanthem to maintain toilets and keep them clean
Sufficient no. of women cubicles need to be built up-roughly 3 times of men-Sufficient no. of women cubicles need to be built up-roughly 3 times of men-
Wherever possible provide urinals for menWherever possible provide urinals for men
People with HIV/AIDS frequently suffer with chronic diarrhea and require toPeople with HIV/AIDS frequently suffer with chronic diarrhea and require to
use toilets moreuse toilets more
Site selection should be such that all sections of people are able accessSite selection should be such that all sections of people are able access
toilets easily-it should be particularly safe for women and girls throughouttoilets easily-it should be particularly safe for women and girls throughout
the day and nightthe day and night
Should provide privacyShould provide privacy
Should allow for disposal of women’s sanitary protectionShould allow for disposal of women’s sanitary protection
Should minimize fly and mosquito breedingShould minimize fly and mosquito breeding
Should have adequate supply of water for anal cleansing an d keep themShould have adequate supply of water for anal cleansing an d keep them
cleanclean

40. Excreta Disposal….Excreta Disposal….
Separate water facility should be provided for hand washings andSeparate water facility should be provided for hand washings and
flushing after use of toiletsflushing after use of toilets
Pit latrines and soakaways (for most soils ) should be at least 30Pit latrines and soakaways (for most soils ) should be at least 30
meters from any groundwater source and the bottom of any latrine ismeters from any groundwater source and the bottom of any latrine is
at least 1.5 meters above the water tableat least 1.5 meters above the water table
Community toilets should be provided with lightingCommunity toilets should be provided with lighting
Toilet paper may be required in certain settings instead of waterToilet paper may be required in certain settings instead of water
Women and girls who menstruate should have access to suitableWomen and girls who menstruate should have access to suitable
materials for the absorption and disposal of menstrual bloodmaterials for the absorption and disposal of menstrual blood
Soap-ash may be proidedSoap-ash may be proided
Toilets with water-seal, ventilated improved pit latrine design orToilets with water-seal, ventilated improved pit latrine design or
correct use of a lid on a squat hole may encourage constant use bycorrect use of a lid on a squat hole may encourage constant use by
peoplepeople

41. Solid Waste DisposalSolid Waste Disposal
Organic wastes impose a constant danger ofOrganic wastes impose a constant danger of
(1) Fly and Rodent breeding(1) Fly and Rodent breeding
(2) Surface water pollution(2) Surface water pollution
(3) create an ugly and depressive feeling(3) create an ugly and depressive feeling
(4) Block drainage channels(4) Block drainage channels
Parameters:Parameters:
(1) Involve people in designing and management of waste disposal(1) Involve people in designing and management of waste disposal
ProgrammeProgramme
(2) Household wastes are put in containers(2) Household wastes are put in containers
(3) Communal Refuse container should be available within 100(3) Communal Refuse container should be available within 100
meters vicinitymeters vicinity
(4) 100-liter refuse container should be available per 10 families(4) 100-liter refuse container should be available per 10 families

42. Solid Waste Management…..Solid Waste Management…..
Medical wastes should be separated and disposed-off separatelyMedical wastes should be separated and disposed-off separately
In disaster situation there is more possibility of infectious sharps andIn disaster situation there is more possibility of infectious sharps and
non-sharps e.g. wound-dressings, blood stained clothes ,placentas..non-sharps e.g. wound-dressings, blood stained clothes ,placentas..
Safety boxes need to be provided to HCWs.Safety boxes need to be provided to HCWs.
Disposal may be done by on-site burial or incinerationDisposal may be done by on-site burial or incineration
At public places like markets. slaughter houses Refuse pits, Bins orAt public places like markets. slaughter houses Refuse pits, Bins or
specified areas should be clearly marked and appropriately fencedspecified areas should be clearly marked and appropriately fenced
In case of disposal of waste by Burial method it should covered withIn case of disposal of waste by Burial method it should covered with
a thin layer of soil at least once in a week to prevent it gettinga thin layer of soil at least once in a week to prevent it getting
attracted by vectors like flies and rodents and becoming a breedingattracted by vectors like flies and rodents and becoming a breeding
site for themsite for them
Such burial sites should also be fencedSuch burial sites should also be fenced
Prevent any laechate from such sites contaminating ground waterPrevent any laechate from such sites contaminating ground water

43. Solid Waste Disposal…Solid Waste Disposal…
At slaughter houses slaughter waste can often be disposed in aAt slaughter houses slaughter waste can often be disposed in a
large pit with a hole cover next to abattoirlarge pit with a hole cover next to abattoir
Blood etc. can be run from the abattoir into the pit through a slab –Blood etc. can be run from the abattoir into the pit through a slab –
covered channel (reducing fly access to the pit)covered channel (reducing fly access to the pit)
Water should be made available for cleaning purposeWater should be made available for cleaning purpose
Controlled Tipping/Sanitary Land-fill:Controlled Tipping/Sanitary Land-fill:
(a) useful for large scale off-site disposal of waste(a) useful for large scale off-site disposal of waste
(b) Sufficient space and mechanical equipments are required(b) Sufficient space and mechanical equipments are required
(c) Waste that is tipped should be covered by soil at the end of each(c) Waste that is tipped should be covered by soil at the end of each
day to prevent scavenging and vector breedingday to prevent scavenging and vector breeding
In all settings staff engaged in above work should be provided withIn all settings staff engaged in above work should be provided with
protective gloves, boots , masks ,soap and availability of waterprotective gloves, boots , masks ,soap and availability of water

44. Drainage FacilitiesDrainage Facilities
Surface Water near human settlements may be coming from:Surface Water near human settlements may be coming from:
(1) household and water point Wastewater(1) household and water point Wastewater
(2) leaking toilets and sewers(2) leaking toilets and sewers
(3) rainwater or rising floodwater(3) rainwater or rising floodwater
Health Risks:Health Risks:
(1) contamination of water supplies and the living environment(1) contamination of water supplies and the living environment
(2) damage to toilets and dwellings(2) damage to toilets and dwellings
(3) vector breeding &(3) vector breeding &
(4) drowning(4) drowning
Important Considerations:Important Considerations:
(1) areas around water points and dwellings are kept free from standing wastewater(1) areas around water points and dwellings are kept free from standing wastewater
(2) storm-water drains are kept clear(2) storm-water drains are kept clear
(3) Water point drainage from washing and bathing points are well planned and(3) Water point drainage from washing and bathing points are well planned and
maintainedmaintained
(4) drainage water should not pollute existing surface or ground water sources or(4) drainage water should not pollute existing surface or ground water sources or
erode themerode them
(5) adequate tools ,equipments and human workforce is available for maintainance(5) adequate tools ,equipments and human workforce is available for maintainance

45. Drainage Facilities….Drainage Facilities….
Sullage or Domestic waste water when gets mixed with human excreta=Sullage or Domestic waste water when gets mixed with human excreta=
SewageSewage
In human settlements during disasters also domestic wastewater should notIn human settlements during disasters also domestic wastewater should not
allowed get mixed with human excretaallowed get mixed with human excreta
Sewage is more difficult and expensive to treat than domestic wastewaterSewage is more difficult and expensive to treat than domestic wastewater
At water points and washing and bathing areas encourage to create smallAt water points and washing and bathing areas encourage to create small
gardens to utilize wastewatergardens to utilize wastewater
Specially protect toilets and sewers from flooding to avoid structural damageSpecially protect toilets and sewers from flooding to avoid structural damage
and leakageand leakage
Local community should be involved in providing small scale drainage worksLocal community should be involved in providing small scale drainage works
as they have good knowledge of the natural flow of drainage water andas they have good knowledge of the natural flow of drainage water and
where channels should be putwhere channels should be put
If off site disposal of wastewater is planned channels should be designed toIf off site disposal of wastewater is planned channels should be designed to
have sufficient flow-velocity for dry-weather sullage and to carry storm waterhave sufficient flow-velocity for dry-weather sullage and to carry storm water
Where the slope is more than 5% apply proper engineering methods toWhere the slope is more than 5% apply proper engineering methods to
prevent excessive erosionprevent excessive erosion
Drainage of residuals from any water treatment processes should beDrainage of residuals from any water treatment processes should be
carefully controlledcarefully controlled

46. Health System in DisastersHealth System in Disasters
Accessibility to all without discriminationAccessibility to all without discrimination
Well trained professionalsWell trained professionals
During armed conflicts , medical facilities and civilian hospitals should notDuring armed conflicts , medical facilities and civilian hospitals should not
be targeted for attackbe targeted for attack
Health and medical staff have rights to get protectedHealth and medical staff have rights to get protected
Public Health impacts may be seen in terms of injuries, psychologicalPublic Health impacts may be seen in terms of injuries, psychological
traumas, increased rates of infectious diseases, malnutrition, complicationstraumas, increased rates of infectious diseases, malnutrition, complications
of chronic disease etcof chronic disease etc
Interventions should be planed on evidence based practices- like adequateInterventions should be planed on evidence based practices- like adequate
quantity of safe water, sanitation, nutritional supplements, food aid/ security,quantity of safe water, sanitation, nutritional supplements, food aid/ security,
shelter and basic clinical careshelter and basic clinical care
Health system beneficiaries are mostly women and childrenHealth system beneficiaries are mostly women and children
Success Indicator of Health services is limitation of crude death rate as wellSuccess Indicator of Health services is limitation of crude death rate as well
as under-5 mortality rate to Less than twice the Baseline rate documentedas under-5 mortality rate to Less than twice the Baseline rate documented

47. Health Systems in Disasters……Health Systems in Disasters……
The average Base-line CMR for the least developed countries isThe average Base-line CMR for the least developed countries is
approximately 0.38 deaths/ 10000 / dayapproximately 0.38 deaths/ 10000 / day
Health agencies should aim to keep CMR at below 1.0/ 10000/ dayHealth agencies should aim to keep CMR at below 1.0/ 10000/ day
When the <5 CMR is unknown , Health agencies should aim toWhen the <5 CMR is unknown , Health agencies should aim to
maintain this rate below 2.0 / 10000/ daymaintain this rate below 2.0 / 10000/ day
No alternate parallel Hospitals / Health facilities should be createdNo alternate parallel Hospitals / Health facilities should be created
by Partners , unless it is clearly indicated by local health authoritiesby Partners , unless it is clearly indicated by local health authorities
When the local health authority is not in a position to take a lead inWhen the local health authority is not in a position to take a lead in
crisis situation, this job can be taken over by United Nationscrisis situation, this job can be taken over by United Nations
Authority like WHO, UNICEF etcAuthority like WHO, UNICEF etc
After initial Health Assessment , a Health Document should beAfter initial Health Assessment , a Health Document should be
created which mentions Health sector priorities and objectives-to becreated which mentions Health sector priorities and objectives-to be
shared with all Partners to achieve itshared with all Partners to achieve it

48. Health Systems in Disasters….Health Systems in Disasters….
Partner Health Agencies should adhere to the health standards andPartner Health Agencies should adhere to the health standards and
guidelines of the country including treatment protocols and essentialguidelines of the country including treatment protocols and essential
drug listsdrug lists
It is advisable to provide resources to existing hospitals so that theyIt is advisable to provide resources to existing hospitals so that they
can start working again or cope with the extra loadcan start working again or cope with the extra load
If at all a Base Hospital is necessary to establish, it should not drainIf at all a Base Hospital is necessary to establish, it should not drain
on local resources , but should be able function on it’s own and iton local resources , but should be able function on it’s own and it
must also be cost-effectivemust also be cost-effective
All the Health Agencies need to coordinate with local / nodal healthAll the Health Agencies need to coordinate with local / nodal health
authority for their allocated responsibilitiesauthority for their allocated responsibilities
A standardized Referral System should be established by LocalA standardized Referral System should be established by Local
/Nodal Authority and has to used by identical protocols by all/Nodal Authority and has to used by identical protocols by all
Priority Health Messages to be spread to local population have to bePriority Health Messages to be spread to local population have to be
developed by consensus and should be consistent for the contentsdeveloped by consensus and should be consistent for the contents

49. Health System in Disasters…..Health System in Disasters…..
Mobile clinics should be well planed for their routes, regularity ofMobile clinics should be well planed for their routes, regularity of
comprehensive services and avoid duplications of visitscomprehensive services and avoid duplications of visits
Standardized management protocols need to develop and to be adhered byStandardized management protocols need to develop and to be adhered by
allall
Drug donations are accepted only if they follow internationally recognizedDrug donations are accepted only if they follow internationally recognized
guidelinesguidelines
While staffing at treatment facility ,ensure to post at least one female healthWhile staffing at treatment facility ,ensure to post at least one female health
worker and one representative of a minority ethnic group which will increaseworker and one representative of a minority ethnic group which will increase
utilization of health care facility by women and people from minority groupsutilization of health care facility by women and people from minority groups
In normal circumstance utilization rate would be 0.5-1.0 consultation /personIn normal circumstance utilization rate would be 0.5-1.0 consultation /person
/year/year
Among displaced populations: 4.0 consultations/ person /yearAmong displaced populations: 4.0 consultations/ person /year
Utilization should be equally represented amongst vulnerable groups likeUtilization should be equally represented amongst vulnerable groups like
women, children and persons belonging to minority-ethnic groupswomen, children and persons belonging to minority-ethnic groups

50. Health Services in Disasters….Health Services in Disasters….
During disaster situations also patient’s rights to privacy,During disaster situations also patient’s rights to privacy,
confidentiality and dignity and informed consent have to enforcedconfidentiality and dignity and informed consent have to enforced
Drug management to be done on four basic principles i.e. selection,Drug management to be done on four basic principles i.e. selection,
procurement, distribution and useprocurement, distribution and use
Bodies of deceased persons pose dangers from public health pointBodies of deceased persons pose dangers from public health point
of view only during specific instances of Cholera and Haemorregicof view only during specific instances of Cholera and Haemorregic
feversfevers
Health Information system should generate critical data-onlyHealth Information system should generate critical data-only
essential information is collectedessential information is collected
Data should be analyzed-feed back provided for timely actionsData should be analyzed-feed back provided for timely actions
Surveillance data should be able to provide warning signalsSurveillance data should be able to provide warning signals
Data should be shared by all working PartnersData should be shared by all working Partners

51. Control of Communicable DiseaseControl of Communicable Disease
At the time of natural calamities between 60%-90% of deaths areAt the time of natural calamities between 60%-90% of deaths are
contributed by Four major communicable diseases namely-Measles,contributed by Four major communicable diseases namely-Measles,
Diarrhea, Acute respiratory infections and MalariaDiarrhea, Acute respiratory infections and Malaria
In no. of cases Acute Malnutrition is noticed as an Associated causeIn no. of cases Acute Malnutrition is noticed as an Associated cause
In certain disasters there have been increased no. of cases ofIn certain disasters there have been increased no. of cases of
Meningococcal Meningitis, Yellow Fever, Viral Hepatitis and TyphoidMeningococcal Meningitis, Yellow Fever, Viral Hepatitis and Typhoid
As such outbreaks of communicable diseases are far lessAs such outbreaks of communicable diseases are far less
commonly associated with acute onset natural disasterscommonly associated with acute onset natural disasters
General Preventive measures like water and sanitation, food-aidGeneral Preventive measures like water and sanitation, food-aid
and food-security, shelter etc. are coordinated by other sectorsand food-security, shelter etc. are coordinated by other sectors
Measles prevention is particularly indicated amongst displacedMeasles prevention is particularly indicated amongst displaced
population or the population affected by conflictpopulation or the population affected by conflict

52. Control of communicable diseases….Control of communicable diseases….
First of all an estimation of Measles coverage of children aged between 9First of all an estimation of Measles coverage of children aged between 9
months to 15 years is donemonths to 15 years is done
If above coverage is found to be Less than 90%, a Mass MeaslesIf above coverage is found to be Less than 90%, a Mass Measles
Vaccination campaign for all children in the age group 06 months-15 yearsVaccination campaign for all children in the age group 06 months-15 years
is initiatedis initiated
Simultaneously Vitamin – A is given to all children between 06-59 monthsSimultaneously Vitamin – A is given to all children between 06-59 months
Above activities should achieve minimum 95% coverageAbove activities should achieve minimum 95% coverage
All infants vaccinated between 6-9 months should receive another dose ofAll infants vaccinated between 6-9 months should receive another dose of
Measles vaccine upon reaching 09 monthsMeasles vaccine upon reaching 09 months
Routine Programme of EPI is re-established to sustain 95% coverageRoutine Programme of EPI is re-established to sustain 95% coverage
For mobile or displaced populations activities are planned in such a way thatFor mobile or displaced populations activities are planned in such a way that
at any point of time at least 95% coverage is maintained amongst allat any point of time at least 95% coverage is maintained amongst all
newcomersnewcomers
Reasons for including children of 06-15 yrs in Measles vaccination: someReasons for including children of 06-15 yrs in Measles vaccination: some
older children may have escaped both earlier measles vaccination andolder children may have escaped both earlier measles vaccination and
measles disease also-hence they are vulnerable-and can serve as a sourcemeasles disease also-hence they are vulnerable-and can serve as a source
of infection for infants and young children , who are at a higher risk of dyingof infection for infants and young children , who are at a higher risk of dying
from the diseasefrom the disease

53. Control of Communicable Diseases…..Control of Communicable Diseases…..
Malaria- Diagnostic facilities are geared up to have lab confirmation in 24Malaria- Diagnostic facilities are geared up to have lab confirmation in 24
hours in every casehours in every case
Anti-malarial drugs are given in prescribed doses for the period specified inAnti-malarial drugs are given in prescribed doses for the period specified in
the Programmethe Programme
Vector control measures and distribution of Insecticide treated mosquitoVector control measures and distribution of Insecticide treated mosquito
nets are synchronizednets are synchronized
Patients of Tuberculosis are treated as per RNTCP guidelines by DOTPatients of Tuberculosis are treated as per RNTCP guidelines by DOT
therapytherapy
Single case=outbreak: stands true in diseases like Cholera, Measles, YellowSingle case=outbreak: stands true in diseases like Cholera, Measles, Yellow
fever, Shigella and Viral Haemorregic Feversfever, Shigella and Viral Haemorregic Fevers
Meningococcal Meningitis:Meningococcal Meningitis:
(a) for areas with >30,000 population:- 15 cases/100,000/week indicates an(a) for areas with >30,000 population:- 15 cases/100,000/week indicates an
outbreak situationoutbreak situation
(b) if no outbreaks of meningitis have occurred in previous +3 years and if(b) if no outbreaks of meningitis have occurred in previous +3 years and if
vaccination coverage is< 80%- there is High outbreak risk- above thresh-vaccination coverage is< 80%- there is High outbreak risk- above thresh-
hold would be 10 cases/100,000/weekhold would be 10 cases/100,000/week
(c) for areas with <30,000 population:- incidence of 5 cases in one week or(c) for areas with <30,000 population:- incidence of 5 cases in one week or
doubling of cases over a three week period confirms an outbreakdoubling of cases over a three week period confirms an outbreak

54. What is a Rapid HealthWhat is a Rapid Health
Assessment?Assessment?
““Collection of subjective and objectiveCollection of subjective and objective
information in order to measureinformation in order to measure
damagedamage and identify those basicand identify those basic needsneeds
of the affected population that requireof the affected population that require
immediateimmediate response”response”
Rapid Health Assessment protocols for emergencies, WHO, 1999Rapid Health Assessment protocols for emergencies, WHO, 1999

55. Objectives of Rapid Health AssessmentsObjectives of Rapid Health Assessments
Collection objectives.Collection objectives.
– identify existing and potential public health needsidentify existing and potential public health needs
– identify gaps and problems in meeting urgent medicalidentify gaps and problems in meeting urgent medical
needsneeds
– assess existing and potential environmental riskassess existing and potential environmental risk
factorsfactors
– assess resource and logistics needsassess resource and logistics needs
– identify managerial, coordination and organisationalidentify managerial, coordination and organisational
gaps, overlaps and problemsgaps, overlaps and problems

56. Objectives of Rapid Health AssessmentsObjectives of Rapid Health Assessments
Analysis objectivesAnalysis objectives
– set priorities for response / reliefset priorities for response / relief
– set priorities for information dissemination andset priorities for information dissemination and
communicationcommunication
– identify resources needed to meet priorities – externalidentify resources needed to meet priorities – external
and internaland internal
– identify additional information needs for the responseidentify additional information needs for the response
and for planning recovery and reconstructionand for planning recovery and reconstruction

57. Questions Answered by aQuestions Answered by a
Rapid Health AssessmentRapid Health Assessment
– Is there an emergency or not?Is there an emergency or not?
– What is the existing response capacity?What is the existing response capacity?
– What decisions need to be made?What decisions need to be made?
– What information is needed to make theseWhat information is needed to make these
decisions?decisions?
– What are the sources of that information?What are the sources of that information?

58. The Purpose of HealthThe Purpose of Health
AssessmentsAssessments
To giveTo give decision makersdecision makers information that willinformation that will
allow them to makeallow them to make timelytimely andand appropriateappropriate
interventions to:interventions to:
• save livessave lives
• minimise injury and illnessminimise injury and illness
• prevent escalation of the emergencyprevent escalation of the emergency
• prevent spreadprevent spread
• support recovery planningsupport recovery planning

59. Rapid Health Assessment:Rapid Health Assessment:
Common MistakesCommon Mistakes
– No policy or guidelines on assessmentNo policy or guidelines on assessment
– No standard collection formatsNo standard collection formats
– No training in assessment skillsNo training in assessment skills
– Different sectors use different terms and methodsDifferent sectors use different terms and methods
– Data cannot be consolidatedData cannot be consolidated
– Too much irrelevant/duplicate data collectedToo much irrelevant/duplicate data collected
– Too much time takenToo much time taken – accurate is better than– accurate is better than
preciseprecise
– Those collecting the data don’t know how it will beThose collecting the data don’t know how it will be
used and don’t have the opportunity to improve theused and don’t have the opportunity to improve the
assessment systemassessment system

60. Rapid Health Assessment -Rapid Health Assessment -
Common MistakesCommon Mistakes
The biggest mistake in forms used by theThe biggest mistake in forms used by the
health sector is that they focus too muchhealth sector is that they focus too much
on collecting (unavailable or unreliable)on collecting (unavailable or unreliable)
morbidity and mortality data rather thanmorbidity and mortality data rather than
health sector function informationhealth sector function information

61. What is Available in the EHAWhat is Available in the EHA
Webpage?Webpage?

62. Recap: the Purpose of AssessmentsRecap: the Purpose of Assessments
To giveTo give decision makersdecision makers information thatinformation that
will allow them to makewill allow them to make timelytimely andand
appropriateappropriate interventions to:interventions to:
• save livessave lives
• minimise injury and illnessminimise injury and illness
• prevent escalationprevent escalation
• prevent spreadprevent spread
• support recovery planningsupport recovery planning

63. Health Needs Assessments (DANA, RHA)
Reporting + Surveillance
Hospitals cough + fever
Clinics and Health Centers diarrhea + fever
Laboratories headache + fever
PHC Programmes: rash + fever
nutrition myalgia + fever
IMCI - epi, ari, cdd etc other fever
water and sanitation malnutrition <5s
vector 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

64. RAPID HEALTH ASSESSMENT FORMATSRAPID HEALTH ASSESSMENT FORMATS

79. FINAL REPORTFINAL REPORT

84. Rehabilitation Aspects in Disasters-Rehabilitation Aspects in Disasters-
PHEMAPPHEMAP
Dr. S. J. GandhiDr. S. J. Gandhi
Deputy Director (Epidemic)Deputy Director (Epidemic)
Commissioner ate of Health ServicesCommissioner ate of Health Services
GandhinagarGandhinagar