Capacity Building for Health Workforce

1. Capacity Building for Health Workforce First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

2. Learning Objectives By the end of this module, the participant should be able to: • Describe the elements of capacity to manage health • risks of emergencies • Identify key elements of capacity for specific health • service delivery functions • Describe the role of a health emergency manager in • health emergency management systems and in • developing health emergency management capacity First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

3. Health Workforce • all persons currently participating in the health labor market Health Workers • all people engaged in actions whose primary intent is to enhance health • Physician • Nursing and midwifery personnel • dentistry personnel • pharmaceutical personnel • laboratory health workers • environmental and public health workers • community and traditional health workers • other health service providers • health management and support workers First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

4. Defining Capacity Sum of: capability resources relationships Within community organization country region world Aims • Reducing illness, disability and death from risks • Promoting health, safety and security First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

5. Defining Capacity • System definition of capacity • Capacity includes capability (knowledge, attitude • and skills) of the component parts, the resources • (financial, equipment) which support the system, • and the relationshipswhich together form the • system. • Capacity is a quantitative measure • Measurement of human and material resources • i.e. number or volume or size. For example, the • capacity of the hospital is 500 beds First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

6. Relevance of Risk Management to HEM Capacity Development • Risk = Hazard x Vulnerability • Capacity • In managing Risk: Capacity is needed to: • Reduce Hazard • Reduce vulnerability • Increase Capacity First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

7. Health Emergency Management Capacity Capacity to perform the following functions: • Reduce hazard • Reduce vulnerability • Respond to reduce and manage Response • consequences • Recover and reconstruct for better Recovery Preparedness First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

8. Disaster Risk Management Framework Response (Capacity utilization) Preparedness (Capacity building) Recovery (Capacity rebuilding for better) First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman (Capacity to Reduce/prevent Hazard) (Capacity to Lessen Impact of hazard) Mitigation Prevention

9. ANATOMY OF COMMUNITY RISK MANAGEMENT Community risk readiness community = hazard  vulnerability multisectoral, all hazards indicators: indicators: indicators: indicators: probability scale/magnitude/ strength/intensity spread duration biological hazards: season, infectivity, latency, transmission resistance, etc. policy, plans, procedures knowledge, skills, attitudes resources legislation national & sectoral policy administrative procedures response & recovery plans preparedness plans technical guidelines management structure institutional managements information systems warning systems human resources material resources financial resources simulations & training education public information community participation research publications People: access to health care measles vaccination under 5 nutrition under 5 mortality access to clean water access to sanitation adequate housing employment/ income female literacy Property: health infrastructure vehicles medical supplies Services: curative care services ambulance services public health services health info system Environment: water/soil/air quality risk of: death injury (mental/ physical) disease (mental/physical) loss of life displacement loss of property loss of income secondary hazards breakdown in security damage to infrastructure breakdown in services Contamination natural phenomena famine diseases of epidemic potential events/crowds intoxification infestations transport accidents structural failures industrial accidents chemical accidents pollution refugees war terrorism First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Prevention & Mitigation Programme Vulnerability Reduction Programme Emergency Preparedness Programme = Community Risk Management  

10. Elements Of capacity to Perform Functions Organizations Systems People First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

11. Organizations In the context of health emergency: • Designated/organized body • Defined organizational structure • Clear roles and directions • United action or functions • Legal framework First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

12. Systems Definition: a “regularly interacting or interdependent group of items forming a unified whole” (Merriam Webster Dictionary) an orderly grouping of facts, principles, or methods in a certain field; any formulated method or plan; a manner of arrangement or procedure (The Random House Dictionary) First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

13. Systems to Manage Health Risks of Emergencies Systems • systems operating at each administrative level • systems in specific sectors • systems to manage specific types of risks • (hazards and vulnerabilities) • systems for specific functions or services First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

14. People People contribute to organizations and systems by providing: • skills, knowledge and attitudes • Competency People may be: • Career (or paid), volunteer and community • Managers, coordinators, operators or responders First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

15. Evacuation Site Scenario • Damaged lifelines • Overcrowding • Poor environmental sanitation • No access to safe water • Inadequate sanitary toilets • Health workers are direct victims • Disrupted basic health services First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

16. Evacuation Site Scenario: Typhoon • Poor environmental sanitation • No access to safe water • Inadequate sanitary toilets • No community surveillance system • Disrupted basic health services • Foul smell of decomposing bodies • Severe depression of the bereaved • and other health workers First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

17. Group Activity 1 In your group, address one of the following: • Poor environmental health condition • Disrupted communicable disease services • Poor management of the dead and the missing • Lack of mental health and psychosocial support Assess the risk and identify capacity needed in terms of organization, systems and people. Write your answers on a flip chart for presentation. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

18. Environmental Health in Evacuation Center Environmental health risks are assessed, including: • Water supply services • Waste handling and disposal • Food safety • Garbage disposal Local Capacity ( laboratory services, sampling, diagnosis and analysis; equipment etc.) Inventory of organizations with environmental health roles and responsibilities (laboratories, surveillance, chemical industries, water supply services, waste disposal services, fire service, etc.) Availability of supplies, reagents, medicines First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

19. Environmental Health in Evacuation Center Environmental health risks: • Food and water borne diseases Environmental Capacity • Environmental assessment, surveillance • Environmental teams • Environmental logistics including systems of distribution • Laboratories and other confirmation devices • Reporting, monitoring, evaluation First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

20. Communicable Disease Communicable health risks are assessed including: • Diseases of Epidemic Potential • Vaccine Preventable Diseases • Vector Born Diseases • Diseases of Public Health Significance Considerations: • Health status • Local capacity, program implementation • Inventory of Organizations • Availability of health services, facilities • Availability of drugs, medicines, supplies, vaccines First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

21. Communicable Disease Communicable health risks: • Epidemic and Outbreak Communicable Disease Capacity • Surveillance System in place in evacuation centers • Surveillance teams available • Case definition etc.. • Epidemiological investigation • logistics including systems of distribution • Laboratories and other confirmation devices • Reporting, monitoring, evaluation • Networking and referral system First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

22. Management of the Dead and Missing MDM Issues: • Identification of the Dead • Cultural Considerations • Final Disposal of the Dead • Management of the Relatives Considerations: Legal framework, functioning coordination mechanisms and organizational structure in place for health emergency preparedness and response Local capacity Inventory of Organizations Mortuary System First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

23. Management of the Dead and Missing MDM health risks? • Myths and realities about dead bodies • Mass burial MDM Capacity • Organizational/Institutional Arrangements; roles and responsibilities; management structures • Procedures (identification, keeping of records, fingerprinting, dental records, DNA and photographing) • Provisions for notification of relatives (next of kin) • Logistics • Reporting, monitoring, evaluation • Networking and referral system First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

24. Mental Health and Psychosocial Support Psychosocial health risk assessment: • Coverage • Silent victims, Family displacement • Medical Responders/Leaders • Early identification and referral Considerations: • Local capacity for emergency provision of essential services and supplies • Inventory of organizations, health facilities, Availability of drugs, medicines, supplies, Availability of training modules and trainers First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

25. Mental Health and Psychosocial Support Psychosocial health risks: • Long lasting; affects rehabilitation and recovery (children, responders, etc.) Psychosocial Capacity • Policies and Plan • Training modules, pool of trainers ; range of services • Advocacy and awareness through education, information management and communication • Health facilities, drugs and medicines • Reporting, monitoring, evaluation • Networking and referral system; Inter and Intra sectoral coordination • Local capacity for emergency provision of essential services and supplies First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

26. Elements Of capacity To manage Health risks of emergencies • Legal framework • Policies • Guidelines • Procedures • Resources • Plans • Knowledge • Attitude • Skills Organizations Systems First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman People

27. EMERGENCY AND HEALTH RESPONSE CAPACITIES Search and rescue First Aid Triage Medical evacuation Primary care Disease surveillance and control Curative care Blood banks Laboratories Referral system Special units (burn, spinal) Evacuation centers Shelter and Water Food and nutrition Energy and Security Environmental health Primary Health Care Care of the dead Psychosocial care Disability care Recovery and Reconstruction COMMUNITY VULNERABILITIES CAPACITIES DIRECT IMPACT DAMAGE AND NEEDS EMERGENCY INDIRECT IMPACT ASSOCIATED FACTORS Climate/ weather/ time of the day Location Security situation Political environment Economic environment Socio-cultural environment Morality, solidarity, spirit Competence, corruption First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

28. EPIDEMIC EMERGENCIES RESPONSE CAPACITIES Case definition Admission criteria Case confirmation Case management Discharge criteria Contact tracing Vector control Environmental controls Surveillance system Referral system Professional education Public Information and awareness Laboratory plans Hospital plans Supplies and equipment Borders control Quarantine Animal culling Commerce/ trade Specific morbidity and mortality OUTBREAK NEEDS - in the community - in health facilities - in health facilities First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Risk for health and lab workers Difficult access Agent unknown

29. General or Cross-cutting Functions • Communication and transport • Information management • Health surveillance • Mental health • Reproductive health • Environmental health • Food safety, emergency feeding and • nutrition • Water supply management • Waste management First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

30. Specific Emergency Response and Emergency Recovery Functions • First aid, self-aid and first-responder • health assistance • Incident site management • Assessing needs • Mass-casualty management • Decontamination • Epidemiological investigation First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

31. Specific Emergency Response and Emergency Recovery Functions • Forensic investigation • Management of the dead and the missing/ • fatality management • Shelter and temporary accommodation (including • evacuation shelters) • Community support • Longer-term issues (health effects, recovery, • rehabilitation, reconstruction) First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

32. Role of the Health Emergency Manager • Determine the risk and plan to manage it • Identify the capacity needed in terms of • Organization,Systems and People • Determine strategies to reach the goals set • Determine resource requirements (Comparefrom • what isavailable to what is requiredand what is • the gap) • Look for resources, identify partners, co share • Determine a point person, time frame andindicators • Monitor and evaluate First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman