HEALTH ASSESSMENTS

1. HEALTH ASSESSMENTS module 9

2. Learning Objectives By the end of this module, the participant should be able to: • Discuss the role of the Health Emergency Manager in Health Assessment • Discuss the purpose of Health Assessments including the need for phased assessments corresponding to the different phases of health emergencies • Describe the components of a Rapid Health Assessment tool and the process of conducting health such assessments • Discuss the benefits and problems associated with health assessment processes, methods and technologies

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

5. Group Activity • Work in groups to design the outline of a Rapid Health Assessment form for local staff to use in the scenario you have been assigned. • The form is one that must be designed to collect information that can be submitted within 48 hours. • At the end of the session, groups will work to revise and present their forms.

6. The Purpose of Assessments Q&A: What is the purpose of conducting assessments in emergencies?

7. The Purpose of Assessments To give decision makers information that will allow them to make timely and appropriate interventions to: • save lives • minimise injury and illness • prevent escalation of the emergency (increased severity) • prevent spread of the emergency to other areas • support response and recovery planning

8. Phased Assessments • One assessment cannot collect all the information needed to manage all the phases of response, recovery and reconstruction • Additional assessments are needed to determine the priorities and targets for immediate response, early relief and recovery, and longer-term recovery and reconstruction • BUT to enable effective decision-making and to avoid duplication and ‘assessment fatigue’ coordination is crucial.

9. Health Assessments are part of the HIS Assessment is the first step in a continuous information gathering process that includes: • Assessments of damage and analysis of needs (of the population and the responding agencies) • Emergency Reporting system • Morbidity and Mortality reporting (by age, sex, location and cause of death) • Surveillance of communicable disease, injury, nutritional status, water quality and disability • Ongoing monitoring of the effectiveness of relief services (health and non-health activity reports) • Evaluation of the operation

10. 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 daily daily ? 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?

11. Common Approach to Assessment Methodologies • Methodologies should be based on standard health indicators • Health assessments should take account of health status of population before the disaster Health indicators can be used in Health Emergency Management for: • Assessing disaster impacts and needs • Monitoring and evaluating programme implementation and outcomes

12. A Policy on Assessments • Defines the general purpose of assessments • Defines the data to be collected • Defines the classification of victims • Defines the classification of damage • Defines the format for the collection • Defines the reporting schedule • Defines the assessment roles and responsibilities of agencies and departments in preparedness and response • Defines the knowledge and skills needed for assessments

13. The All Hazards Approach and Assessment • 80% of what we do in emergencies is generic – we do it for every emergency – the all hazards approach • No need to wait for field information to do this • 15% is specific to the hazard • Much can be done before field data is available but an assessment is needed to provide the quantitative data • 5% is unique to the event – the people, the place and the time • The assessment will provide all of this data

15. Multi-sectoral assessments

16. Damage Assessment and Needs Analysis (DANA) A multi-sectoral, team activity that uses standard protocols to collect data that is analysed to define: • the causative factors of problems • what needs to be done? • the extent of the problem • how much of which resources are needed?

17. Damage Assessment and Needs Analysis (DANA) • the likely trends • for how long? • constraints (climatic, geographic, political, social, logistical, organisational etc.) • priorities and targets over the relief and recovery period

18. Group Activity Work in your groups to answer the following questions: • What are the benefits of the health sector being involved in a multi-sector DANA? • What can be some constraints to a multi-sectoral approach?

19. Which Information? • The population: • demography, culture, geography, climate • baseline causes of morbidity and mortality • The support systems: • information flows • logistics • coordination • communication • resource flows • The basic needs: • food • water • shelter • energy / fuel • security • acute medical care • hygiene and sanitation etc.

20. Pre-assessment Information • any existing demographic information • any existing national, provincial or district emergency profiles • local risk assessments • local capacity assessments • inventory of resources and deficits • maps • directory of local staff and experts (government and NGO) • lists of emergency materials and supplies • logistics arrangements for emergencies • standing orders and administrative guidelines

21. Why Assess Damage? • Guides the setting of relief priorities: • Needs caused by damage: • Direct needs e.g. treat the injured – will the damages affect this? • Indirect needs – caused by damage e.g. loss of access to water supply • Function and safety issues –– can a service be delivered, is a building safe (building “triage”) • Evacuate or not ? • Can people access the service? • Repair or provide a temporary service? • Guides planning for repair, rebuilding and reconstruction

22. Factors Determining Damage and Needs • the vulnerabilities of the affected communities and of different individuals and groups within those communities • the readiness of response agencies • the gaps in essential resources, including logistics capacities • the impact, extent and duration of the hazard

23. Stage Time-frame General Needs Health Sector Responsibilities Immediate first search and rescue safe extraction, resuscitation and first aid 24 evacuation / shelter triage and transport system hours food primary medical care water detoxification / decontamination public information system acute medical and surgical care (first line and referral) injury disability emergency coordination, communication, logistics and reporting systems (including and registers) Short term end of security emergency epidemiological surveillance for VBD, VPD, DEP, DPHS first week energy (fuel, heating, light etc.) treatment and control of cases of VBD, VPD, DEP, DPHS, PUCD environmental health services: strengthen blood banks and laboratories (diagnosis, confirmation, referral) * vector control strengthen burns, spinal / head injury, orthotics / prosthetics, dental services * personal hygiene strengthen referral system - curative, mental health and obstetric services * sanitation, waste disposal etc. nutrition surveillance and support (including micronutrient supplementation) dead and missing (emergency measles vaccination and Vitamin A) Medium end of protection (legal and physical) (re) establishment of the health information system term first month employment restoration of preventative health care services such as EPI, MCH, etc. public transport restoration of priority disease control programmes such as TB, malaria etc. public communications restoration for services of non-communicable diseases / obstetrics psychosocial services care of the disabled (mental and physical) Long term end of education reconstruction and rehabilitation 3 months agriculture specific training programmes environmental protection health information campaigns / health education programmes disability and psychosocial care Conclusion compensation / reconstruction evaluation of lessons learned restitution / rehabilitation revision of policies, guidelines, procedures and plans prevention and preparedness upgrade knowledge and skills, change attitudes and practices Vector Born Disease, Vaccine Preventable Disease, Diseases of Epidemic Potential, Diseases of Public Health Significance, Potentially Unstable Chronic Disease) General and Health Needs

24. Categories of Information The assessment involves the collection of two key categories of information: • Analysis of the needs of the victims • Immediate needs arising from the situation • Future needs arising from damage / disruption to services / infrastructure • Analysis of the damage to: • Critical resources • Critical infrastructure and fixtures • Critical services

25. Information on Victims A report describing the impact of a hazard will provide: • Number of casualties • killed; injured; sick; disabled; • by age, sex, location and probable cause of death • Number of affected • total affected; severely affected; critically affected;

26. Classification Based on Severity The following criteria are used to describe the severity of the impact on people: • affected • all those living within the geographical area involved • severely affected • those who have lost one or more of their lifelines • critically affected • those who have lost all of their lifelines • OR who have been displaced i.e. those totally dependent on others to support them

27. Critical Services - Basic Needs and Lifelines Basic needs are the minimum requirements needed for the survival of the affected population (also called “pre-requisites for health”). Q&A:What are the basic needs for survival of a population?

28. Critical Services – Basic Needs and Lifelines Basic needs for survival: • water • food • shelter (and clothing in cold climates) • energy (fuel) • (acute medical care)

29. Critical Services – Basic Needs and Lifelines Lifelines are services that are needed to deliver the basic needs. Q&A: What lifelines can you identify that would enable the meeting of these basic needs?

30. Critical Services – Basic Needs and Lifelines Critical lifelines: • Utilities (water, electricity, gas) – sources and networks • Communications systems • Transport networks (air, sea, road) • Distribution systems

31. Critical Services – Basic Needs and Lifelines First priority of the government: To restore lifelines and meet basic needs

32. Assessing Facilities and Services For each facility or service in the affected area, the assessment grades function according to a pre-defined scale: For example: • destroyed / no function possible • more than 50% reduction in capacity • less than 50% reduction in capacity • undamaged / full function

33. Health Assessments

34. What is a Rapid Health Assessment? “collection of subjective and objective information in order to measure damage and identify those basic needs of the affected population that require immediate response” Rapid Health Assessment protocols for emergencies, WHO, 1999

35. Public Health Consequences of Disasters • temporary population displacements • increased numbers of deaths and injuries • new cases of disease and disability • exacerbation of and increased numbers of cases of psychological and social behaviour disorders • food shortages and nutritional deficiencies

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

37. Emergencies and Health HEALTH RESPONSE search and rescue first aid triage medical evacuation primary care disease surveillance and control curative care blood banks laboratories referral system special units (burns, spinal) evacuation centres shelter water food and nutrition energy security environmental health primary health care care of the dead psychosocial care disability care recovery reconstruction Community VULNERABILITIES CAPACITIES DIRECT IMPACTS DamageandNeeds EMERGENCY INDIRECT IMPACTS ASSOCIATED FACTORS Climate / weather / time of day Location Security situation Political environment Economic environment Socio-cultural environment Morale, solidarity, spirit Competence, corruption

38. Objectives of Rapid Health Assessments Collection objectives • identify existing and potential public health needs • identify gaps and problems in meeting urgent medical needs • assess existing and potential environmental risk factors • assess resource and logistics needs • identify managerial, coordination and organisational gaps, overlaps and problems

39. Objectives of Rapid Health Assessments Analysis objectives • set priorities for response / relief • set priorities for information dissemination and communication • identify resources needed to meet priorities – external and internal • identify additional information needs for the response and for planning recovery and reconstruction

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

41. Categories of Information The assessment involves the collection of three key categories of information: • Analysis of the damage to: • critical resources • critical infrastructure and fixtures • critical services • Analysis of the needs of the response agencies • immediate needs arising from the situation • future needs arising from damage / disruption to services / infrastructure • Analysis of the needs of the victims • immediate needs arising from the situation • future needs arising from damage / disruption to services / infrastructure

42. Rapid Health Assessment task The first task is to assess functioning of all the health facilities in the area (hospitals, clinics, laboratories, warehouses, blood banks, administration): • Staff – dead, injured, missing, absent • Access – can staff / people reach the facility • Buildings – damages, safety, loss of electricity / gas / water, loss of fuel (diesel) • Supplies and equipment damaged or lost, including vehicles

43. Rapid Health Assessment tasks - cont. The next task is to assess needs arising from loss function : • Temporary services needed? • Repairs needed? • Replacements needed (staff and materials)?

44. Rapid Health Assessment tasks - cont. The next task is to assess urgent health needs of the population: • Overview of actual and potential causes of morbidity and mortality, and numbers of cases The final report will make recommendations on: • Resource needs • Personnel needs • Management and organisational needs • Logistics and communication needs

45. Use the Coordination Mechanism It is not necessary to go to the field to collect detailed information from other sectors At the daily coordination meetings, reports and assessments from other sectors are shared – these can be sent as ANNEXES to health sector reports The Emergency Reporting System should take over from assessments as soon as possible

46. Planning a Rapid Health Assessment • Set the assessment objectives, team skill needs and time frame • Collect the data: • reviewing existing information • inspecting the affected area • interviewing key people • carrying out a rapid survey • Analyse and interpret the findings • Issue orders and instructions • Disseminate the report and communicate the findings

47. Preparing for an Rapid Health Assessment • What information should I collect before going to the field? • What collection methods are appropriate given: • the specific context of the emergency, and • weather, security, time, logistics, technical, cultural constraints? • What will be the main sources of information? Is an interpreter needed?

48. Preparing for an Rapid Health Assessment - cont. • What is the composition of the team and the role of each team member? • What are the security, logistics and communication needs of the team? • What equipment to take – maps, contact information, forms, specimen bottles, paper / pens, personal items

49. Q&A • Does your country have a policy and guidelines, protocols, standard forms for Rapid Health Assessment? • Are people trained in health assessment? • What are the common weaknesses of rapid health assessments?

50. Rapid Health Assessment: Common Mistakes • No policy or guidelines on assessment • No standard collection formats • No training in assessment skills • Different sectors use different terms and methods • Data cannot be consolidated • Too much irrelevant/duplicate data collected • Too much time taken – accurate is better than precise • Those collecting the data don’t know how it will be used and don’t have the opportunity to improve the assessment system