Patrick Martiny , patrick.martiny@skynet.be

1. International Conference on Health Equity in Asia DISASTER AND HEALTH CARE SYSTEM MANAGEMENT December 13, 2012 Patrick Martiny, patrick.martiny@skynet.be

2. Definition one: hazard A dangerous phenomenon, substance, human activity or condition That may cause loss of life, injury or other health impacts, property damage, loss of livelihoods and services, social and economic disruption, or environmental damage. Comment: Hazards arise from a variety of geological, meteorological, hydrological, oceanic, biological, and technological sources, sometimes acting in combination. UNISDR (2009)

3. Definition two: disaster A serious disruption of the functioning of a community or a society, Involving widespread human, material, economic or environmental losses and impacts, Which exceeds the ability of the affected community or society to cope using its own resources. Comment: Disasters are often described as a result of the combination of: the exposure to a hazard; the conditions of vulnerability that are present; and insufficient capacity or measures to reduce or cope with the potential negative consequences. Disaster impacts may include loss of life, injury, disease and other negative effects on human physical, mental and social well-being, together with damage to property, destruction of assets, loss of services, social and economic disruption and environmental degradation. UNISDR (2009)

4. Definition three: health system A health system “consists of all organizations, people and actions whose primary intent is to promote, restore or maintain health”. Its goals are “improving health and health equity in ways that are responsive, financially fair, and make the best, or most efficient, use of available resources”. WHO (2007).

5. Definition four: complex adaptative systems Health interventions are introduced as innovations to health systems—complex adaptive systems - that change and adapt in response to endogenous and exogenous actions, disturbances or triggers. As with other dynamic complex systems, health systems comprise interacting feedback loops and non-linear relationships. In such systems the effects of decisions are separated in time and space, hence, the consequences of actions involving one or more elements of the system may not be immediately visible or accurately predictable. These relationships extend beyond the health system and are intricately linked to the context within which the system is embedded. Perturbations in the context influence system elements and changes in system elements affect the context. Further, each intervention is internalized within a distinctive adoption system comprising multiple agents (individuals and organizations that operate within a set of cultural norms and values) that act in ways that are not easily predictable. The actions of these agents are interconnected; action by one agent changes the context for other agents. The interaction of the innovation and the adoption system with the context influences the responsiveness of the context, which, in turn, influences the adoption and assimilation of the innovation in the health system. These dynamic interactions are non-linear, and can lead to unpredictable system responses with unintended consequences. RifatAtun et al (2010).

6. Functions for health care organizations Adapt. from Sicotte et al. (1998)

7. Six building blocks for production of care The WHO health system framework (2007)

8. Quality of care • Effectiveness and safety • Comprehensiveness and integration • Person centeredness and responsiveness • Continuity • A regular and trusted provider as entry point Integrated health care system • No overlapping and no gaps left • No competition between units but cooperation; each level provides care for the health problems it is best suited for • Smooth circulation of people and information

9. A framework for health system dynamic. Adapt. from van Olmen et al. (2012)

10. A framework for health system dynamic. Adapt. from van Olmen et al. (2012)

12. Insufficient attainment of goal & outcomes DISASTER HAZARD Not supportive values Insufficient production of care

13. Revision of goal & outcomes HAZARD DISASTER Adaptation of production of care Supportive values

14. Adaptation of production of care • Reinforcing existing units, redeployment of staff. • Making use of health care unit networks. • Creation of complementary provisional units. • Creation of a vertical program. • Reconstruction of care system • … • Focus on all building blocks (health care organisation, human resources, finances, information, leadership ...)

15. Grid of analysis for adaptation of care • The importance, the urgency of the health problem • The complexity of the intervention • The willingness of stakeholders (adoption system) • The health system (the organisation and performance of the health system, its resources ...). • The broad context (politic, technological opportunities, financial constraints ...) Adapt. from Atun et al. (2010)

16. Grid of analysis for adaptation of care Adapt. from Atun et al. (2010)

17. Atun R et al (2008). Health systems and systems thinking. In: Coker R et al. Health Systems and the Challenge of Communicable Disease. Experiences from Europe and Latin America. European Observatory on Health Systems and Policies Series, XXII: 121-140. • Atun R et al. (2010) Integration of targeted health intervention into health systems: a conceptual framework for analysis. Health Policy and Planning, 25: 104-111. • Sicotte C et al (1998). A conceptual framework for the analysis of health care organizations' performance. Health Serv Manage Res, 11, 24-41; discussion 41-8. • International strategy for disaster reduction. UNISDR Terminology on disaster reduction. United Nations: Geneva, 2009. • van Olmen J et al (2012). Analysing Health System Dynamics. A framework. Studies in Health Services Organisation & Policy, 28, 2nd edition. • WHO (2007). Strengthening Health Systems to improve health outcomes.