Health Cluster 90 Day Plan - draft
South Asia earthquake - 2005
Situation Analysis
The October 8 earthquake left over 80% of health facilities either destroyed or damaged beyond use. The majority of health care providers were affected themselves by loss of family members and loss of homes. The health care system in the six worst earthquake affected districts was effectively rendered inactive. By the end of November, the combined response of the Pakistan Military and the Ministry of Health, with support from the humanitarian cluster has sixteen field hospitals functioning and forty per cent of Basic Health Units supported to provide primary health care to the affected population. The biggest challenge for the next 90 days will be the provision of adequate sanitation and primary health care facilities to populations living in camps over the winter.
Achievements
Sixteen field hospitals are in place and at the request of the Federal Relief Commissioner (FRC) will remain until 31 March at least (pending funding, for many). Provided air evacuation services remain in place, it is felt that this number of hospitals is sufficient to cope with the emergency life saving needs of the affected population. The field hospitals are no longer dealing with acute earthquake related trauma but are providing essential surgical services and hospitalised care for severe medical conditions. The field hospitals working group is now drafting an exit strategy and a gradual handover to permanent hospital facilities. This is being done in conjunction with the provincial Health Secretaries both in NWFP and Pakistan Administered Kashmir and the respective Relief Commissioners for each province.
Primary health care (PHC) activities are the focus of most members of the health cluster with more than 44 health partners supporting PHC in pre-existing Basic Health Units (BHUs) or in facilities set up nearby to link to pre–existing structures as much as possible. Health partners consist of Ministry of Health personnel deployed from other parts of the country, international and national NGOs and individual health practitioners from overseas or Pakistan. More than 30 New Emergency Health Kits and trauma kits have been distributed to health partners working with BHUs, providing basic drugs and equipment for the needs of more than 300,000 people for three months.
A Disease Early Warning System (DEWS) is in place for the health partners to provide feedback to the National Institute of Health any trends or changes in disease patterns. Six response teams are available to investigate reported outbreaks. An alarming increase in cases of acute watery diarrhoea was detected in one spontaneous camp in Muzaffarabad during the second week of November and was immediately responded to. Case management was improved, numbers controlled and the outbreak was contained. Nevertheless the unsanitary conditions of this and other camps continue to give cause for concern as case management is never as effective as case prevention.
Standard case definitions and treatment guidelines have been prepared by the Ministry of Health and posted on the joint WHO/MOH web site along with reporting forms for easy reporting online. Other reports are fed back through the national surveillance system.
Vaccination campaigns have been ongoing in the earthquake affected districts since the disaster. These include measles, diphtheria, tetanus, polio and vitamin A. To date the total children who have received vaccination is 300,000.
Twenty mobile service units (MSU) are in operation to provide locations for pregnant women to deliver with the assistance of a trained female professional. 200,000 hygiene kits have been provided by UNFPA and distributed to women of child bearing age; a further 400,000 are planned.
Nine mental health teams have been mobilised to focus on psychosocial support for the earthquake affected population. A three day training of trainers course for mental health professionals has been held in Islamabad to mobilise the mental health professional community to recognise and treat signs of mental and psychosocial problems as a result of the earthquake, bereavement, loss of home and displacement.
Needs Assessment
The health cluster has been informed by the needs assessment carried out by the camp management cluster and is aware of the urgent need for sanitation in camps and for access to primary health care for the camp population. An assessment of the existing situation with regard to environmental health is planned within the next 90 day period.
Cluster Target Groups/Areas
Hospital Care
1) Maintain life saving services through sixteen field hospitals (FH) to provide secondary-tertiary health care facilities in affected areas.
Coordinate a referral system allowing for smooth transfer of patients from FHs to permanent tertiary care health centers in Abbottabad, Muzaffarabad, Islamabad / Rawalpindi and Peshawar. Facilitate communication between FHs to ensure a maximum utilization of available facilities before referral is considered.
Maintain through UNHAS a helicopter referral system for evacuation of patients to Islamabad for health needs beyond the capability of FHs. Review on a weekly basis all patients referred from FHs to tertiary care centers.
Expand services at FHs beyond trauma and emergency to include pediatrics, obstetrics, infectious diseases and respiratory care in addition to meeting the routine health needs of the population they serve.
Plan an exit strategy for FHs by linking them with local permanent facilities (district headquarters hospitals, rural health centres). Focus will be on facilitating a smooth transition from FH to reconstructed permanent facilities.
Emphasize training and employment of local people as health personnel, especially paramedical staff, to meet the increased needs of the population. Help to be sought from national and international institutions for training of permanent staff as well as for providing interim personnel.
Primary Health Care
2) Through more than 35 health cluster partners, provide support to over 150 Basic Health Units across six earthquake affected districts by provision of medical personnel, drugs and equipment. Where severely damaged, BHUs will be supported with prefab structures and tents to provide greater protection during winter. 3) Ensure basic primary health care facilities are available to 250,000 people living in spontaneous and planned camps. This may be through the provision of either MOH or NGO staffed clinics in the camp or through PHC facilities provided by the Pakistan Military. Advice and guidance will be supplied to the Pakistan Military on the Sphere standards for health care provision of camp populations.
4) Pre-position as many medical teams and New Emergency Health Kits as possible in selected combined Pakistan / British Military Forward Supply Areas that will be inaccessible during the winter months. One NGO has so far offered to position staff and supplies in Kahuta, Bagh District. A further nine sites may be selected.
5) Working closely with the water and sanitation cluster, the health cluster will ensure that all camps in which the cluster is working are adequately provided with clean water and that sanitation facilities are sufficient in quantity and maintained according to Sphere standards.
6) Maintain 20 mobile service units staffed with at least one female doctor and a lady health worker (LHW) to provide maternity services and other reproductive health services to women in areas where there is no Basic Health Unit. Provide UNFPA hygiene kits to all women of child bearing age through the LHW programme or other health cluster partner participation.
7) As part of the safe blood transfusion programme, three blood refrigerators will be procured and established in Muzaffarabad, Bagh and Rawalakot. Health messages on HIV and AIDS will be delivered by radio and through written media.
8) Work within the Ministry of Health EPI programme to carry out mass immunisation against measles and diphtheria (DPT) according to protocols in all earthquake affected districts. 9) Re-functionalise fifteen TB centres in NWFP through provision of tents, microscopes, drugs, furniture and training to make functional a total of 26 centres in NWFP.
10) Increase awareness of environmental health hazards by assessing the existing situation, coordinating actors involved and providing training in better hospital waste management.
Disease Surveillance
11) Move towards a sustainable system by working closely with district health authorities to deploy two officers of the district health team for surveillance. Expand the disease early warning system beyond the major centres to all accessible functioning health facilities. Increase local capacity to respond to disease outbreaks by training and activating an epidemic response and disease control team in every district. Provide feedback on the disease early warning system to all health cluster partners by publishing and disseminating a weekly morbidity and mortality report. About 60% of major centres are currently covered by the surveillance system. In 90 days health cluster plans to have increased surveillance to 80% coverage.
Mental Health and Psychosocial Issues
12) Maintain nine current teams of trained professionals to provide mental health care and psychosocial support across the six earthquake affected districts. A gradual increase in the number of teams is planned. Continue the Training of Trainers programme for mental health professionals in Islamabad (mid November). Training programmes for various non-physician personnel is planned, such as for teachers, health workers, volunteers, religious and community leaders.
13) Ensure a referral mechanism is in place for patients presenting with mental health or psychosocial issues and living in camps.
Challenges
All health cluster partners are committed to remaining actively engaged in the earthquake affected areas until the end of March 2006 but funding continues to be the major constraint to their doing so. Many NGOs are providing primary health care in remote locations and at high altitude by setting up self sufficient camps and supporting existing BHUs. These agencies are helping to provide first line care, vaccination coverage and midwifery services. The Ministry of Health welcomes support from these partners until it has regained capacity and human resources to take over. Without these NGOs, many communities would be without primary health care this winter.
Planning Assumptions
- Approximately two thirds of the population will remain in or as near to their own homes as possible.
- Approximately one third will be in camps or other alternative accommodation.
- Most health facilities in the earthquake affected region have been destroyed or damaged beyond use.
- There will be a greater proportion of women and children in the camps than men.
- Greater and earlier than usual seasonal migration patterns from high ground to lower ground will take place.
- Populations living in mountainous areas are not necessarily the most vulnerable.
- Women will not seek medical care from a male for obstetric and gynaecological problems.
- There will be increased needs for health care provision for the disabled.
- There will be increased needs for psychosocial health care provision.
- The Pakistan Government will continue to allow international medical staff open access to all areas of AJK.