Training for emergencies

World Health • 49th Year, No.6, November- December 1996 29 Training for emergencies Mohamed-Mahmoud Hacen This severely dehydrated child was given treatment during a WHO training course on diarrhoeal diseases and cholera in Kano, Nigeria. A WHO /ODA mission sent to seven African countries to assess their capacity to manage complex health emergencies emphasizes the training and preparation of human resources. Emergency situations in Africa, stemming primarily from the many civil conflicts that have broken out in the past 10 years, have led to the displacement of millions of persons while hundreds of thousands have been killed, injured, disabled, orphaned or traumatized. Health infrastructures have been looted and destroyed and in many areas have simply been abandoned because of lack of security. The provision of drugs and other supplies has become particularly difficult and, in many cases, impossible. Health personnel, the key factor in making sure that people trauma- tized by displacement and privation receive the care they need, are equally hard-hit by civil conflict. At the same time there has been a dramatic deterioration in the living conditions that determine health status : housing, food, water supply and sanitation. People in emergency situations have received a considerable amount of aid in recent years from the inter- national community. Yet, because of the frequency, scale, recurrence or prolongation of complex emergen- cies linked with civil strife, interna- tional aid has tended to level off or even diminish. The reasons for this are often summed up as "donor fatigue". In addition, "no go areas" have developed during violent conflicts, where it is difficult or impossible for expatriate aid person- nel to work. The greatest loss of life and the most acute health problems tend to occur in communities that are far removed from external aid, or else in the early stages of conflicts before such aid can be provided. Looking for opportunities The best possible response to all these constraints is to strengthen national and local capacities to deal with emergency situations, and it is to precisely this effect that the World Health Assembly, at its 48th session in May 1995, adopted a resolution stressing the need to build up na- tional emergency preparedness programmes, especially in "disaster- prone" countries. In response to this resolution , WHO's Division of Emergency and Humanitarian Action and the United Kingdom's Overseas Development Administra- tion (ODA), sent a mission early in 1996 to seven African countries. The aim was to identify, with all the partners concerned, both the opportu- nities for strengthening national capacity for managing health emer- gencies and the obstacles that need to be overcome so this can be done effectively. Emphasis was placed on the training and preparation of human resources. The WHO/ODA mission noted a number of important aspects of capacity building, particularly with regard to training and preparedness: • National health personnel always play a vital role in emergency situations; yet this role is often underestimated. • Certain public services always manage to function with the means available in spite of all kinds of difficulties. • National NGOs, both the church- based ones and others, often keep health services going in the hard- est-hit areas. • Community health workers, and particularly traditional birth attendants trained by the health ministry, are playing a major role in offering health care to rural communi ties of Liberia. In Somalia, essential health services have been kept going by national health workers supported by international agencies and NGOs from neighbouring countries. • Even when they are present in strength, outside humanitarian aid organizations tend to recruit more and more national technical staff. • Training and preparation of national health personnel make a major contribution to strengthen- ing a country's ability to manage health emergencies. • However, there is still no con- certed, well-planned, systematic and widespread training effort that covers all the categories of health personnel likely to be 30 Emergency drills, such as this exercise in Peru, are part of training for disaster preparedness. concerned in an emergency situation. • Investment in strengthening national capacities is seen as a pressing need by national author- ities and their partners in all the countries visited. Training and preparation of health personnel are everywhere recognized as essential. • Community health workers- first aid workers, traditional birth attendants and traditional healers -are always present in the af- fected communities, even the most remote ones, and tend to stay there even during the Worst emergencies. These people offer first aid and help the professional health workers; sometimes they provide the only health care available. • Nurses and midwives give the services and often run the health centres that represent the first contact between a local commu- nity and the national health care system. They form the backbone of human resources for health, and often live within the crisis- stricken community. Given appropriate training and enough resources, they can prevent or resolve most of the health prob- lems that arise in emergency situations. • Doctors are the people chiefly responsible for managing health districts and organizing health care in hospitals and clinics. Their skills in managing and organizing care are essential for coping effectively with the health aspects of emergencies. • National health authorities need to be highly skilled in evaluating the risks, the training, the plan- ning of response and the support needed at all operational levels of the national health care system. Many fields of action By nature multidisciplinary, training for the management of health emer- gencies must include the following: - evaluating the risks, the points of vulnerability and the early warn- ing signals; - ensuring fundamental health services in emergency situations; - control of epidemics; - nutritional surveillance and rehabilitation; - emergency health care and war surgery; caring for psychological trauma, particularly among women and children; - water, sanitation and environment in emergencies; - community participation in health services .and health promotion; - use of health as an entry point for resolving conflicts within com- munities and promoting civil peace and human rights; - logistics, supplies, communica- World Health • 49th Year, No.6, November-December 1996 tions and telecommunications; - management of health care in high-risk situations, including security measures, means of survival and negotiating with the warring parties; - coordination, complementarity and mutual support between the different partners at local , district and central levels; - managing the transition from the emergency phase to rehabilitation and development. The different types of training should form part of a si ngle plan that en- sures harmony and coordination between the different categories of personnel. Training of health per- sonnel is an essential element in strengthening a country's capacity to protect health and provide health care in emergencies. But training can guarantee the desired results only if it is integrated in a global plan of emergency preparedness and disaster response that includes evaluating risks, planning, making resources available and putting in place appro- priate organizational and legal mea- sures. Finally, both preparation for emergencies and response to them must by their very nature be intersec- toral processes whether in the com- munity or at national level. The health aspects of this process must be closely coordinated with other sec- tors in ways that are appropriate to · each particular country. • Dr Mohamed-Mahmoud Hocen is the WHO Representative for Madagascar and Reunion Island, and was head of the WHO/ODA assessment mission. His address is B.P. 362, Antananarivo I 0 I , Madagascar