REGIONAL COMMITTEE
Provisional Agenda item 10.1
Fifty-seventh Session Kurumba, Maldives 7-9 September 2004
SEA/RC57/11
9 August 2004
CONSIDERATION OF THE RECOMMENDATIONS ARISING OUT OF THE TECHNICAL DISCUSSIONS ON EMERGENCY HEALTH PREPAREDNESS
CONTENTS
1. INTRODUCTION .....................................................................................................................1 2. DISCUSSION POINTS............................................................................................................2 3. GROUP DISCUSSIONS .........................................................................................................4 4. BROAD STRATEGIES IN STRENGTHENING EMERGENCY HEALTH PREPAREDNESS ...................................................................................................5 5. CONCLUSIONS AND RECOMMENDATIONS ....................................................................6 6. CLOSING SESSION................................................................................................................7
1. INTRODUCTION In conjunction with the forty-first meeting of the Consultative Committee for Programme Development and Management (CCPDM), Technical Discussions were held on the subject of “Emergency Health Preparedness” on 20 July 2004 under the Chairmanship of Prof Azrul Azwar, Director-General of Community Health, Department of Health, Republic of Indonesia. Mr Ahmed Salih, Director, Ministry of Health, Maldives, was elected Rapporteur. The working paper for the Technical Discussions, along with the Annotated Agenda, formed the basis for the Technical Discussions. Together with the CCPDM participants, special invitees from the civil society sector and sister UN agencies participated in the discussions.
1.1 Opening Remarks by the Chairman The Chair welcomed the participants to the meeting and explained that for this year’s Technical Discussions on the topic of “Emergency Health Preparedness” had been chosen because of its relevance to Member States in the Region in the context of the changing global events, recent events in the countries, and the regular cycle of natural hazards affecting communities and populations. The Chair stated that this was a very good opportunity to recall the resolution on disaster preparedness adopted by the forty-fourth session of the Regional Committee and review the progress in the implementation of that resolution. The Chair invited the participants to engage in the discussions within the framework provided by the working paper and the Annotated Agenda.
1.2
Introduction of the Topic
The Chair requested Dr Luis Jorge Perez, Regional Adviser for Emergency Preparedness and Response, to introduce the working paper. Dr Perez’s presentation emphasized that the key factor in emergency health preparedness (EHP) was risk management and its mainstreaming in the planning and implementation of health and development activities. Emergency preparedness and response became more effective when risks were identified as also the ways and means to address them. The presentation further stressed on the explanation of risk management and related concepts. Risks were characterized in terms of populations affected and that risks varied between communities and within communities. Making risk management central to the disaster cycle was important since the risk approach could be applied at various phases of any emergency or disaster. The links between disasters and development were described with an emphasis on how risk reduction could actually assist in achieving the Millennium Development Goals (MDGs). The regional situation in regard to emergencies was presented. It highlighted common hazards and vulnerabilities and differences in capacities. Although many of the Member States have common natural hazards, the issue of complex emergencies occurring in several countries of the Region was raised. A case study of the current floods affecting three Member States (Bangladesh, India and Nepal) was described. An update on the current situation and a description of the response
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was presented highlighting the strengths, namely, decentralized response, intersectoral collaboration and community-based approaches. The community-based preparedness programme in Bangladesh was cited as an example of a sustainable approach. The success story of Gujarat, India, with health sector action from disaster to development was highlighted. Lastly, the effort of Nepal in addressing the risk of a major earthquake was presented as a focused but comprehensive effort for a specific risk. In conclusion, two important points were highlighted: • • Although Member States have addressed the issue of emergencies, there is a need for more concerted effort; and EHP is a cross-cutting issue and thus needs collaboration from all other programmes (e.g. communicable diseases control, mental health, information and advocacy).
The Chairperson summarized the issues raised in the presentation and then opened the floor for plenary discussions.
2. DISCUSSION POINTS • • The key issue in preparedness is strengthening the health infrastructure at all levels, particularly at the grassroots. The management of epidemics that follow a natural hazard (e.g. flood and cyclones) needs to be efficient. There is a need to have very good Standard Operating Procedures (SOPs) so that the emergency team and those involved in epidemic management and surveillance are able to manage the event efficiently without gaps. The Safe Community Initiative in Indonesia where capacities of communities are built to address specific hazards whereby risks and vulnerabilities in the communities are reduced was mentioned. The initiative also includes community advocacy to involve other sectors and, in the case of Indonesia, through the Red Cross/Crescent and the Scouting Movement. A joint committee under the President of the Republic of Indonesia is responsible for intersectoral collaboration. Complex emergencies, refugees and internally displaced persons, mainly due to political, ethnic and cultural issues, are priorities that need to be addressed. Logistics and resources are key issues in preparedness and response. The military has vast resources, particularly for logistics, but these may not be used in some cases of complex emergencies, e.g. refugees or internal displacement situations. There is a need to define the role of the health sector. Since the health sector cannot address emergencies by itself, it is important that the health sector describe clearly what it can deliver. Apart from the MDGs, environmental issues are an important area in which risk management principles can be applied. Preparedness for emergencies should be closely linked to communicable diseases control units to address issues of post-disaster surveillance and logistics support for surveillance.
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Movement of populations (e.g. refugees, internally displaced persons) has also increased the risk of these communities for communicable diseases such as HIV/AIDS. Addressing vulnerable populations through a strengthened health infrastructure is a key factor. Women and children are most vulnerable in emergencies. The example of Gujarat wherein services for pregnancy and child care were the big priorities after the emergency phase, was cited. The implications of small-scale disasters for a small country were immense. Ferry accidents, a possible oil tanker spill or an air crash were some aspects that would need guidelines and training for the health sector. Risk management is a key factor in emergency health preparedness. In the health sector, the integration of certain aspects of the departments of communicable and noncommunicable diseases may be an initial step towards this. Policy development and implementation can bring immense changes in emergency preparedness and response. There are recurring emergencies and one-off emergencies and the health sector should be able to respond to both types. Many of the issues which determine appropriate and efficient preparedness and risk management relate to governance. Strengthening the health system is key in preparedness. One aspect of this is effective routine immunization; this should be ensured. Community participation and social mobilization are important strategies in preparedness. Improving health intelligence is also an area that the health sector should address in emergency health preparedness. Information and communication is important prior to, during and after an emergency. Managing media means dealing with them even before an emergency and training them as well. During an emergency it is important to ensure that the flow of information within ministries of health and the larger public is consistent. Building capacity of the information/media units in ministries of health is key in this regard and policies are important to define this area of emergency management. There is a need to provide support to the health staff in remote areas to strengthen preparedness. Emergency preparedness and response envisages collaboration with other sectors., The health sector should be able to bring them in as partners. It is important to create a mechanism for multisectoral preparedness, planning and action either through a working group or a committee to avoid ad hoc response which very often is inadequate and inappropriate.
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Dr Perez further shared the work of other countries in emergency preparedness and response: Indonesia’s efforts in rehabilitation and peace building in Aceh; Sri Lanka’s management of the health issues in the Northeast and the floods in May 2003; DPR Korea’s management
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of the Ryongchon blast; Timor-Leste’s management of certain natural hazards in spite of having a fledgling programme; and Maldives’ management of a recent ferry accident. He stated that these examples showed that the issues mentioned on governance, intersectoral collaboration, effective planning and collaboration among other health programmes are key in emergency health preparedness. Dr Perez then reiterated the issue of the health MDGs and the contribution that can be made by risk reduction measures in their achievement.
3. GROUP DISCUSSIONS The participants were divided into three groups and asked to identify the main challenges faced in emergency health preparedness and propose solutions to them. Group 1 was represented by Mr Pemba Wangchuk; Group 2 by Dr Ganthimathi, and Group 3 by Mr Anshu Sharma. All the three groups made presentations. The following is a summary of the outputs of the three groups: Challenges and specific solutions (1) Political will is needed as this sets the framework for policy and action. • • • • • • • Advocacy and leadership of ministries of health Working and collaborating with media National and local plans and focal points needed Decentralized action in all phases of the emergency yields more sustainable results Resource allocation through budget at various levels of administration Institutionalization of disaster management Integrating risk management as part of development planning (one group noted that WHO had a key role in advocating this to the health sector as well as its sectoral partners and other UN agencies).
(2)
Intersectoral cooperation • • • • • Led by national/ provincial/district/ local and focal point with statutory provisions for authority National focal points represented by all relevant sectors National sectoral plans supported by a management information system Clear guidelines and defined roles for each sector Clear mechanism for this cooperation to be established that functions regularly.
(3)
Community participation • • To be initiated during non-emergency phase with civil society organizations and other agencies under the national plan Training and awareness to prevent and deal with emergencies
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• • • • • • • (4)
Community contingency action plans Private sector involvement Participation in vigilance and surveillance Recognition of services provided Active participation in the restoration of services Access to information Link with local authorities.
Capacity building of the health sector • • • • • • Development and implementation of a clear policy Comprehensive and strategic planning based on risk assessments Monitoring and evaluation Logistics in all phases of an emergency Resource allocation and investment in EHP and risk reduction Systematic flow of information in prevention, preparedness and action during emergencies linked to surveillance systems.
(5)
Intercountry cooperation • • • • • • To be initiated in the non-emergency phase Focus on common issues and resources Establishment of common platforms and mutual support Supported by good communication and transportation systems Networking Led and guided by WHO leadership.
4. BROAD STRATEGIES IN STRENGTHENING EMERGENCY HEALTH PREPAREDNESS • • • • • Development of norms and policies Capacity building of institutions and human resources Coordination and liaison with other sectors and mobilization of resources Research and development Community involvement and strengthening
Roles of Member States and WHO The discussions then addressed the strategies and roles of Member States and WHO in emergency preparedness and response with the working paper as the background document.
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The key issues raised were: (1) (2) (3) Revision of the International Health Regulations in relation to emergency preparedness and response. Community participation as a main strategy in addressing emergency health preparedness. Clarification of the role of WHO which participants defined as (in addition to those in the working paper) • • (4) Advocacy in the health sector and other sectors and agencies Coordinating role in the health sector in all phases of disaster.
Important role of civil society in community participation as compared to that of government.
The Chair pointed out that additions to the working paper were needed based on the comments made by the participants.
5. CONCLUSIONS AND RECOMMENDATIONS 5.1 Conclusions (1) (2) (3) Risk management is the core method in the development of effective and efficient emergency health preparedness and response activities. Risk management should be incorporated in all development planning activities so that emergency and disaster management is well linked to sustainable development. Member States should build political will by developing policies and legislations and invest in their budgets for risk management initiatives and programmes and emergency health preparedness, response, recovery, rehabilitation and mitigation. Strategies described in the paper provide very good guidance for Member States and each of these strategic directions can be further refined in the context of individual countries and the risks they face. Defining the roles of the health sector in Member States and that of WHO and other partners is the key to reducing disaster risk.
(4)
(5)
5.2 Recommendations (1) Policies should be developed and legislation enacted to promote and incorporate risk management, vulnerability assessment and risk mitigation into national and local health and development activities and provide resources to support the implementation of such policies. Focal points and units should be identified in the ministry of health for emergency health preparedness and response. Disaster management in the health sector should be institutionalized.
(2) (3)
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(4) (5)
Comprehensive strategic planning based on risk assessments should be supported. A clear capacity building strategy should be developed according to the actual needs of each country on risk management, risk communication, emergency preparedness, information management etc. in collaboration with other relevant sectors. Disaster management principles and activities should be included in school, college and training curriculum. Coordination mechanisms should be developed for facilitating inter- and intracollaboration and enhancing networking and mapping of resources among partners. Resource mobilization mechanisms should be developed to support response in emergencies. Informed decision should be promoted based on evidence and “lessons learnt” exercise.
(6) (7) (8) (9)
(10) Communities should be involved in the development and implementation of disaster risk reduction efforts.
6. CLOSING SESSION The Chair then invited the Deputy Regional Director to deliver the closing remarks. Dr Poonam Khetrapal Singh thanked the participants for their valuable inputs and said that these would be included in the working paper to be submitted to the Regional Committee. She stated that the challenges and strategies portion in the document would be suitably modified. For preparedness to be enhanced and risks and vulnerabilities reduced, collaboration within and across different sectors needed to be maximized. For this, the roles of various sectors had to be clearly defined. A comprehensive strategic risk approach was needed which would include risk assessment, risk planning and risk management. Integrating risk management as part of development planning was desirable. A coordinating body at the highest level of government would be helpful in implementing this approach. Strengthening community participation needed to be encouraged. Dissemination of correct information was critical. All these needed to be done in a manner that resources were utilized optimally so as to meet the objectives of risk reduction. The Technical Discussions Group proposed that the fifty-seventh session of the Regional Committee adopt a resolution on the subject. A draft resolution was accordingly prepared for consideration by the Regional Committee. The Chair closed the session with a vote of thanks.