HEALTH SECTOR ASSESSMENTS

IN EMERGENCIES

3rd ANNUAL REGIONAL TRAINING COURSE ON THE

MANAGEMENT OF PUBLIC HEALTH RISKS IN
DISASTERS FOR THE EASTERN MEDITERRANEAN
MPHR 3
CAIRO, 20-31 May 2007
Damage Assessment and Needs Analysis (DANA)

A multi-sectoral, team activity that uses standard protocols to

collect data that is analysed to define:

the main problems in relief

the causative factors of those problems
what needs to be done?
the extent of those problems
how much of which resources are needed?
the likely trends
for how long?
the constraints (climatic, geographic, political, social,
logistical, organisational etc.)

The information is used to:

set priorities and targets for the relief operation
allocate specific responsibilities to participating agencies
 Which Information?

The population: The basic needs:

demography, culture, Shelter/clothing
geography, climate Water/sanitation
baseline causes of Food/preparation
morbidity and Energy/fuel
mortality

The support systems: Security

coordination Acute medical care
communication Personal hygiene
logistics Waste management
information flows etc.
resource flows
Why assess damage?

Guides planning for repair, rebuilding and

reconstruction
Guides the setting of relief priorities:
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?
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
Questions and Answers

Work in your groups to answer the following

question (30 minutes):

What are the health needs in emergencies ?

Construct the following table.

 Needs in an Emergency

Vector Born Disease, Vaccine Preventable Disease, Diseases of Epidemic Potential, Diseases of Public Health Significance, Potentially Unstable
Chronic Disease)
Categories of information

The assessment involves the collection of two key

categories of information:

Analysis of the damage to:

critical resources
critical infrastructure and fixtures
critical services

Analysis of the needs of the victims

immediate needs arising from the situation
future needs arising from damage/disruption to
services/infrastructure
Information on victims

A report describing the impact of a hazard will provide the

number of:

Number of casualties
killed; injured; sick; disabled;
by age, sex, location and probable cause of
death

Number of affected
total; severe; critical;
Classification based on severity

The following is 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
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):
water
food
shelter (and clothing in cold climates)
energy (fuel)
(acute medical care)

Lifelines are services that are needed to deliver the basic needs:
Utilities (water, electricity, gas) sources and networks
Communications systems
Transport networks (air, sea, road)
Distribution systems

First priority of Government restore lifelines and meet basic

needs
Assessing facilities and services

For each facility or service in the affected area, the

assessment classifies facilities according to function:

destroyed / no function possible

more than 50% reduction in capacity

less than 50% reduction in capacity

undamaged / full function

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
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
Emergencies and Health HEALTH RESPONSE

search and rescue

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

recovery
reconstruction
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
Reference Values
Prepare tools to assist planning

Public Health Predictors template.x

ls
Health Sector Assessments by Hazard Class

1. Natural Hazards
focus first on recording damage to health sector, then on the needs of the
health facilities to restore some function, then on the meeting needs
arising from actual and potential causes of morbidity and mortality

2. Technological Hazards
focus on capacity to meet the needs arising from the actual and potential
causes of morbidity and mortality

3. Biological hazards
focus on capacity to meet the needs arising from the actual and potential
causes of morbidity and mortality

4. Societal Hazards
In conflict - focus first on recording damage to health sector, then on the
needs of the health facilities to restore some function, then on the
meeting needs arising from actual and potential causes of morbidity and
mortality
In other situations - focus on capacity to meet the needs arising from the
actual and potential causes of morbidity and mortality
 Needs Assessment and Programme Monitoring
Assess resources and Assess health status
infrastructure (morbidity, mortality, nutrition)
Is there damage to health
sector infrastructure?
Is there damage to health
Is there a major health problem?
sector resources?
Is there damage to lifelines?
YES YES
Can the health system cope?
Can the community cope?
NO
strengthen existing services/
organise temporary services
Mobilise additional resources
Seek expert advice
Organise epidemiological studies
and surveys
Programme Indicators
water, sanitation, waste, shelter, food supply and
1
nutrition services in place / meeting needs
NO curative, preventative, promotional and
2
rehabilitative services in place / meeting needs
situation specific preventative actions being taken
3 vector control, measles vaccination, vitamin A,
public awareness, antenatal care etc
4 guidelines issued and being followed
Monitor and Evaluate
reporting and surveillance systems for injury,
YES 5 disease, nutrition, water quality, vectors, food
safety, mental health, disability in place
referral systems in place, including laboratories,
6
psychosocial, chronic diseases and disability care
essential drugs and equipment available,
7
appropriate and sufficient
management, logistics, security and
8
communications systems in place / meeting needs
9 staff safety, information, training needs being met
community health information / health education
10
needs being meet
plans for rehabilitation and reconstruction address
11 issues of equity, access, coverage and risk
reduction
SUMMARY

Emergency

?
Rapid Health Document URGENT
Assessment damages and needs

Needs from loss of function

due to damage
Emergency
Needs of health sector to
Reporting system
deliver emergency services
+ Needs of the affected
Injury/disability population that affect their
Emergency Disease/vectors health
Surveillance Mental health

System Nutritional status

Water quality
Learning Objectives

By the end of this module, the participant should be able

to:
Discuss the purpose of Damage Assessment and
Needs Analysis (DANA)

Develop a model Rapid Health Assessment (Rapid

Health Assessment) form/protocol for their country

Discuss the weaknesses and strengthens of DANA

and Rapid Health Assessment processes, methods
and technologies
HEALTH SECTOR ASSESSMENTS
IN EMERGENCIES

Thank you