1. SYMPOSIUM ON THE COMMEMORATION OF THE ISDR CAMPAIGN, WELKOM, SOUTH AFRICA, 14- 15 OCTOBER 2009  THE THEME: HOSPITALS SAFE FROM DISASTERS. Reduce Risk, Protect Health Facilities, Save Lives  By Dr J.K.M. CHUWA, MD,Mmed.  MINISTRY OF HEALTH AND SOCIAL WELFARE  DAR ES SALAAM  UNITED REPUBLIC OF TANZANIA

2. Tanzania Country Profile *Area* Population 945,087 sq. km37.9 million (projection 2008)

3. Country profile contd  Tanzania is one of the countries in East Africa.  Borders with North, Kenya and Uganda, West Rwanda, Burundi DRC and Zambia, South, Malawi and Mozambique and East, Indian Ocean.  Area 945,087sqkm include islands of Mafia, Pemba and Zanzibar.  Water surface 59,050 sqkm while land surface 886,037sqkm.  Population-37.9 million ( 2004 extrapolation) 51% women and 49% men respectively.

4. Country profile contd  The country is a United Republic, between Tanzania Mainland and Zanzibar.  Administratively, is divided into 26 regions and over 120 districts.  The official capital city is Dodoma but the government is operating from Dar es Salaam.

5. Country profile contd  Over 80% population live in the rural areas engaged on agricultural activities.  NRI 2.9%.  Economic growth rate is 5.6% per annum with GDP of $ 262 by 2003.

6. MEDICAL AND HEALTH INFORMATION  Health System Network  Has well established health care delivery system.  Following Independence and after Arusha Declaration equal distribution and equity in accessing the health facilities in the country increased.  As result there were a rapid expansion of health services to the rural areas where majority of the people live.

7. MEDICAL AND HEALTH INFORMATION-contd.  Currently, Tanzania has a total of 4,961 health facilities both public and private.  The government itself has 409 health centres, 2450 dispensaries. These are Primary Health Care Facilities.  These health facilities are linked by 74 hospitals that include district and regional hospitals as well as 4 specialized and teaching hospitals in the country.  The remaining facilities belongs to various groups e.g.. Parastatal Organizations, NGO and private sectors.  There are over 65,000 health workers engaged in health care delivery in the country. 70% are in the public sector.

8. COUNTRY HEALTH INDICATORS  Health Indicators  Crude Birth Rate39/1000 live births  Crude Death Rate17/1000 live births  Infant Mortality Rate 102/1000  Life Expectancy 45 years  Total Fertility Rate 5 children born by a woman  HIV/AIDS rate 5.7% (2009)

9. Health Problems  Malaria is the most leading cause of morbidity and mortality for all age groups in the country.  The leading five cause of mortality in under 5 children are, Malaria, Pneumonia, Anaemia, Clinical AIDS and Tuberculosis.

10. Disaster Profile in Tanzania The Office of the Prime Minister in collaboration with other relevant key sectors conducted Vulnerability Assessment in all 21 regions in Tanzania Mainland. Results revealed as follows chronologically.  Epidemics- They occur regularly in the country. Common epidemics being Cholera,Plague,Meningitis, Malaria HIV/AIDS etc.

11. DISASTER PROFILE CONTD  Major accidents that occurs in every year. These include transport accidents, industrial and chemical accidents e.g.. MV Bukoba marine accident 1996, Dodoma train accident 2002 and several motor traffic accidents which do happen every now and then.  Fire that occurs in urban as well as bush and forest fires.  Pest infestations and vermin occurs as outbreaks of locusts, army worms, cassava mill bugs, quelea quelea, rodents etc.

12. DISASTER PROFILE CONTD  Drought-That roughly occurs every after 4 years. Prone areas are central part and northern zones of Tanzania.  Floods-that occur almost every year. El-nino affected almost all parts in the country in 1997-98 and we are expecting another El-Nino rains with possible floods this month.

13. DISASTER PROFILE CONTD  HIV/AIDS pandemic which is severe in the country.  Cyclones and strong winds which are common in coastal areas including Zanzibar.In the year 2006 we experienced tidal waves( tsunamis which caused 13 deaths leaving behind property damage.  Civil strife, these occurs among pastoralists and farmers in some part of the country.  Tanzania had war against Uganda in1978.

14. DISASTER PROFILE CONTD  Refugees mainly from Burundi, Rwanda and DRC  Earthquakes- Have occurred in many parts of the country but it has not caused very serious damages.  Landslides in mountainous and mining areas such as Tanzanite and Gold mine industries.  Volcanic Eruptions we have experienced volcanic eruption in Mt Oldonyo-Lengai in Arusha and we have volcanic potential mountains e.g. Mt Kilimanjaro and Rungwe.  Terrorism- Bomb blast e.g. American Embassy bomb blast 1998. Also we have been receiving terrorist threats of using Weapons of Mass Destruction (Chemical, Biological and Radiological and Nuclear) hazmants.

15. LEGAL FRAMEWORK  1990 The GOT established Disaster relief Act No 9 now under review.  National Disaster policy of 2004 and National Operational guidelines in place.  Established Disaster Management Department centred at PMO, covers 21 mainland regions. And Zanzibar has the similar Dept.  President declares a disaster situation in the country by powers given under the Act No 9.

16. INSTITUTIONAL FRAMEWORK  1990 Disaster Relief Co-ordination Dept established at the PMO.  Disaster Committees formed from National to village levels  Technical committees at ministries down to village level established.  There are Ministerial and regional focal persons.

17. INSTITUTIONAL FRAMEWORK contd  Established Disaster Management Training Centre at one of our University ie the University of Land and Architectural Science (ARDHI University)  Emergency units under ministries e.g. Fire Dept ( Search and Rescue) in the Ministry of Home Affairs MoHA, Emergency Preparedness and Response Section in the Ministry of Health and Social Welfare (MOHSW)  Early Warning Units, in the Ministry of Agriculture and Food Security, Tanzania Meteorological Agency, Disease Surveillance in MOHSW and Seismic Activities at University Dar es Salaam, Tanzania.

18. PRIME MINISTER NADMAC DISASTER MANAGEMENT COMMISSION UN, INTERNATIONAL ORGANIZATIONS, NGOS & PRIVATE SECTOR TECHNICAL COMMITTEE S EARLY WARNING DISASTER MANAGEMEN T FORUM REGIONAL DISASTER MANAGEMENT COMMITTEE DISTRICT DISASTER MANAGEMENT COMMITTEE WARD DISASTER MANAGEMENT COMMITTEE VILLAGE DISASTER MANAGEMENT COMMITTEE POLICIES & STRATEGIES POLICIES & STRATEGIES RESPONSE PREPAREDNESS MITIGATION PREVENTION

19. HOSPITAL AND HEALTH FACILITIES DISASTERS  Health facilities provide emergency services during disasters.  Health facilities can sucumb disasters within and without the hospital facilities  Common intrahospital disasters include  Outbreak of fires at the hospital premises,  Outbreak of diseases  Massive food poisoning

20. HOSPITAL AND HEALTH FACILITIES DISASTERS  Accidents due to collapse of hospital building  Terrorist actions  Biological, Chemical, Radiological and Nuclear hazmats due to terrorist actions

21. HOSPITAL AND HEALTH FACILITIES DISASTERS-contd  Disasters that can happen outside the health facilities, but can affect the hospitals include:  Earthquakes  Tsunamis  Cyclones  Lighting  Floods  Explosions ( chemical, bomb blasts, nuclear)

22. HOSPITAL AND HEALTH FACILITIES DISASTERS-MITIGATION MEASURES  Conduct health hazard assessment and analysis  Proper facility design and construction  Early warning and alert so as to get informed on an impending disaster  Adherence to building codes and standards while constructing health facilities  Enforcement measures are critical to ensure that health facilities are built according to seismic standards

23. PREPAREDNESS Measures  Safety of health facilities  Supply management and essential services  Look for surge capacity which include more spaces, morgue etc.  Capacity building by training of human resources  Health workers develop hospital emergency/contingency plan  Emergency Public Information should be given to the general population to avoid unnecessary panic on impending disaster

24. PREPAREDNESS CONT  Protect the lives of the patients and health workers by ensuring the hospital buildings are constructed according to building codes and standards.  Conduct simulation exercises and training

25. RESPONSES Measures  Activate the emergency hospital contingency plan  Mobilize Rapid Response Teams at various levels.  Mobilize pharmaceuticals and other medical supplies readily.  Enhance disaster response capacity  Increase survival rate of disaster victims at all levels in the certain locality by reducing morbidities and mortality of disaster victims.  Improve the capacity of hospitals and medical facilities to be prepared to manage emergencies and mass casualty management

26. CHALLENGES  Inadequate human resources  Shortages and untimely availability of funds to prepare for and respond to emergencies and disasters.  Lack of proper town/municipal master plan  Poor law enforcers to enable people adhere to building standards  Shortages of pharmaceutical and other medical supplies during emergency situation

27. THE END  THANK YOU FOR YOUR ATTENTION