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MODULE 3 HEALTH EMERGENCY MANAGEMENT CAPACITY

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1 MODULE 3 HEALTH EMERGENCY MANAGEMENT CAPACITY

2 By the end of this module, the participant should be able to:
Learning Objectives By the end of this module, the participant should be able to: Describe the elements of capacity to manage health risks of emergencies Identify key elements of capacity for specific health service delivery functions Describe the role of a health emergency manager in health emergency management systems and in developing health emergency management capacity Introduce the learning objectives to the module. A short introduction is required as the first set of questions for the module will help to introduce the key concepts covered in this module.

3 Outline of the presentation:
Relevance of Risk Management to Health Emergency Management Capacity Development Elements of capacity to manage health risks of emergencies Elements of capacity for specific health service delivery functions Roles of a health emergency manager in developing health emergency management capacity

4 Challenges Health Emergency Roles of HEM Management in Disaster
Risk Mgt. concepts Risk mgt. services Health Emergency Management Capacity Delivery of functions/Services: Preparedness Response Recovery Introduce the learning objectives to the module. A short introduction is required as the first set of questions for the module will help to introduce the key concepts covered in this module.

5 Risk = Hazard x Vulnerability
Relevance of Risk Management to HEM Capacity Development Risk = Hazard x Vulnerability Capacity In managing Risk: Reduce Hazard Reduce vulnerability Increase Capacity Capacity is needed to reduce hazard and vulnerabilities as well as to manage the risks of emergencies

6 ANATOMY OF COMMUNITY RISK MANAGEMENT
readiness hazard = vulnerability multisectoral, all hazards indicators: indicators: indicators: indicators: probability scale/magnitude/ strength/intensity spread duration biological hazards: season, infectivity, latency, transmission resistance, etc. People: access to health care measles vaccination under 5 nutrition under 5 mortality access to clean water access to sanitation adequate housing employment/ income female literacy Property: health infrastructure vehicles medical supplies Services: curative care services ambulance services public health services health info system Environment: water/soil/air quality policy, plans, procedures knowledge, skills, attitudes resources legislation national & sectoral policy administrative procedures response & recovery plans preparedness plans technical guidelines management structure institutional managements information systems warning systems human resources material resources financial resources simulations & training education public information community participation research publications risk of: death injury (mental/ physical) disease (mental/physical) loss of life displacement loss of property loss of income secondary hazards breakdown in security damage to infrastructure breakdown in services Contamination natural phenomena famine diseases of epidemic potential events/crowds intoxification infestations transport accidents structural failures industrial accidents chemical accidents pollution refugees war terrorism Prevention & Mitigation Programme Vulnerability Reduction Programme Emergency Preparedness Programme = Community Risk Management

7 Group Activity I What do you understand by the term “capacity” in the context of health emergency management? Ask: What do you understand by the term “capacity” in the context of health emergency management? Supplementary question: Can you describe the system which you have for health emergency management in your country?

8 System definition of capacity
Defining Capacity System definition of capacity Capacity includes capability (or capacity) of the component parts, the resources (financial, equipment) which support the system, and the relationships which together form the system. Capacity is a quantitative measure Measurement of human and material resources i.e. number or volume or size. For example, the capacity of the hospital is 500 beds Capacity is the available capability, resources and relationships to manage risks. Capacity is also built on application of good practice. In Module 2, the risks were identified. Module 3 refers to the resources available to manage the risks. This definition reflects more a system definition of capacity. Capacity includes capability (or capacity) of the component parts, the resources (financial, equipment) which support the system, and the relationships which together form the system. “Synergy” may be a better word than “sum” as we aim to build a system which is greater than the sum of the component parts. The capacity aims to reduce illness, disability and death from risks. It also promotes health, safety and security. Capacity aims to achieve improved health outcomes from the risks to communities. PHEMAP focuses on identifying the elements of health emergency management capacity and the functions which need to be performed to manage health risks. There are other definitions which are used, as follows: Capacity: tends to be considered more in quantitative terms, eg: a measurement of human and material resources i.e. number or volume or size. For example, the capacity of the hospital is 500 beds. Capability is a term which is more often used by the military and emergency services: a qualitative assessment of human and material resources i.e. ability or competence or authority and how capacity can be used.

9 Defining Capacity Sum of: capability resources relationships Within
community organization country region world Aims Reducing illness, disability and death from risks Promoting health, safety and security Capacity is the available capability, resources and relationships to manage risks. Capacity is also built on application of good practice. In Module 2, the risks were identified. Module 3 refers to the resources available to manage the risks. This definition reflects more a system definition of capacity. Capacity includes capability (or capacity) of the component parts, the resources (financial, equipment) which support the system, and the relationships which together form the system. “Synergy” may be a better word than “sum” as we aim to build a system which is greater than the sum of the component parts. The capacity aims to reduce illness, disability and death from risks. It also promotes health, safety and security. Capacity aims to achieve improved health outcomes from the risks to communities. PHEMAP focuses on identifying the elements of health emergency management capacity and the functions which need to be performed to manage health risks. There are other definitions which are used, as follows: Capacity: tends to be considered more in quantitative terms, eg: a measurement of human and material resources i.e. number or volume or size. For example, the capacity of the hospital is 500 beds. Capability is a term which is more often used by the military and emergency services: a qualitative assessment of human and material resources i.e. ability or competence or authority and how capacity can be used.

10 Health Emergency Management Capacity
Capacity to perform the following functions: Reduce hazard Reduce vulnerability Respond to reduce and manage consequences Recover and reconstruct to reduce and manage consequences In health emergency management, there are different functions performed at different levels of administration: Local level Regional level National level Inter-regional level International level To perform all these various functions, various specific capacities need to be developed in these various levels of administration

11 Disaster Risk Management Framework
Response Preparedness Recovery Prevention Mitigation (Capacity utilization) (Capacity building) (Capacity rebuilding for better) (Capacity to Reduce/prevent Hazard) (Capacity to Lessen Impact of hazard) The relevance of capacity in Risk Management The capacity developed during the preparedness phase is the measure for efficient response during emergency The capacity utilized during the emergency response will be the basis of recovery for the better based on lessons learned and good practices The capacity to prevent/reduce hazard and to lessen the impact of hazard will remain to be of primary considerations

12 Organizations Systems People Elements Of capacity To manage Health
risks of emergencies Organizations Systems People

13 10 elements of Health Emergency Preparedness: Legal framework Policies
In Risk Management Module: Capacity is directly associated to health emergency preparedness 10 elements of Health Emergency Preparedness: Legal framework Policies Guidelines Procedures Resources Plans Knowledge Attitude Skills Organizations Systems Ask: What do you understand by the term “capacity” in the context of health emergency management? Supplementary question: Can you describe the system which you have for health emergency management in your country? People

14 Group Activity II What do you understand by organizations, in the context of health emergency management? Give examples. What are systems in health emergency management? Give examples. How does people contribute to organizations and systems?

15 Organizations In the context of health emergency:
Designated/organized body Defined organizational structure Clear roles and directions United action or functions Legal framework According to “The Random House Dictionary”, Organize means to form as or into a whole, especially for united action; to give organic structure or character to…. In health emergency management organizations are designated or organized bodies, with a well defined organizational structure to depict authority and control, with clear roles and directions to perform united actions or functions, all based on a legal framework

16 Systems Definition: a “regularly interacting or interdependent group of items forming a unified whole” (Merriam Webster Dictionary) an orderly grouping of facts, principles, or methods in a certain field; any formulated method or plan; a manner of arrangement or procedure (The Random House Dictionary) A system therefore is an orderly manner of arrangement, procedure, or plan of action to perform function or health emergency operation

17 Systems to Manage Health Risks of Emergencies
systems operating at each administrative level systems in specific sectors systems to manage specific types of risks (hazards and vulnerabilities) systems for specific functions or services Ask: What is a system? Definition of a system: A system is a “regularly interacting or interdependent group of items forming a unified whole” (Merriam Webster Dictionary). The relationships and interdependence of items within the system result in the capacity of the system being greater than the sum of the individual capacities of its parts. Systems systems operating at each administrative level systems in specific sectors systems to manage specific types of risks (hazards and vulnerabilities) systems for specific functions or services Ask: How many different levels of administration/government are there is your country? What are they? What roles are defined at each level? Responses could include: national, sub-national (provincial/state, regional, town, district), local and community (baranguay, tambon etc) levels. Participants can also be encouraged to consider the international links with regional organizations and with international organizations. Ask: What sectors are responsible for managing health risks? What other sectors contribute to the management of health risks (and how)? Sectors include: health, agriculture, emergency services, social welfare, communications, transportation, security. Sectors also defined as public sector, private sector and community sector. There are systems to manage specific types of risks (such as natural hazards, technological hazards, biological hazards, societal hazards) Ask: When does health normally take the lead? For example, communicable disease risks. Ask: What systems exist, which provide specific functions or services to manage health risks? Focus on health sector. Answer: systems for specific functions or services (such as health surveillance, hospital, risk communication, emergency response, mental health, military health, water supply, sewerage, communications, transportation, information management, and community support). Conclude with the point that if we agree that we are talking about systems, then we need someone to manage the system.

18 Systems to Manage Health Risks of Emergencies
Logistics Management Information Management Coordination and Networking Surveillance System Human Resource Development Communication and Public Information Mass Casualty Management Ask: What is a system? Definition of a system: A system is a “regularly interacting or interdependent group of items forming a unified whole” (Merriam Webster Dictionary). The relationships and interdependence of items within the system result in the capacity of the system being greater than the sum of the individual capacities of its parts. Systems systems operating at each administrative level systems in specific sectors systems to manage specific types of risks (hazards and vulnerabilities) systems for specific functions or services Ask: How many different levels of administration/government are there is your country? What are they? What roles are defined at each level? Responses could include: national, sub-national (provincial/state, regional, town, district), local and community (baranguay, tambon etc) levels. Participants can also be encouraged to consider the international links with regional organizations and with international organizations. Ask: What sectors are responsible for managing health risks? What other sectors contribute to the management of health risks (and how)? Sectors include: health, agriculture, emergency services, social welfare, communications, transportation, security. Sectors also defined as public sector, private sector and community sector. There are systems to manage specific types of risks (such as natural hazards, technological hazards, biological hazards, societal hazards) Ask: When does health normally take the lead? For example, communicable disease risks. Ask: What systems exist, which provide specific functions or services to manage health risks? Focus on health sector. Answer: systems for specific functions or services (such as health surveillance, hospital, risk communication, emergency response, mental health, military health, water supply, sewerage, communications, transportation, information management, and community support). Conclude with the point that if we agree that we are talking about systems, then we need someone to manage the system.

19 People contribute to organizations and systems by providing:
skills, knowledge and attitudes Competency People may be: Career (or paid), volunteer and community Managers, coordinators, operators or responders Ask: what do people contribute in capacity building? People contribute skills, knowledge and attitudes, as well as competencies. Ask: what is the difference between skills and knowledge? Definition of ‘skill’: the ability to do something well; expertise or dexterity; a particular ability. Definition of ‘knowledge’: information and skills acquired through experience or education; the sum of what is known; awareness or familiarity gained by experience of a fact or situation: Responses should draw attention to practical versus abstract capabilities. Ask: What is competency? Definition of ‘competency’: the necessary skill or knowledge to do something successfully Responses should highlight the ability to do something well, to achieve goals, etc. What are some of the important qualities or attitudes required for health emergency management: eg. commitment, dedication, persistence, ethics, leadership.

20 Elements Of capacity Perform Functions Organizations Systems People

21 Group Activity III What are the health risks expected from the hazard assigned to your group? What are the roles and function of the ministry of health in response to the hazard?(You may identify your organization or identify the level of administration) What capacities must they have in place in order for them to perform their roles and functions

22 ANATOMY OF COMMUNITY RISK MANAGEMENT
readiness hazard = vulnerability multisectoral, all hazards indicators: indicators: indicators: indicators: probability scale/magnitude/ strength/intensity spread duration biological hazards: season, infectivity, latency, transmission resistance, etc. People: access to health care measles vaccination under 5 nutrition under 5 mortality access to clean water access to sanitation adequate housing employment/ income female literacy Property: health infrastructure vehicles medical supplies Services: curative care services ambulance services public health services health info system Environment: water/soil/air quality policy, plans, procedures knowledge, skills, attitudes resources legislation national & sectoral policy administrative procedures response & recovery plans preparedness plans technical guidelines management structure institutional managements information systems warning systems human resources material resources financial resources simulations & training education public information community participation research publications risk of: death injury (mental/ physical) disease (mental/physical) loss of life displacement loss of property loss of income secondary hazards breakdown in security damage to infrastructure breakdown in services Contamination natural phenomena famine diseases of epidemic potential events/crowds intoxification infestations transport accidents structural failures industrial accidents chemical accidents pollution refugees war terrorism Prevention & Mitigation Programme Vulnerability Reduction Programme Emergency Preparedness Programme = Community Risk Management

23 VULNERABILITIES CAPACITIES
EMERGENCY AND HEALTH HEALTH RESPONSE Search and rescue First Aid Triage Medical evacuation Primary care Disease surveillance and control Curative care Blood banks Laboratories Referral system Special units (burn, spinal) Evacuation centers Shelter and Water Food and nutrition Energy and Security Environmental health Primary Health Care Care of the dead Psychosocial care Disability care Recovery and Reconstruction COMMUNITY VULNERABILITIES CAPACITIES DIRECT IMPACT DAMAGE AND NEEDS EMERGENCY INDIRECT IMPACT ASSOCIATED FACTORS Climate/ weather/ time of the day Location Security situation Political environment Economic environment Socio-cultural environment Morality, solidarity, spirit Competence, corruption

24 EPIDEMIC EMERGENCIES HEALTH RESPONSE OUTBREAK Case definition
Admission criteria Case confirmation Case management Discharge criteria Contact tracing Vector control Environmental controls Surveillance system Referral system Professional education Public Information and awareness Laboratory plans Hospital plans Supplies and equipment Borders control Quarantine Animal culling Commerce/ trade Specific morbidity and mortality OUTBREAK NEEDS - in the community - in health facilities - in health facilities Risk for health and lab workers Difficult access Agent unknown

25 Health Emergency Capacity Development Plan Matrix
Risk Capacity needed Preparedness Strategies/ Activities Time Frame Resource Requirement Person Responsible Indicators Required Available Resource

26 General or Cross-cutting Functions
Risk communication Occupational health and safety Facility design Organization-based disaster planning Managing critical supplies and protecting infrastructure These slides focus on general and specific functions. Capacity for managing health risks can be broken down into the following functions. The first set of functions are general or cross-cutting in that they support or apply to other functions, or they address hazard and vulnerability reduction, response and recovery. You may add comments about each of these functions. Risk communication: an interactive process of sharing information and perceptions about risks, decisions, actions or policies aimed at managing risks. Occupational health and safety - measures for promoting, establishing and maintaining a safe and healthy working environment and work methods to facilitate optimal physical and mental health in relation to work. Facility design – safe siting, design and construction of structural and non-structural aspects of facilities to manage risks and to optimise functional capacity of the facility. Organization-based disaster planning – emergency response planning at the organizational level to manage internal and external emergencies. Managing critical supplies and protecting infrastructure (see also transport – logistics) Critical infrastructure: physical and information technology facilities, networks, services and assets that, if disrupted or destroyed, would have a serious impact on health, safety, security or economic well-being or the effective functioning of governments. This infrastructure relates to: information and communication; electric power generation, transmission, and distribution; oil and gas storage and distribution; banking and finance; transport; water supply; and emergency assistance. Critical supplies: goods, material and equipment used by organizations to provide services to meet the essential needs of an affected population, including food, drugs, medical supplies, water, clothing, rescue equipment, electric generators and shelter.

27 General or Cross-cutting Functions
Communication and transport Information management Health surveillance Mental health Reproductive health Environmental health Food safety, emergency feeding and nutrition Water supply management Waste management Please present the slide. If time allows, facilitate short discussion about each function. Communication and transport Communication – facilities, equipment and procedures to send or receive information, such as telephone, radio or computer. Transport: the movement of people, supplies or other material used in connection with the preparedness, response or recovery of an emergency event from one location to another. Includes logistics : the system of forecasting, procuring, storing, transporting and distributing supplies, personnel and facilities to support operations. Information management - coordinated information management strategies and interoperable systems to support system-wide and organizational functions. Information management includes data and information collection, filtering, analysis and dissemination to inform decisions about managing risks. Health surveillance - systematic ongoing collection, collation and analysis of data for public health purposes and the timely dissemination of public health information for assessment and public health action as necessary. Mental health – coordinated plans and services to address mental health and psychosocial support needs of communities at risk of disasters and communities affected by disasters Reproductive health - Environmental health – coordinated plans and services to manage risks from the natural and built environment to health: water supply services, waste handling and disposal, food safety, vector control, hygiene promotion Food safety, emergency feeding and nutrition – Food safety - assurance that food will not cause harm to the consumer when it is prepared and/or eaten according to its intended use. Water supply management: provision of sufficient, safe, acceptable, physically accessible and affordable water for personal and domestic uses, to prevent death from dehydration, to reduce the risk of water- related disease and to provide for consumption, cooking and personal and domestic hygienic requirements. Waste management -

28 Specific Emergency Response and Emergency Recovery Functions
First aid, self-aid and first-responder health assistance Incident site management Assessing needs Mass-casualty management Decontamination Epidemiological investigation The presentation then moves to functions required for response and recovery. Please present the slide. Facilitate short discussion about each function. First aid, self-aid and first-responder health assistance – First Aid: A) in cases in which a person needs medical treatment, treatment for the purpose of preserving life and minimizing the consequences of injury until medical treatment is obtained. (B) Treatment of minor injuries that would otherwise receive no medical treatment or that do not need medical treatment. First-responder health assistance: measures carried out by personnel (usually law enforcement, fire services and emergency medical services) arriving first at incident sites, including workplaces, to save lives and reduce injury and other health effects. Incident site management - coordination of all activities and processes that must occur at the site of the event. Assessing needs - an assessment of unmet needs in regard to those affected by the event. Mass-casualty management - the medical response to an event in which the number of casualties is large enough to disrupt the normal course of emergency and health care services. Activities include pre-hospital emergency care; hospital reception and treatment; and redistributing patients to other hospitals when necessary. Decontamination: The process of making individuals, equipment and objects safe to unprotected personnel and harmless to all properties and surroundings by absorbing, destroying, neutralizing or removing any biological or chemical agent or radiological agents within the object or clinging to or around it. Epidemiological investigation - a process used to identify how suspected human cases of a disease or intoxication occurred, to assess the clinical impact of the disease or condition and to determine the risk that infected or contaminated people or their environment may represent for others.

29 Specific Emergency Response and Emergency Recovery Functions
Forensic investigation Management of the dead and the missing/ fatality management Shelter and temporary accommodation (including evacuation shelters) Community support Longer-term issues (health effects, recovery, rehabilitation, reconstruction) Please present the slide. Facilitate short discussion about each function. Ask whether this is a complete list. Is there anything missing? Forensic investigation - an analytical process requiring the use of scientific facilities to collect evidence and to determine the appropriate strategic response. Management of the dead and the missing/ fatality management - handling and final disposal of dead bodies – includes search and rescue, body retrieval, disaster victim identification, psychoscoial support and grief counselling for families and friends, repatriation of bodies, culturally appropriate disposal of bodies (eg cremation, burial). Shelter and temporary accommodation (including evacuation shelters): rapidly assembled housing for victims of the emergency event whose permanence is beyond that of emergency shelter but not intended as long-lasting. Community support: mechanisms whereby local authorities, with participation from representatives of all ethnic communities, identify immediate emergency rehabilitation needs, or other support structures, that would bring the communities working together and reduce tensions. Longer-term issues (chronic and long term health effects, recovery, rehabilitation, reconstruction)

30 Specific Emergency Response and Emergency Recovery Functions
Hazard and Risk Reduction functions Preparedness Functions Recovery & Response General and Cross Cutting Functions Functions for specific services CAPACITY 10 Elements of Preparedness Service Delivery Please present the slide. Facilitate short discussion about each function. Ask whether this is a complete list. Is there anything missing? Forensic investigation - an analytical process requiring the use of scientific facilities to collect evidence and to determine the appropriate strategic response. Management of the dead and the missing/ fatality management - handling and final disposal of dead bodies – includes search and rescue, body retrieval, disaster victim identification, psychoscoial support and grief counselling for families and friends, repatriation of bodies, culturally appropriate disposal of bodies (eg cremation, burial). Shelter and temporary accommodation (including evacuation shelters): rapidly assembled housing for victims of the emergency event whose permanence is beyond that of emergency shelter but not intended as long-lasting. Community support: mechanisms whereby local authorities, with participation from representatives of all ethnic communities, identify immediate emergency rehabilitation needs, or other support structures, that would bring the communities working together and reduce tensions. Longer-term issues (chronic and long term health effects, recovery, rehabilitation, reconstruction)

31 Evacuation Site Scenario Damaged lifelines Overcrowding
Poor environmental sanitation No access to safe water Inadequate sanitary toilets Health workers are direct victims Disrupted basic health services The previous slides have addressed the functions which actively reduce the risks. This is against the background of other functional areas which also provide capacity to manage health risks. Relate this to the 10 elements of preparedness presented in the Risk Management module: legal framework, policy, guidelines, procedures, plans, authority and coordination, resources, skills, knowledge and attitudes. What is the full systemic capacity to manage risks? policy development: covers policies, guidelines, protocols, legislation and strategic plans for health emergency management. These documents establish long-term goals, assign responsibilities for achieving goals, establish recommended work practices and determine criteria for decision-making. They may be created at all administrative levels of an organization or country and be developed in consultation with those who are required to implement it. risk assessment: a method of determining the nature and extent of risk by analysing potential hazards and evaluating existing conditions of vulnerability that could pose a potential threat or harm to people property, livelihoods and the environment on which they depend. risk management functions: - coordination of emergency response and emergency recovery planning and operations; - general and cross-cutting functions; - prevention, mitigation and preparedness; - specific emergency response and emergency recovery functions. Emergency response: the provision of assistance or intervention during or immediately after a disaster to meet the life preservation and basic subsistence needs of those people affected. It can be of an immediate, short-term or protracted duration. Emergency recovery: decisions and actions taken after a disaster with a view to restoring or improving the pre-disaster living conditions of the stricken community while encouraging and facilitating necessary adjustments to reduce disaster risk. Coordination: intersectoral and intrasectoral aspects of coordinating emergency response and emergency recovery at each level of administration and for sectors. Mitigation: structural and nonstructural measures undertaken to limit the adverse impact of natural hazards, environmental degradation and technological hazards. Preparedness: activities and measures taken in advance to ensure effective response to the impact of hazards, including issuing timely and effective early warnings and temporarily evacuating people and property from threatened locations. Prevention: activities taken to avoid the adverse effects of hazards and means to minimize related environmental, technological and biological disasters. Capacity development and training: measures to increase the capability of individuals, organizations and systems to manage the health risks, including development of relationships, training activities, production and dissemination of technical material and research in all organizations, including schools of medicine and public health and other institutions. Monitoring and evaluation: to monitor changes to factors that affect risks; applying agreed criteria, indicators or standards to monitor, review and report on the relevance and performance of policies, legislation, plans, organizational structures and functions and reviewing exercises and operations, in order to sustain and build the capacity to manage risks.

32 Group Activity IV As Health Emergency Manager, what could be the priority service that you could deliver to reduce the possible secondary health risks in the evacuation site? Name just one. What capacities must you have to be able to deliver such health services to manage the risk? People Organization System Refer to the Module 2 on Risk Assessment. Ask participants what are the key indicators of capacity for risk assessment? We are seeking the descriptions of good practice for risk assessment based on discussions from Module 2. Focus on the process of risk assessment and the content of risk assessments. Background Risk assessment Risk assessment is a multiple-step process to assess the potential likelihood and effects of natural and technological hazards at the national, subnational and local levels. Risk assessment involves many organizations in assessing hazards and vulnerability. It evaluates risks, determines priorities and identifies cost-effective measures to manage risks. Information from security threat assessment and risk assessment is necessary for systems at each level of administration, sectors and organizations to plan, develop and implement capacity for managing risks, including prevention, preparedness, response and recovery measures. Health organizations are represented on intersectoral risk assessment activities (who represents the health sector) A unit in the Ministry of Health has overall responsibility for coordinating health risk assessment from all sources of risk Health organizations participate in health risk assessment, such as health surveillance, hospitals, laboratories, mental health and environmental health Organizations outside the health sector participate in health risk assessment Mechanisms and representative bodies exist for coordinating and integrating health risk assessment Organizations are responsible for coordinating risk assessment for health risks from natural hazards, technological, biological and societal hazards Organization identifies its role in contributing to system-wide and sectoral risk assessment identifies lead agencies responsible for coordinating system-wide and sectoral risk assessments organization has internal arrangements for conducting risk assessments assesses risks in terms of hazards and the vulnerability and resilience of elements considers the range of sources of risk, including: natural hazards, technological hazards, biological and societal hazards identifies populations most at risk due to higher levels of vulnerability analyses risks in terms of likelihood and consequences (quantitatively and qualitatively) determines priorities across hazards and vulnerability policies, emergency response and recovery plans, and capability development plans are developed based on risk assessment risk assessment is monitored and reviewed regularly risk assessments are shared among government, private sector and non-government organizations and individuals involved in managing risks within and between levels of administration within and between sectors (such as health, emergency management and security)

33 Evacuation Site Scenario: Typhoon
Poor environmental sanitation No access to safe water Inadequate sanitary toilets No community surveillance system Disrupted basic health services Foul smell of decomposing bodies Severe depression of the bereaved and other health workers The previous slides have addressed the functions which actively reduce the risks. This is against the background of other functional areas which also provide capacity to manage health risks. Relate this to the 10 elements of preparedness presented in the Risk Management module: legal framework, policy, guidelines, procedures, plans, authority and coordination, resources, skills, knowledge and attitudes. What is the full systemic capacity to manage risks? policy development: covers policies, guidelines, protocols, legislation and strategic plans for health emergency management. These documents establish long-term goals, assign responsibilities for achieving goals, establish recommended work practices and determine criteria for decision-making. They may be created at all administrative levels of an organization or country and be developed in consultation with those who are required to implement it. risk assessment: a method of determining the nature and extent of risk by analysing potential hazards and evaluating existing conditions of vulnerability that could pose a potential threat or harm to people property, livelihoods and the environment on which they depend. risk management functions: - coordination of emergency response and emergency recovery planning and operations; - general and cross-cutting functions; - prevention, mitigation and preparedness; - specific emergency response and emergency recovery functions. Emergency response: the provision of assistance or intervention during or immediately after a disaster to meet the life preservation and basic subsistence needs of those people affected. It can be of an immediate, short-term or protracted duration. Emergency recovery: decisions and actions taken after a disaster with a view to restoring or improving the pre-disaster living conditions of the stricken community while encouraging and facilitating necessary adjustments to reduce disaster risk. Coordination: intersectoral and intrasectoral aspects of coordinating emergency response and emergency recovery at each level of administration and for sectors. Mitigation: structural and nonstructural measures undertaken to limit the adverse impact of natural hazards, environmental degradation and technological hazards. Preparedness: activities and measures taken in advance to ensure effective response to the impact of hazards, including issuing timely and effective early warnings and temporarily evacuating people and property from threatened locations. Prevention: activities taken to avoid the adverse effects of hazards and means to minimize related environmental, technological and biological disasters. Capacity development and training: measures to increase the capability of individuals, organizations and systems to manage the health risks, including development of relationships, training activities, production and dissemination of technical material and research in all organizations, including schools of medicine and public health and other institutions. Monitoring and evaluation: to monitor changes to factors that affect risks; applying agreed criteria, indicators or standards to monitor, review and report on the relevance and performance of policies, legislation, plans, organizational structures and functions and reviewing exercises and operations, in order to sustain and build the capacity to manage risks.

34 Group Activity V In your group, address one of the following:
Environmental health Communicable disease Management of the dead and the missing Mental health and psychosocial support Assess the risk and identify capacity needed in terms of organization, systems and people. Write your answers on a flip chart for presentation. (20 minutes) Provide participants with a handout of the functions. Present the activity as follows. Assign the groups one of the following functions. You could allocate the same function to each group – this will save time in the reporting back. In your groups, select one risk management function with which you are familiar. Following the model for risk assessment, please identify the five indicators of capacity for each function. Write your indicators of good practice on to a flip chart for presentation. (20 minutes) Participants should not identify statistical indicators, but rather focus on good practice actions required for this particular function.

35 Health Emergency Capacity Development Plan Matrix
Risk Capacity needed Preparedness Strategies/ Activities Time Frame Resource Requirement Person Responsible Indicators Required Available Resource

36 Environmental Health in Evacuation Center
Environmental health risks are assessed, including: Water supply services Waste handling and disposal Food safety Garbage disposal Local Capacity ( laboratory services, sampling, diagnosis and analysis; equipment etc.) Inventory of organizations with environmental health roles and responsibilities (laboratories, surveillance, chemical industries, water supply services, waste disposal services, fire service, etc.) Availability of supplies, reagents, medicines

37 Environmental Health in Evacuation Center
Environmental health risks: Food and water borne diseases Environmental Capacity Environmental assessment, surveillance Environmental teams Environmental logistics including systems of distribution Laboratories and other confirmation devices Reporting, monitoring, evaluation

38 Communicable Disease Communicable health risks are assessed including: Diseases of Epidemic Potential Vaccine Preventable Diseases Vector Born Diseases Diseases of Public Health Significance Considerations: Health status Local capacity, program implementation Inventory of Organizations Availability of health services, facilities Availability of drugs, medicines, supplies, vaccines

39 Communicable Disease Communicable health risks: Epidemic and Outbreak Communicable Disease Capacity Surveillance System in place in evacuation centers Surveillance teams available Case definition etc.. Epidemiological investigation logistics including systems of distribution Laboratories and other confirmation devices Reporting, monitoring, evaluation Networking and referral system

40 Management of the Dead and Missing
MDM Issues: Identification of the Dead Cultural Considerations Final Disposal of the Dead Management of the Relatives Considerations: Legal framework, functioning coordination mechanisms and organizational structure in place for health emergency preparedness and response Local capacity Inventory of Organizations Mortuary System

41 Management of the Dead and Missing
MDM health risks? Myths and realities about dead bodies Mass burial MDM Capacity Organizational/Institutional Arrangements; roles and responsibilities; management structures Procedures (identification, keeping of records,fingerprinting, dental records, DNA and photographing) Provisions for notification of relatives (next of kin) Logistics Reporting, monitoring, evaluation Networking and referral system

42 Mental Health and Psychosocial Support
Psychosocial health risk assessment: Coverage Silent victims, Family displacement Medical Responders/Leaders Early identification and referral Considerations: Local capacity for emergency provision of essential services and supplies Inventory of organizations, health facilities, Availability of drugs, medicines, supplies, Availability of training modules and trainers

43 Mental Health and Psychosocial Support
Psychosocial health risks: Long lasting; affects rehabilitation and recovery (children, responders, etc.) Psychosocial Capacity Policies and Plan Training modules, pool of trainers ; range of services Advocacy and awareness through education, information management and communication Health facilities, drugs and medicines Reporting, monitoring, evaluation Networking and referral system;Inter and Intra sectoral coordination Local capacity for emergency provision of essential services and supplies

44 Group Activity VI In your group, discuss the role of the Health Emergency Manager in developing health emergency management capacity Provide participants with a handout of the functions. Present the activity as follows. Assign the groups one of the following functions. You could allocate the same function to each group – this will save time in the reporting back. In your groups, select one risk management function with which you are familiar. Following the model for risk assessment, please identify the five indicators of capacity for each function. Write your indicators of good practice on to a flip chart for presentation. (20 minutes) Participants should not identify statistical indicators, but rather focus on good practice actions required for this particular function.

45 Role of the Health Emergency Manager
Determine the risk and plan to manage it Identify the capacity needed in terms of Organization, Systems and People Determine strategies to reach the goals set Determine resource requirements (Compare from what is available to what is required and what is the gap) Look for resources, identify partners, co share Determine a point person, time frame and indicators Monitor and evaluate Provide participants with a handout of the functions. Present the activity as follows. Assign the groups one of the following functions. You could allocate the same function to each group – this will save time in the reporting back. In your groups, select one risk management function with which you are familiar. Following the model for risk assessment, please identify the five indicators of capacity for each function. Write your indicators of good practice on to a flip chart for presentation. (20 minutes) Participants should not identify statistical indicators, but rather focus on good practice actions required for this particular function.

46 Health Emergency Capacity Development Plan Matrix
Risk Capacity needed Preparedness Strategies/ Activities Time Frame Resource Requirement Person Responsible Indicators Required Available Resource

47 By the end of this module, the participant should be able to:
Learning Objectives By the end of this module, the participant should be able to: Describe the elements of capacity to manage health risks of emergencies Identify key elements of capacity for specific health service delivery functions Describe the role of a health emergency manager in health emergency management systems and in developing health emergency management capacity. This discussion on capacity is a precursor to Module 14 on capacity assessment and development. It will help participants to assess capacity in order to identify possible areas for capacity development in their country, region or organization. If time permits, ask participants to give consideration to one strength and one area for improvement in their country, region or organization, and to share with the group. At the end of the session, ask participants to consider the multiple role of health emergency managers in assessing capacity and developing capacity for manage health risks of disasters.

48 THANK YOU


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