1. Module 5 Emergencies and the Health Systems

2. Module 5 Hospital System Health System Epidemiology and Surveillance Prevention and Control of Communicable Disease Food and Water and Nutrition Sanitation Preparedness Response Recovery Health System

3. Module 5 Objectives At the end of this 1-hour session, the participants will be able to: Define and discuss the building blocks of the health system Discuss how emergencies/disasters disrupt the existing health system Describe health emergency response using the health systems approach

4. Module 5 Contents WHO health system building blocks Health systems in emergencies

5. Module 5 Emergency Save lives

6. Module 5 Emergency Health system Evacuation centres Security Nutrition Surveillance Disease prevention and control Logistics Information Management Resource Mobilization Risk Communication Save lives

7. Module 5 What is a health system?

8. Module 5 The Health System A health system consists of all organizations, people and actions whose primary intent is to promote, restore or maintain health Includes efforts to influence determinants of health as well as more direct health-improving activities Includes A mother caring for a sick child at home Private care providers Behaviour change programmes Vector-control campaigns Health insurance organizations Occupational health and safety legislation Inter-sectoral action by health staff

9. Module 5 The WHO Health Systems Framework System building blocksGoals/outcomes Service delivery Health workforce Information Medical products & technologies Health financing Leadership/ governance Improved health (level and quality) Responsiveness Financial risk protection Improved efficiency Access coverage Quality safety

10. Module 5 The WHO Health Systems Building Blocks Service delivery Health workforce Information Medical products and technologies Health financing Leadership/governance

11. Module 5 The WHO Health Systems Building Blocks Service delivery Effective, safe, quality personal and non-personal health interventions to those who need them, when and where needed, with minimum waste of resources Health workforce Responsive, fair and efficient to achieve the best health outcomes possible, given available resources and circumstances Sufficient numbers and mix of staff, fairly distributed Competent, responsive and productive. Information ensures the production, analysis, dissemination and use of reliable and timely information on health determinants, health systems performance and health status

12. Module 5 The WHO Health Systems Building Blocks Medical products and technologies Equitable access to essential medical products, vaccines and technology Assured quality, safety, efficacy and cost-effectiveness, and their scientifically sound and cost-effective use Health financing Adequate funds for health, in ways that ensure people can use needed services, and are protected from financial catastrophe or impoverishment associated with having to pay for them Leadership/governance Existence of strategic policy frameworks that are combined with effective oversight, coalition-building, the provision of appropriate regulations and incentives, attention to system- design, and accountability

13. Module 5 Health Systems in Emergencies Emergencies/disasters affect the health system Consideration for assessment, planning and implementation of response Response, reconstruction and preparedness phases

14. Module 5 How do disasters affect the health system? Socio-political context Environmental context Economic context Community lifelines: water, electricity, transportation 6 Building Blocks of the Health System: Health services Health Workforce Health Information Medical Products and Technologies Health Financing Health Governance Health Source: Informal discussion with Dr R Lejano, UC Irvine, 2009

15. Module 5 Activity 3: How emergencies/disasters affect the health system Divide into 3 groups Discuss on how disasters can affect the building blocks of the health system, Group A: Service delivery, health workforce Group B: Information, medical products and technologies Group C: Health financing, leadership/ governance List down salient points and discuss with the group

16. Module 5 Activity 3: Results Service delivery Health workforce Information Medical products and technologies Health financing Leadership/governance

17. Module 5 How disasters affect the health system Service delivery Medical & surgical services: outpatient and inpatient care Public health services: immunization, health promotion, reproductive health, environmental health, maternal and child health Health workforce Direct and indirect impact to health professionals and their families Same number of staff to work on increased demand Safety, security & psychosocial support

18. Module 5 How disasters affect the health system Information Information system breakdown Need for rapid information Medical products and technologies Damages and losses Increased demand for medical products and technologies

19. Module 5 How disasters affect the health system Health financing Direct and indirect economic losses Increased demand for expenditure Response require faster resource/finance mobilization mechanisms Leadership/governance Increased demand for quick decision making Shift to emergency mode Influx of external agencies, NGOs and groups

20. Module 5 WPRO Health Systems Assessment Tool WHO/WPRO, 2009 (Lejano, Sablan, et al) Tool developed for assessment of the health systems in order to aid health emergency planners and policy makers for medium- and longer- term decisions. Questions are answerable by YES or NO.

21. Module 5 WPRO Health Systems Assessment Tool Service delivery Are there health facility structures/buildings and/or key equipment within them that have been damaged by the disaster? Are there support systems that have been damaged by the disaster? Are there health services/programs that have been compromised by the disaster?

22. Module 5 WPRO Health Systems Assessment Tool Health workforce Did staff complement/ number of personnel reporting for work become a problem in the adequate carrying out of emergency response and recovery measures? Did staff knowledge and skills become a problem in the adequate carrying out of emergency response and recovery measures? Were the members of the hospital staff affected by disrupted lifelines (i.e., communication, transportation, shelter)?

23. Module 5 WPRO Health Systems Assessment Tool Information Are there concerns regarding health information systems concerning individuals as patients? Are there concerns regarding health information systems on health facilities? Are there concerns regarding health information on the general population? Are there concerns regarding health information concerned with public health?

24. Module 5 WPRO Health Systems Assessment Tool Medical products and technologies Is there adequate supply of essential drugs in the health facilities? Are these readily available and affordable? Are there concerns regarding quality of the drugs/vaccines available in the health facilities and pharmacies? Are there concerns regarding availability, safety and accessibility of blood transfusion services in the health facilities? Are there concerns regarding the availability of hospital equipment necessary for the basic surgical, anesthetic, medical and emergency care appropriate for the level of service a health facility offers? Are there concerns regarding safety, reliability and availability of diagnostic and laboratory technology services in the area? Are there concerns regarding safety, reliability and availability of diagnostic and imaging services in the area?

25. Module 5 WPRO Health Systems Assessment Tool Health financing Did the disaster affect (increased, decreased, scrapped) the revenue, government funding, and expenses of the health facilities in the subject area? Was funding of health programs affected (increased, decreased, scrapped) by the disaster?

26. Module 5 WPRO Health Systems Assessment Tool Leadership/governance Did the disaster reveal any major issues in how emergencies are responded to, in how tasks and funds are allocated during emergencies, and how decisions are made during emergencies? Did the government and other agency response to the disaster divert from and possibly change the way decision-making, allocation of funds, and allocation of tasks among agencies are made during an emergency?

27. Module 5 References http://www.wpro.who.int/sites/hsd/overview.htm Philippine Floods Response: Evaluation using the Health Systems Approach (WHO/WPRO, 2009)