Health Action in Crises Global Health Cluster response to the 2007 IAWG call for action Dr Nevio Zagaria Recovery and Transition Programs Health Action in Crises WHO Cairo, November 2008

Health Action in Crises Structure of the presentation Normative work Build the case / advocacy Strategic issues for discussion

Health Action in Crises Normative work

Health Action in Crises Level of Care Community Care Primary Care Secondary & Tertiary Care General Clinical Services Child Health Nutrition Communicable Diseases STI & HIV/AIDS Maternal & Newborn Health Sexual Violence Non Communicable Diseases Environmental Health Sub Sectors Initial Key Services Key Services – Sub Sectors and Level of Care Reproductive Health OPD Vaccinations TF EWARS MISP Injury Care & Mass Casualty Management Water Quality Control

Health Action in Crises Key health services at primary level, by sector

Health Action in Crises Key health services at community level, by sector

Health Action in Crises Key health services at secondary level, by sector

Health Action in Crises Build the case / advocacy

Health Action in Crises

HeRAMS - North Darfur - Health System Analysis Health Services Availability (%) in Maternal & Newborn Health, March 2008 Source: State MoH, WHO

Health Action in Crises * None of the Primary Care Facilities (RH, PHCC, PHCU and Mobile Clinics) of the Admin Unit provides the Service or Package of Services Maternal & Newborn Health Service monitored: BEOC Identification of Gaps* in the provision of Key Services & Sub Sectors at the level of Administrative Units i-HeRAMS – Health Sub Sectors and Key Services Gap Analysis

Health Action in Crises HeRAMS - North Darfur - Health System Analysis Health Services Availability (%) in Sexual Violence, March 2008 Source: MoH, WHO

Health Action in Crises * None of the Primary Care Facilities (RH, PHCC, PHCU and Mobile Clinics) of the Admin Unit provides the Service or Package of Services Sexual Violence Package monitored : - Clinical Management of Rape Survivors - Emergency Contraception - PEP for STI & HIV Infections Identification of Gaps* in the provision of Key Services & Sub Sectors at the level of Administrative Units i-HeRAMS – Health Sub Sectors and Key Services Gap Analysis

Health Action in Crises Rural Hospitals vs PHCCsPHCCs vs PHCUs HeRAMS - North Darfur - Health System Analysis Staffing Patterns based on Health Facilities Type, March 2008 Source: State MoH, WHO

Health Action in Crises Access to Emergency Obstetric Care Proportion of Caesarean Sections over Expected Births (%) during 2007 North Darfur - March 08 Source: State MoH, WHO

Health Action in Crises BPHFS Availability per 100,000 persons – by Province, Afghanistan, 2007 Source: MoH, HIMS

Health Action in Crises BPHFS Availability per 100,000 persons

Health Action in Crises District Hospitals Availability per 100,000 persons – by Province Source: MoH, HIMS

Health Action in Crises % of Deliveries assisted by skilled attendants, by Province, 2007, Afghanistan Source: MoH, HIMS

Health Action in Crises % of CS performed over Expected Deliveries in 2007, by Province, Afghanistan Source: MoH, HIMS

Health Action in Crises % of Caesarean Sections over Expected Deliveries, by Province, Afghanistan 2007 Source: MoH, HIMS

Health Action in Crises Strategic issues for discussion

Health Action in Crises Crisis-affected areas Humanitarian Space: Defined by political and security considerations ("potential humanitarian coverage") Access to beneficiaries: Defined by security considerations, resource availability and programme management capacities ("operational humanitarian coverage") Affected area, humanitarian space, access to beneficiaries and access to services moving Beneficiaries' access to assistance/services: Geographical Functional Cultural Financial ("service coverage") (its extension is a sectoral objective)

Health Action in Crises KEY CHALLENGE FOR HEALTH SECTOR IN PROTRACTED CRISIS AND IN RECOVERY Need for simultaneously: – protect lives and reduce disease, malnutrition and disabilities among the vulnerable populations in the affected areas (the humanitarian imperative), – strengthen the institutional capacity to pursue longer term health development goals including the health and nutrition related MDGs, to discharge the essential public health functions, to provide critical health services and to extend social protection in health (the developmental imperative).

Health Action in Crises Basic Premises The impact of purely humanitarian health and nutrition relief interventions approaches its limits Need for intensifying actions of institutional capacity building among national counterparts (including non State actors where relevant) in order scale up the priority public health interventions that need to be put in place

Health Action in Crises Development BeforeAfter Emergency Response Reconstruction Recovery Development A thinking shift is needed?

Health Action in Crises Health System Building Blocks (Taken from: Strengthening Health Systems to Improve Health Outcomes: WHO's Framework for Action, WHO, 2007).

Health Action in Crises Leadership and Governance Humanitarian principles, negotiation of humanitarian access Shadow alignment: key stakeholders' role in supporting structures, institutions or systems that are compatible with the existing or potential organization of the state Decentralization, building back better New environment generated by the Humanitarian Reform and the Cluster Approach in particular: new coordination or partnership relationships across the stakeholders ? Contracting health services to non state actors

Health Action in Crises Service Delivery Basic Health Packages: how to move from MISP to comprehensive RH services and achieve high coverage? Inclusive design and planning of "transitional" standards for service delivery: present agreed standards do not meet the challenges, how to reach high coverage of all MISP component in areas with disrupted health systems?

Health Action in Crises Issues for discussion on RH in crisis Take into account the implications of the adoption of the cluster approach in areas in crisis, and adapt the MISP accordingly Identify common problem in scaling up MISP in protracted crisis before moving to comprehensive RH RH support to field actors within Health Cluster Coordinator’s functions