1. Needs Assessment Toward a Unified Approach 5 – 6 November 2009 Stock-tacking of Health Cluster Needs Assessment and Monitoring Practices By Dr. Nevio Zagaria, WHO/HAC Global Health Cluster,

2. Achievements of Global Health Cluster Consensus on the sub-sectors of the health response in humanitarian crisis list and definitions of health services by level of care Generation of tools, including methodologies, standard forms, data entry and analysis software's on: –Initial Rapid Assessment –Health Resources Availability and Monitoring System (HeRAMS) –Health Information & Nutrition Tracking System (HINTS) –Health (Monitoring) Information System (HIS)

3. Core Health Indicators (total # suggested: 26) 1.Health Resources Availability (A 1-8) 2.Health Services Coverage (C 1-6) 3.Risk Factors (R 1-7) 4.Health Outcome (O 1-5)

4. Challenges The scale of the capacity building effort on indicators & tools and their use for producing knowledge to inform strategic planning of international and national technical staff that have to take place at field level From IRA for health sector to Multisectoral IRA Build the central role of the ICCG in leading and strategizing the needs assessment process from phase 0 Promote the shift to place indicators at the centre of the discussion, and how tools serve the purpose to generate and process the indicators related data Lack of capacity to generate the indicators and produce knowledge from their analysis

5. Next Steps Nairobi workshop 19-20 Nov on how to promote and use the indicators and tools at field level (20 GHC partners) and develop SOPs Definition of the ToRs of the ICCG highlighting its leading role on the need assessments and monitoring Final agreement and active promotion by key technical clusters and ICCG to move from IRA to MIRA and related global inter-cluster technical support

6. Health Status of Affected Populations Initial Rapid Assessment (IRA) Early Warning Systems (HINTS) Health Resources Availability Health System Performance HeRAMS Health Resources Availability Mapping System Routine reporting, ad hoc surveys, HMIS, etc. Identification of GAPS in the Humanitarian Response Targets – Benchmarks – Thresholds – etc. Information needs Information for HCC and HC partners is needed on: Tools available … for the collection, collation and analysis of this information: Desired situation … expressed in terms of specific programmatic targets, international standards, benchmarks, etc.

7. 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 & Mental Health 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

8. HEALTH INFRASTRUCTURES AVAILABILITY

9. Primary Health Care System Framework Average # of Persons per type of Health Facility, by State Darfur Region, June 2008 ( PHCC: Primary Health Care Centre; PHCU: Primary Health Care Unit)

10. HeRAMS - PHCC Availability Average Number of Persons per PHCC, by Locality and Major IDP Camps North Darfur - March 08

11. South Darfur: Functioning PHCCs, per Locality, by managing partner, Dec-08 versus Aug-09 3 March 201611

12. HEALTH HUMAN RESOURCES AVAILABILITY

13. Availability of Human Resources in Camps versus in PHC Facilities SWABI District May 2009 District*Camps** HR TypeNN / 10,000 population N Male Medical Officer870.4237.2 Female Medical Officer100.0541.2 Lady Health Visitor410.282.5 Lady Health Workers6473.23410.7 EPI Technician440.220.6 Medical technicians750.461.9 TOTAL9044.57724.1 *Estimate district pop. (resident + IDPs) : 2,033,422 (source Nadra) ** Estimated pop living in camps as of week (23): 31,963 (source WHO to be checked)

14. HEALTH SERVICES AVAILABILITY

15. HeRAMS - Availability of Health Services to address Sexual Violence at PHCCs (#: 75), by managing partner, North Darfur, December 2008

16. * None of the Primary Care Facilities of the Admin Unit in red provides the package of services to address sexual violence. Sexual Violence Package monitored : - Clinical Management of Rape Survivors - Emergency Contraception - PEP for STI & HIV Infections i-HeRAMS – Gap Analysis of Sexual Violence health services, by Locality, North Darfur, March 2008

17. * None of the Primary Care Facilities of the Admin Units in red provides the Basic Emergency Obstetric Care Service Maternal & Newborn Health Service monitored: BEmOC i-HeRAMS – Gap Analysis of Basic Emergency Obstetric Care, by Locality, North Darfur, March 2008

18. Trend Analysis example 3 March 201618 West Darfur: provision of Maternal & Newborn service at PHCCs (December 08: 41 PHCC; August 08: 39) PHC Level P62 Antenatal care: assess pregnancy, birth and emergency plan, respond to problems (observed and/or reported), advise/counsel on nutrition & breastfeeding, self care and family planning, preventive treatments) as appropriate P63Skilled care during childbirth for clean and safe normal delivery P65 Basic emergency obstetric care (BEmOC): parenteral antibiotics + oxytocic/ anticonvulsivant drugs + manual removal of placenta + removal of retained products with manual vacuum aspiration (MVA) + assisted vaginal delivery 24/24 & 7/7 P66Post partum care: examination of mother and newborn (up to 6 weeks), respond to observed signs, support breast feeding, promote family planning

19. HEALTH SERVICES COVERAGE

21. Limitation -Response Rate (MIAR) 2007/2008- MIAR: Monthly Integrated Activity Report

22. EXTERNAL EVALUATION OF ECHO SUPPORTED WHO PROJECT: “SUSTAINED SUPPORT TO THE REFERRAL SYSTEM AND SECONDARY CARE FOR THE INTERNALLY DISPLACED AND CONFLICTAFFECTED POPULATION IN DARFUR,SUDAN” MAY 2009, JOHAN VON SCHREEB

23. RISK FACTORS

25. HEALTH OUTCOMES

26. Mean score of WHO Disability Assessment Schedule in surveyed populations in Indonesia and Thailand Indonesia N: 10,598 September 2006 Thailand N: 1,190 December 2006 Reference population* WHO-DAS II mean score 8.4113.016.48 * WHODAS surveys in 14 Countries with over 100,000 respondents in the general population

27. WHO-DAS II household survey, Thailand December 2006: general main score and by the domains with significant variance across the three categories Village category Whodas 12 CognitionMobility Life activitiesSociety 1-Unaffected 8.37.012.012.711.3 2-Affected w/o death 12.312.515.422.414.6 3-Affected w death 14.216.019.621.816.4 Total 13.014.017.620.715.3