Health Action in Crises

Global Health Cluster response to the 2007 IAWG call for action

Dr Nevio ZagariaRecovery and Transition Programs

Health Action in CrisesWHO

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

CommunityCare

Primary Care

Secondary & Tertiary Care

General Clinical Services

Child Health

Nutrition

Communicable Diseases

STI & HIV/AIDS

Maternal & Newborn Health

Sexual Violence

Non CommunicableDiseases

Environmental Health

Sub Sectors Initial Key Services

Key Services – Sub Sectors and Level of Care

Rep

rod

uct

ive

Hea

lth

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

Health Action in Crises

HeRAMS - North Darfur - Health System AnalysisHealth Services Availability (%) in Maternal & Newborn Health, March 2008

Maternal & Newborn HealthAvailability of Services (%) at Primary Care Level in ND

84.3

72.3 72.3

51.8

28.9 31.3

93.596.8 96.8

90.3

48.4 48.4

78.8

57.7 57.7

28.8

17.321.2

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

Family Planning * Antenatal Care Postnatal Care Clean & Safe NormalDelivery *

Basic EssentialObstetric Care (BEOC)

Essential NewbornCare

All

Partners

SMoH

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 HealthService 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 AnalysisHealth Services Availability (%) in Sexual Violence, March 2008

Sexual ViolenceAvailability of Services (%) at Primary Care Level in ND

36.1

80.7

18.1 15.7

67.7

90.3

29.0 29.0

17.3

75.0

11.57.7

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

Clinical Management ofRape Survivors

Emergency contraception Post Exposure Prophilaxisfor STI&HIV infections

Sexual Violence Package

All

Partners

SMoH

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 ViolencePackage 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

Average number of Staff per Facility Type

1.6

3.7

15.9

0.0

3.4

0.41.6

0.5

2.1 2.0

0.3

1.70.9 0.4

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

20.0

MO MA Nurse PHO MW Vacc. LabPerson

Rural Hospitals

PHCC

Rural Hospitals vs PHCCs PHCCs vs PHCUs

HeRAMS - North Darfur - Health System AnalysisStaffing 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

0.00

2.00

4.00

6.00

8.00

10.00

12.00

14.00

16.00

18.00

20.00A

FG

HA

NIS

TA

N

Uru

zgan

Kab

ul

Hira

t

Far

yab

Kan

daha

r

Zab

ul

Kho

st

Kun

duz

Bag

hlan

Far

ah

Gho

r

Nan

garh

ar

Gha

zni

Kun

ar

Pak

tya

Tak

har

Lagh

man

Nim

roz

Bad

akhs

han

Hilm

and

Day

kund

i

Bad

ghis

Pak

tika

Bal

kh

Sam

anga

n

Sar

i Pul

Kap

isa

War

dak

Par

wan

Loga

r

Bam

yan

Nur

ista

n

Pan

jshe

r

Jaw

zjan

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

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

AF

GH

AN

IST

AN

Nim

roz

Par

wan

Kho

st

Kun

ar

Uru

zgan

Lagh

man

Nur

ista

n

Kan

daha

r

Kun

duz

Bad

akhs

han

Nan

garh

ar

Gho

r

Kab

ul

Hira

t

Gha

zni

Sar

i Pul

Far

ah

Far

yab

Bad

ghis

Hilm

and

Day

kund

i

Bag

hlan

Kap

isa

Sam

anga

n

Tak

har

Zab

ul

Pak

tya

Bam

yan

Pak

tika

War

dak

Loga

r

Bal

kh

Pan

jshe

r

Jaw

zjan

Source: MoH, HIMS

Health Action in Crises

% of Deliveries assisted by skilled attendants, by Province, 2007, Afghanistan

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

50.0

AF

GH

AN

IST

AN

Hilm

an

d

Ba

dg

his

Gh

or

Da

yku

nd

i

Uru

zg

an

Ka

nd

ah

ar

Ba

da

kh

sh

an

Za

bu

l

Ka

pis

a

Pa

ktika

Nu

rista

n

Pa

rwa

n

Fa

rya

b

Ba

mya

n

Hir

at

Ku

na

r

Ta

kh

ar

Sa

ri P

ul

Wa

rda

k

Ku

nd

uz

Pa

njs

he

r

Ba

gh

lan

Ba

lkh

Sa

ma

ng

an

Ja

wzja

n

Na

ng

arh

ar

Gh

azn

i

Fa

rah

Kh

ost

Nim

roz

Pa

kty

a

La

gh

ma

n

Ka

bu

l

Lo

ga

r

Source: MoH, HIMS

Health Action in Crises

% of CS performed over Expected Deliveries in 2007, by Province, Afghanistan

0.00

0.50

1.00

1.50

2.00

2.50

3.00

AF

GH

AN

IST

AN

Hilm

an

d

Nim

roz

Nu

rista

n

Ka

pis

a

Gh

or

Pa

kty

a

Ba

dg

his

Uru

zg

an

Da

yku

nd

i

Pa

rwa

n

Sa

ri P

ul

Ku

na

r

Ja

wzja

n

La

gh

ma

n

Fa

rya

b

Za

bu

l

Ka

nd

ah

ar

Pa

njs

he

r

Ba

da

kh

sh

an

Ba

gh

lan

Ba

mya

n

Ku

nd

uz

Na

ng

arh

ar

Gh

azn

i

Sa

ma

ng

an

Lo

ga

r

Wa

rda

k

Fa

rah

Kh

ost

Ta

kh

ar

Ba

lkh

Pa

ktika

Hir

at

Ka

bu

l

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 beneficiariesand access to services

movingmoving

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

Before After

Emergency Response

Reconstruction

RecoveryDevelopment

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