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The Yolanda Experience: The Yolanda Experience: Lessons LearnedLessons Learned
44th Annual Convention of Philippine College of Physicians
5 May 2014
TEODORO J. HERBOSA, MD Undersecretary of Health
Coordinator, Disaster and Rehabilitation Management Task Force
Outline
• Introduction• What were prepared?• What happened?• What have been done?• Specific challenges and way forward
Introduction• On November 08, 2013, Typhoon “YOLANDA” made seven landfalls:
– Guiauan, Eastern Samar, 4:40am– Dulang-Tolosa, Leyte, 7:00am– Daanbantayan, Cebu, 9:40am– Bantayan Island Cebu, 10:40am– Concepcion, Iloilo, 12:00nn– Tibiao, Antique, 3:00pm– Busuanga, Palawan
• PAGASA’s morning bulletin recorded maximum sustained winds of 235 kph and gustiness of up to 275 kph
• Many areas have become out of reach as the typhoon destroyed power and communication lines
• Major airports and ports closed down• Major roads in greatly affected areas have become impassable due to
devastating effects of the typhoon
Typhoon “Yolanda” Landfalls
Typhoon “Yolanda” Storm Surges
Affected Areas in Eastern Visayas
What were prepared?
November 6:• Alert Memorandum was issued to all CHDs• Prepositioned logistics worth PhP 350MNovember 7• Code Blue alert was raised in the CHDs most
at risk• CHD OpCen opened for 24 hours• Continuous monitoring
Timeline of DOH Response
Nov 6 Nov 7 Nov 8 Nov 9 Nov 10 Nov 11
Alert memo issued to all
CHDs
Logistics prepositioned in CHDs VI, VII,
and VIII
Typhoon Yolanda Landfall
DOH-CO on Code Red
No lifelines in affected
areas
Medical response
teams ready to board C130
Code Blue raised in all CHDs at risk
OpCen operational 24
hours
Continuous monitoring of the situation
DOH personnel on duty at NDRRMC
No communication from CHD VIII;
Only qualitative info
and pictures from
mainstream media
CARAGA and Albay medical
response teams arrived
in Tacloban
Continuous monitoring of the situation
Secretary Ona and other
officials visited Tacloban
Teams from MM hospitals
arrived in Tacloban
Context: Unprecedented magnitude of Typhoon Yolanda effects
What happened?
What happened?Region Province Deaths Injured
IV-A Quezon, Batangas 3 6IV-B Palawan 19 63V Albay, Masbate, Camarines
Norte6 32
VI Iloilo, Aklan, Capiz, Antique, Negros Occidental
**285 2,733
VII Cebu, Bohol 74 22
*VIIITacloban City, Leyte, Samar, Eastern Samar, Biliran
5,803 26,123
IX Zamboanga 0 1CARAGA Surigao del Sur 0 1
Total 6,190 28,981
Note: *NDRRMC Sitrep No. 92 as of January 14, 2014 for Region VIII.**CHD VI reported 285 deaths while NDRRMC reported 294 deaths. Discrepancies in figures are still subject for validation by the CHD VI.
What happened?Other impactsOther impacts
People CHD personnel who reported for work in the first week
15 out of 267 (5.6%)
Local health personnel who reported for work in the first week
Ground estimate of 10 to 20%
Health Infrastructure
3 Damaged offices (Warehouse and prepositioned logistics destroyed)
PHP 50,350,000.00
50 out of 91 assessed hospitals are damaged (45 partial, 5 complete; 45 functional, 5 non functional)
PHP 696,810,800.00
550 out of 1,593 assessed RHU/BHS are damaged (354 partial, 183 complete; 350 functional, 180 non functional)
PHP 541,239,000.00
EVRMC as the only remaining functional hospital in Tacloban with personnel on duty for 3 straight days
250 bed hospital accommodating 60 admissions reaching 300 inpatients, and 70 E.R. Consultations (daily averages)
What happened?Health facility status
Region / Province
No. of existing
HF
No. of assessed
HF
No. of damaged
HF
Extent of Damage Operation StatusEstimated Cost of
DamagePartially damaged
Completely damaged
FunctionalNon-
functional
Region VIII 620 289 289 177 92 177 92 1,013,119,800.00
Leyte 334 195 195 153 42 153 42 665,354,300.00Eastern Samar 141 78 78 15 43 15 43 279,186,200.00
Western Samar 145 16 16 9 7 9 7 68,629,300.00
Region VII 1,007 74 71 19 52 19 52 29,930,000.00
Region VI 1,907 1,282 418 366 52 372 44 149,675,000.00
Region IV-B 146 42 41 41 0 41 0 100,625,000.00
Total 3,680 1,687 819 603 196 609 188 1,293,399,800.00
What have been done?Logistics provided
SourceSource RecipientRecipient Amount Amount
DOH-Central Office
CHD IV A 80,640.00CHD IV B 702,640.00CHD V 932,658.00CHD VI 9,736,688.26CHD VII 8,009,607.30Washed Out (Tacloban Airport) 1,130,897.50CHD VIII 78,990,219.70Sub-allotment (EAMC, V, VII, and VIII) 42,300,000.00
Total DOH Central Office logisticsTotal DOH Central Office logistics 141,883,351.00DOH HOSPITALS CHD VIII 4,025,232.54CHD's (I,IV-A, IV-B, V, VI, VII, VIII, X, XI, XII, MM, CAR, CARAGA) CHD IV-A, IV-B V, VI, VII,VIII 46,882,754.10Total DOH Central Office logistics 50,907,986.64Local Donation CHD VI, VII, VIII 14,023,226.65International Donation CHD VII, VIII 21,006,027.40Total donationsTotal donations 35,347,174.05
GRAND TOTALGRAND TOTAL 228,138,511.69
Note: Logistics include essential medicines, aquatabs and ORS, hospital and laboratory equipments, family tent and cot beds, cadaver bags, fogging machines, generator sets, computer equipment
What have been done?
• As the Health Cluster lead, DOH provided support to 144 registered foreign medical teams as well as other local and international NGOs through:– Deployment coordination– Technical advice through provision of local
protocols and guidelines– Health services report consolidation– Early disease warning detection and response
What have been done?
• Facilitated the acceptance and quality control of donated medicines and medical supplies
• Health promotion activities and other public health advisories
• Provision of cadaver bags• Assistance to NBI and LGUs in the
management of the dead
What have been done?
• Deployment of composite team with toxicology experts to manage the secondary event of oil spill in Barangay Botongan, Estancia, Iloilo
What have been done?Summary of Services
Areas of ServiceAreas of Service Specific AccomplishmentsSpecific Accomplishments
Hospital services 34,522 patients served2,127 operations conducted
Health teams deployed (composite teams)
298 teams (154 national, 144 international). National teams are composed of 1,827 personnel). Approximately 20% were deployed to Tacloban while the rest are distributed across all affected areas
Public Health services 126,299 out-patient consultations46,865 measles immunization 12,165 tetanus vaccination No disease outbreak as of today
Nutrition services 73,730 children screened for acute malnutrition (141 cases managed)69,764 children received supplementary feeding program33,619 children received vitamin A supplementation27,020 children received multiple micronutrient powder8,876 pregnant/lactating women assessed and counseled for infant and young child feedingNo worsening of nutrition condition and no deaths related to malnutrition in the areas
Water, Sanitation, and Hygiene services
1,747 latrines constructed/ rehabilitated206,051 hygiene kits distributed199,278 water kits distributed
MHPSS services 1,196 recipients of Counseling6,924 recipients of Psychological First Aid12,875 recipients of Psychosocial Processing32 advance case referrals
What have been done? Hospital services
REGIONNo. of Patients
served
Consultations
AdmissionNo. of
Operations Conducted
Status
ER OPDNo. of
ReferralNo. of
DischargedNo. of Deaths
REGION VIII 30,375. 2,194. 30,896. 3,318. 2,046. 190. 619. 83.Leyte 30,375. 2,123. 30,810. 3,247. 1,944. 190. 600. 83.
Eastern Samar 0. 71. 86. 71. 102. 0. 19. 0.Western
Samar0. 0. 0. 0. 0. 0. 0. 0.
REGION VII 2,598. 0. 2,598. 149. 60. 0. 0. 3.REGION IV-B 155. 55. 61. 18. 21. 0. 0. 0.NCR (Patients from Reg.8; Villamor Airbase)
1,394. 690. 408. 226. 219. 10.
GRAND TOTAL:
34,522. 2,249. 34,245. 3,893. 2,127. 416. 838. 96.
What have been done?Team mobilization
PROVINCE CITY/MUNICIPALITY
DOH TEAMS DEPLOYED (120)
OTHER LOCAL HEALTH
RESPONDERS (34)
FOREIGN TEAMS (124)
TOTAL (278)
NO. OF TEAMS
NO. OF PERSONNEL
NO. OF TEAMS
NO. OF PERSONNEL
NO. OF TEAMS
NO. OF PERSONNEL
NO. OF TEAMS
NO. OF PERSONNEL
LEYTE TACLOBAN 53 626 15 367 14 279 82 1272ORMOC 4 59 8 34 8 127 20 220OTHERS 21 263 5 39 18 248 44 550
SAMAR EASTERN SAMAR 16 147 6 142 22 289WESTERN SAMAR 1 11 1 11
CEBU DAANBANTAYAN, MACTAN, CAMOSTES IS., SAN REMEGIO, TABUELAN, BORBON, TOBOGON, BOGO, STA. FE, MEDELLIN 8 49 4 90 10 167 22 306
METRO MANILA VILLAMOR AIRBASE, PASAY 11 72 1 4 12 76DSWD NROC 5 11 5 11
PALAWAN CULION 1 5 1 5ILOILO, CAPIZ, AKLAN, ANTIQUE
4 91 1 50 2 74 7 215
OTHERS 5 12 5 12
What have been done?Public Health services
What have been done?Nutrition services
What have been done?WASH services
REGION
No. of Population Served
Provision of Potable Water
Water TestingDistribution
of Water Container
Water Treatment/Disinfectant
Provision of Water for General/ Domestic
Use
Construction/ Installation of
Toilets & Latrines
Hygiene Kits Provided*
Jerry Cans Provided
Others (water
purifier, mobile water tanks)
VIII 20,681,572 41,008 230,385 84,380 224,137 1,610 166,815 251,802 193
Leyte 20,681,572 14,631 230,137 84,200 224,137 1,590 142,271 249,217 171Eastern Samar 0 20,905 248 180 0 20 20,020 2,585 22Western Samar - 5,472 - - - - 2,709 - -Biliran - - - - - - - - -
VII - 1,500 - - - - 3,886 - 2
VI 0 21,088 1,653 0 0 157 15,917 1,653 618
IV-B - 4,000 - - - - - - -
Total 20,681,572 67,596 232,038 84,380 224,137 1,767 184,803 253,455 813
What have been done?MHPSS services
REGION
No. of Population Served
PFACommunity &
Family SupportCounselling
Psycho-education
session
Psychosocial processing
Stress Management
Program
Referral of cases
DefusingMental Health
Services not specified
VIII 1,261 245 696 113 2,205 290 17 415 1,962Leyte 1,261 245 696 113 2,193 278 17 415 1,336Eastern Samar 0 0 0 0 12 12 0 0 626Western Samar - - - - - - - - -Biliran - - - - - - - - -Northern Leyte - - - - - - - - -VII 672 0 408 0 302 0 0 0 0VI 0 0 0 0 9,917 0 0 0 0IV-B - - - - - - - - -NCR 4,991 311 92 155 451 310 15 5 15
Total 6,924 556 1,196 268 12,875 600 32 420 1,977
Gaps identified
In consideration of the magnitude of Typhoon Yolanda and the new normal, there is a need to:
• Update logistics and lifeline needs for emergency health sector response
• Ensure health facilities to remain functional during disasters
• Enhance equipment and preparation of health response teams (local and international)
• Update health emergency preparedness, response, and recovery plans
• Update systems for health service delivery especially for mega disasters
Some specific challenges identified
• Current procurement plan accounted mainly for non-capital outlay needs during emergency/disaster
• Some operational issues on cash advance releases/ liquidation experienced
• Team mobilization, composition, qualifications, and deployment not clearly defined in responding to Yolanda
• Current policies and guidelines covering most aspects of health emergency and disaster response lack provisions in addressing “mega” or “new normal” emergencies and disasters
• Current CHD and hospital response plans did not match the surge capacities requirements contingency and business-continuity components
Way forward
On February 19 to 21, top management level of the Department of Health held a strategic planning workshop to increase its capacity to respond to emergencies and disasters. There were five identified strategic objectives:
1. Improve the responsiveness of policies and plans at all levels to mega disasters
2. Institutionalize effective ICS at all levels supported by functional OpCen and IMS
3. Enhance the logistics and financing capacities to support response operations
4. Build-up the resiliency of hospitals and other health facilities against mega disasters
5. Enhance the adequacy, timeliness and appropriates of health services delivered