public health situation analysis - who · collective action for better health outcomes phsa -...

Collective action for better health outcomes

HEALTH CLUSTER COORDINATION TRAINING

May 2019, Brazzaville

Public Health Situation Analysis


Health cluster action

• Health Management Information System (HMIS)• Vaccination coverage estimation• Health Cluster Bulletin• Ad hoc Infographics

Health System Performance

• Public Health Situation Analysis (PHSA)• Rapid Health Assessment• Humanitarian Emergency Settings Perceived Needs (HESPER) Scale• Early Warning Alert and Response System (EWARS)• Population Mortality estimation•Monitoring Violence against Health (MVH)

Flow chart of Public Health Information Services

Health Status and Threats for affected

Populations

•Who, What Where (3W) matrix• Partners’ List• Health Resources Availability Monitoring System (HeRAMS)

Health Resources and Availability

Operational Indicator Monitoring


PHSA - Purpose

• Identify the current health status and potential health threats that the population may face, the functioning of the health system, and thehumanitarian health response.

• The PHSA aims to provide all health sector partners, including local and national authorities, nongovernmental organizations (NGOs), donor agencies and United Nations agencies with a common and comprehensive understanding of the public health situation in a crisis in order to inform evidence-based collective humanitarian health response planning.

• Also feeds inter-cluster products (e.g. HNO) and serves as quick summary of situation for new actors


SOPs

• http://www.who.int/entity/health-cluster/resources/publications/Public-Health-Situation-Analysis-SOPs.pdf?ua=1


Methodology

• Data source: secondary data review

• Led by:

– Level (CO, RO, HQ) depending on situation & capacity

– Independently or in collaboration


When and which version?

• New event

• Need of update

• Vulnerable context (preparedness)

• There are two versions:

– Short-form (first 48-72 hours, never updated)

– Long (Full)-form (within 2 weeks, updated as needed)

• Release of PHSA should not be delayed due to incomplete information


Geographic scope

• In multi-country crises, a separate PHSA should be conducted for

each affected country

• Where crises are confined to a well-demarcated sub-national

portion of a country, the PHSA should cover only that sub-national

area

• Where sufficient information exists to create sub-national analyses,

such analyses are encouraged.


Interactions between PHSA, RRA and STARProduct / aim Focus Method Aim When Team

Rapid Risk Assessment

Current event and its outbreak risk

RRA Providing risk assessment

Upon notification

DVA

Public HealthSituation Analysis

Potential risks/vulnerabilities/hazards/NCD health threats;Underlyingfactors

Secondary Data ReviewRRA

Providing overall situation analysis;Indentify priorities and info gaps

48-72 hrsUpon request

MDC

Strategic RiskAssessment

Long term Risk management cycle;All hazard approach

Expert judgement/ workshop

Identifypriorities for preparedness

Related to plan CPI


PHSA for WHO Grading and Re-Grading

• Generally it is expected that the PHSA will be done after initial

grading of a new emergency; further, it is most applicable to the

setting of an activated coordination mechanism (e.g., Health

Cluster), which is unlikely to be present at the very onset of a new

emergency. Thus, the PHSA is rarely helpful in determining the initial

grade.

• However, the PHSA is very useful at the time of re-grading, in order to provide the evidence on the scale of a health crisis, which

informs the regrading decision.


Distribution of PHSA

• While being based primarily on secondary data, a PHSA may

nevertheless contain information that is not in the public domain,

and as such may be sensitive

• Primary ownership of the PHSA rests with the relevant WCO. Thus,

the extent of distribution of the PHSA should be governed by the

WCO

• It is expected that the WCO will distribute the PHSA, at a minimum,

within the country Health Cluster

• Public dissemination encouraged (e.g., HR.info)


Presenting imprecise or conflicting data

• It is understood that a needs assessment, at least initially,

takes place in a dynamic, information-poor environment.

– As such, it is acceptable and indeed preferable to provide

rough ranges for percentages, totals and other statistics

• If no data available, say so!

• Indicate uncertainty – e.g. “some sources say xxx, others

disagree”

• If sex/age-disaggregation data not available, consider

using estimates from similar situations to improve

gender/etc. sensitivity

– e.g. we know there are 100,000 displaced persons, and we can

estimate that 5% of them are pregnant (from other similar

situations), so we need antenatal care for 5,000 people)


Source data

• vSHOC / Sharepoint (for existing crises)

• humanitarianresponse.info

• WHO Country Office records (e.g., annual reports)

• Ministry of Health website

• Risk profiles (especially STAR profile where available)

• Internet searches


PHSA Short-form Template


Sections of Short-form Template

1. Summary of the crisis

2. Map of the affected country/region

3. Health Status and Priority Threats

4. Health System Needs

5. Humanitarian Health Response (3/4W matrix)

6. Information gaps & recommended information sources

7. Key References

8. Contacts


Information at a glance

Snapshot of crisis at a quick glance

• Type of crisis displayed in humanitarian icons

• WHO Region

• INFORM-index.org – Risk assessment for countries in

humanitarian crisis

– Hazards & exposure, vulnerability , lack of coping capacity


Example


Summary of crisis & Key Figures

Summary of the crisis

• Brief - approximately 1 paragraph

• Key onset of crisis dates

• Main concerns

Key Figures

• Humanitarian profile

• Deaths

• Injuries

• Internally displaced persons


Example


Emergent Severe Health Concerns & Key Immediate Risks

Emergency severe health concerns• National and regional data• Brief but relevant information• Add additional headings if

necessary• Most up-to-date statistics• Reliable source of information• See suggested indicatorsKey immediate risks (1st month)• Complete table in consultation

with Regional office, Country office


Scoring the magnitude of health threats /needs

• For the vast majority of questions, one should be able to at least

make a plausible assumption about what could happen as a result

of the crisis. Only a few questions should be scored as ‘Unclear’.

• One should resist the temptation to score every question as ‘High’

• One should provide a score without thinking about the mitigating

impact of the humanitarian health response.


Underlying factors, Determinants of healthContext….


ExampleTo understand the key health threats, it is important to understand the pre-crisis burden of disease for the main groups of disease

Narratives that explain and justify table


Health System Status and Main Figures

Health system status

• National and regional information

• Brief – relevant information

Main figures on disruption of key health system components

• 1 or 2 sentences each heading


Example


National and International Humanitarian Capacity & No of partners

National and International humanitarian capacity

• Include Who-does-What-Where (3W) Map

N of partners

• Number of health cluster/sector partners


Information Gaps & Information priorities, action required

Information gaps

• Identify information gaps, action required and related outcome

Information priorities & action required

• Prioritize information gaps and corresponding action required – i.e. PRIMARY DATA (e.g. RHA)


Key documents

Key documents• Use most up-to-date statistics• Example of sources

– WHO • Country Profiles• Disease outbreak news• TB country profile• NCD country profile• Global Health Observatory country data• Vaccine-preventable diseases: monitoring

system. 2017 global summary (country specific)

– Cluster sources• Protection cluster gender-based violence

information management system

– UNAIDS Country level profile– International Diabetes Federation regional

fact sheets & country reports– The Mental health & Psychosocial Support

Network (MHPSS.net)

Complete the “confidence in available information” section after completion of the PHSA


Example


Long-form Template

• The long-form PHSA builds upon the short-form (hence most fields in

the short-form can be copied and pasted directly into the long-

form), adding depth to the information presented in the short-form

• A few unique additional elements

– Magnitude of expected health threats and their expected evolution

over time

– Disruptions to key health system components and their expected

evolution over time


Health Threats Evolution Table


Health Threats Evolution Methodology

• Where there are predicted changes in risk, the box should be used

to indicate the justification for the prediction

• Timing is primarily based either on predictable seasonality (such as

rainy season and malaria, or lean season and malnutrition) or on

predictable evolution from onset.

– An example of the latter would be trauma injuries after a sudden-onset

natural disaster: the timing of need would be immediate, and indeed

would dramatically decrease after one week

• If no plausible prediction can be made about the course of a given

threat (e.g., an outbreak with a rare pathogen), it is better to leave

it grey than make unfounded predictions.


Health System Disruptions Table


Health System Disruptions Methodology

• Timing of changes in disruption is more difficult to predict than

timing of changes to disease threats

• However there are situations where prediction can be made.

– For example, certain health system components are predictably less

functional during rainy seasons when roads become impassable.

– Another example is that financing shortfalls can sometimes be

predicted several months in advance (in the absence of mitigating

measures).

• For each of the above domains, it is useful to include a brief

narrative about the health system status prior to the crisis, in order to

provide context


A note about Recommendations

• The PHSA does not include recommendations about priority

interventions, as the PHSA is meant to serve as a springboard for on-

the-ground response joint response planning amongst all health

cluster/sector partners, informed by local capacities/resources/

limitations/political considerations.

• PHSA should be rapid, so no time for lengthy response planning

discussion with the partners prior to publication

• Stick to information gaps, not operational recommendations


Conclusions

• All complex crises need a PHSA

• For acute onset, go to short-form; otherwise just go to long-form

• Contact RO or HQ for support


PHSA in AFRO (2019)

• Long format: South Sudan, Mali, CAR,Ethiopia

• Short format: Mozambique, Comoros, Ethiopia, Congo, RDC(Kassai

region), Cameroon (2), Burkina faso


Challenges

• When to initiate the PHSA?

• Who initiate PHSA

• Finalise the PHSA and share information

• GBV information

• Updating PHSA long format

public health situation analysis - who · collective action for better health outcomes phsa -...

Documents