tehran university of medical sciences institute of public health research health in emergency &...
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Tehran University of Medical Sciences Institute of Public Health Research
Health in Emergency & Disaster Department (HE&DD)
Rapid Assessment in Disaster
Ali Ardalan MD, MPH, PhD
Assistant Professor
Learning Objectives:
By the end of the session, participants will be able to:
Explain the characteristics of data & information
after disasters
Explain the importance & main applications of
rapid assessments following disasters
Develop a rapid assessment form
To criticize a rapid assessment report
• Lack of information as the strongest indicator of a crisis
• Lack of information is not = to lack of data
Disaster impact on information
• Routine information systems collapse
• Population movements lack of reliable denominators
• Collection & analysis of data clash with other priority activities
Disaster impact on information
Zones
Earthquake- stricken area
No information is available, or what is available is flawed to
such a degree to be useless. Therefore:
Postpone any decision until new data become available:
Paralysis by analysis
OR
Given gravity of crisis, there is not time to gather
reliable data; Proceed quickly with field activities
Main Myth of Health Information in Crises
The opportunity cost of information in emergencies
Accuracy and comprehensiveness
Cos
t: c
apac
itie
s & o
ppor
tuni
ties
Non-routine data collection methods in emergencies
Type When What How
Rapid reconnaissance
Immediately after a disaster
A quick, preliminary inspection of the disaster area
Satellite imagery Overflights Mapping Drive/walk through
RHA As soon as it is
possible to go to the area
A quick collection of information to confirm the emergency, measure the impact, identify health needs and guide response
Visual inspection Analysis of records Interview of key
informants Rapid surveys
(MUAC, etc)
Surveys When the situation stabilises and response has been activated
A detailed study in which information is systemati-cally collected in a sample of population (morbidity, mortality, nutrition, KAP)
Probability sampling Non-probability s.
The 10 Priorities in Emergency
1. Rapid assessment of health status2. Mass immunization against measles!
3. Environmental hygiene and water availability
4. Food availability
5. Shelter
6. Case management, therapeutic protocols
7. Prevention and control of epidemic prone diseases
8. Health information system (public health)9. Human resources
10. Coordination of interventions
source : Refugee Health, MSF
Rapid Assessment
Rapid Health Assessment
Rapid Public Health Assessment
Rapid Epidemiological Assessment
Rapid…………… ?.
Purpose of Rapid Health Assessment (RHA)
The purpose of a rapid assessment is to:
Confirm the emergency
Describe the type, impact and possible evolution of the emergency
Measure its present and potential health impact
Assess the adequacy of existing response capacity & immediate
additional needs
Recommend priority action for immediate response
Disseminate findings widely
RA: Main issues
Area of information?
Source of information?
Which instrument?
Team composition?
Report format?
RA: Area of Information
MAIN ISSUE
Nature of the emergency:• Main causative hazard • Additional hazards • Projected evolution
Affected area• Administrative division • Access to area:
Main routes and conditions Distance from the closest town outside the affected area Closest operational airport, port or navigable river
Affected population:• Characteristics (e.g residents, refugees, IDPs) • Number/estimates • Sex/age breakdown • Patterns of settlement/movement • Source of information & method of data collection
RA: Area of Information
HEALTH IMPACT
Direct impact: reasons for alert• Main causes of morbidity and mortality• CMR • Under-5 Mortality Rate • Malnutrition status • Reports/rumours of outbreak• Other reasons for concern:
e.g. traumas/injures due to landmines, etc
Indirect health impact • e.g. damage to water plants, other vital infrastructures or
lifelines
Pre-emergency baseline morbidity and mortality data
Projected evolution of the health situation: • Main causes of concern in the coming months
RA: Area of Information
VITAL NEEDS: THE CURRENT SITUATION
• Water
• Excreta disposal
• Food
• Shelter and environment on site
• Soap and buckets
• Fuel and cooking utensils
• Clothing and blankets
RA: Area of Information
CRITICAL CONSTRAINTS
• Security
• Transport and logistics
• Social/political and geographical constraints
RA: Area of Information
RESPONSE CAPACITY
Activities already underway Measles coverage
National contingency plans, procedures, guidelines and special expertise
Operational support• Location of field forward control post • Health system: Closest functioning health unit and
referral system • External assistance: Closest organization and relevant
resources • Capacity for reprogramming the resources above • State of communications• Storage capacity close to affected area and supply lines
RA: Area of Information
RESPONSE CAPACITY
Operational coordination:
• Lead agency
• Mechanisms
• Flows of information
Strategic coordination
• Relations between government and UN country team
• National institutions for emergency management
• Standing agreements with neighbouring areas
• Relations between government and international community at large
RA: Source of information
• Visual inspection
• Analysis of records
• Interview of key informants
• Rapid surveys
RA: Instrument
• Minimal Essential Data Set (MEDS)
• Evaluation Criteria
RA Instrument: International Source
1. WHO: Rapid Health Assessment Protocol for Emergencies
2. UNICEF: Handbook for Emergencies
3. IFRC: Handbook for Delegates
4. Sphere: Humanitarian Charter & Minimum Standards in Disaster
Response
5. MSF: Refugee Health
6. OFDA: Field Operation Guide
7. CDC: Famine-Affected, Refugee, and displaced populations:
Recommendations for Public Health Issues
RA Instrument: Evaluation Criteria
1. Disaster specificity (Specific / Non-specific)
2. Assessment focus: (Site-targeted / System targeted)
3. Metadata (Captured / Not captured)
4. Information priorities (Critical / Non-critical)
5. Performance indicators (SMART / not SMART)
6. Benchmarks (Present / Absent)
7. Data structure (Checklist / Template)
8. Portability (High / Intermediate / Low)
9. Time needed (Stated / Unstated)
10. Field utility (High / Low)
RA: Team Composition
• Public health professional
• Epidemiologist
• Environmental health expert
• …
RA: Report Format
RA: Report Format
RA: Information User
Wide spectrum:
• UN Agencies
• NNGOs & INGOs
• MOH departments
• Health sector partners
• Media
• …
RA: Common Problems
Poorly coordinated; each organization doing
different assessment
Findings not disseminated
Findings ignored
Ongoing information system not established
Contact info:
e-mail: [email protected]
Office/FAx: +98-21- 88951401
Mobile: +98- 9123050192
Ali Ardalan MD MPH PhD
Assistant Professor
Health Emergency & Disaster Department (HE&DD)
Institute of Public Health Research
Tehran University of Medical Sciences