Using the Minimum Standards in Health

1. 3.4 Using the Minimum Standards in Health

2. HEALTH ACTION Health Systems Essential Health Services Prioritising services 1 Cmnicbl diseases child health Sexual and RH Injury Mental Non-cmuncbl 2 1 1 1 1 1 1 3 2 2 2 4 3 Please see page 290 in the 2011 edition 5 6 Basically divided into two main themes….

3. Health System means: “all the organizations, institutions and resources that are devoted to producing health actions” – WHO definition. Essential Health Service means: “preventive and curative health services that are appropriate to address the health needs of populations affected by disasters.” – Sphere page 309

4. Health systems standard 1: Health service delivery “People have access to effective, safe and quality health services that are standardized and follow accepted protocols and guidelines.” Namibian Ministry of Health clinic (please see page 296 of the 2011 Edition)

5. Health systems standard 2: Human resources “Health services are provided by trained and competent health workforces who have an adequate mix of knowledge and skills to meet the health needs of the population.” Community health workers can identify vulnerable groups, detect trends in disease patterns and provide early warning for rapid response to emergencies. – WHO photo - 2009 (please see page 301 of the 2011 Edition)

6. Health systems and infrastructure standard 3: Drugs and medical supplies “People have access to a consistent supply of essential medicines and consumables.” UNHCR photo (please see page 302 of the 2011 Edition)

7. Health systems standard 4: Health financing “People have access to free primary healthcare services for the duration of the disaster” British Council photo How would you measure this standard? (please see page 304 of the 2011 Edition)

8. Health systems standard 5: Health information management “The design and delivery of health services are guided by the collection, analysis, interpretation and utilisation of relevant public health data. ” K. Foster photo - Malawi How would you measure this standard? (please see page 305 of the 2011 Edition)

9. Health Information Systems include: • CMR • Under 5 MR • Proportional Morbidity and Mortality • Cause-specific mortality rate • Incidence rates for most common diseases • Health facility utilisation rate • Number of consultations/clinician/day

10. Health systems standard 6: Leadership and coordination “People have access to health services that are coordinated across agencies and sectors to achieve maximum impact.” St. Mary’s Hospital – LACOR UGANDA (please see page 307 of the 2011 Edition)

11. Essential health services standard 1: Prioritising health services “People have access to health services that are prioritised to address the main causes of excess mortality and morbidity.” IFRC photo What do you think this standard is really about? What common problems does it seek to avoid? NSF photo – Turkish earthquake damage (please see page 309 of the 2011 Edition)

12. Some Basic Terminology Exactly the same as death. Mortality is the most solid health concept - understood across all cultures. Mortality Morbidity Sick Death Rate Total number of deaths per a period of time and a known population total. Incidence Health event per unit time Prevalence Snapshot of a health condition at a single point in time.

13. Some key indicators…. “The crude mortality rate (CMR) is maintained at, or reduced to, less than double the baseline rate documented for the population prior to the disaster.” “The under -5 mortality rate (CMR) is maintained at, or reduced to, less than double the baseline rate documented for the population prior to the disaster.” (please see page 310 of the 2011 Edition) What do these two statements really mean?

14. Death Rate Calculation (CMR) Deaths/10,000/day = Number of deaths x 10,000 Days counted x population If 21 people have died in one week out of a total population of 5,000, then what is the death rate?

15. Death Rate Calculation • Number of deaths x 10,000 • Days counted x population • 21 (deaths) x 10,000 • 7 (days) x 5,000 (total pop.) • or 6/10,000/day

16. Baseline reference mortality data by region (CMR) 0.25 0.25 0.33 0.16 0.16 0.22 0.19 0.22 0.41 0.25 0.25 Global average (please see page 311 of the 2011 Edition)

17. Essential health services - control of communicable diseases standard 1: communicable disease prevention “People have access to information and services that are designed to prevent the communicable diseases that contribute most significantly to excess morbidity and mortality.” IRC photo (please see page 312 of the 2011 Edition)

18. Outside a Kabul health post involved in the UNICEF-supported measles immunization campaign, a sign provides directions for families seeking vaccinations for their children UNICEF photo

19. Essential health services - control of communicable diseases standard 2: Communicable disease diagnosis and case management “People have access to effective diagnosis and treatment for those infectious diseases that contribute most significantly to preventable excess morbidity and mortality.” NIRPHAD photo (please see page 314 of the 2011 Edition)

20. Essential health services - control of communicable diseases standard 3: Outbreak detection and response “Outbreaks are prepared for, detected, investigated and controlled in a timely and effective manner.” Bangladesh carries out the largest mass measles vaccination campaign ever – WHO photo (please see page 316 of the 2011 Edition)

21. Essential health services – child health standard 1: Prevention of vaccine-preventable diseases “Children aged 6 months to 15 years have immunity against measles and access to routine Expanded Programme on Immunization (EPI) services once the situation is stabilised.” Child with measles – CDC photo (please see page 321 of the 2011 Edition)

22. Generalized rash lasting more than 3 days and temperature over 38 degrees Centigrade and cough, runny nose or red eyes More Terminology: Measles

23. CDC Illustration – from the New York Times

24. Measles Koplik spots Measles Exanthem Day 1 Measles Exanthem Day 2

25. Vitamin A and Measles A synergistic effect Measlesunmasks underlying Vitamin A deficiency Vitamin A deficiency (even sub-clinical) increases the morbidity and mortality of measles infections Vitamin A alone administered to the high risk target population can significantly reduce measles associated morbidity and mortality

27. Essential health services – child health standard 2: Management of newborn and childhood illness “Children have access to priority health services that are designed to address the major causes of newborn and childhood morbidity and mortality.” (please see page 323 of the 2011 Edition) A mother cradles her malnourished baby in a field hospital in a refugee camp in Dadaab, Kenya, 2011. Boris Roessler, DPA / Landov

28. Essential health services – sexual and reproductive health standard 1: Reproductive health “People have access to the priority reproductive health services of the Minimum Initial Service Package (MISP) at the onset of an emergency and comprehensive RH as the situation stabilises.” What’s in the MISP? (please see page 325 of the 2011 Edition)

29. What’s the MISP? • Minimum • Initial • Service • Package • Basic, limited RH • for use in emergency, without site-specific needs assessment • services to be delivered to the population • supplies and activities, coordination and planning

30. Reproductive Health includes: • Safe motherhood, including emergency obstetric care • Sexual and gender-based violence prevention & response • Prevention and care of STDs/HIV • Family planning

31. Major Causes of Maternal Death

32. The WHO New Emergency Health Kit for 10,000 people for 3 months … * The original New Emergency Health Kit (NEHK) was last updated in 1998 and is currently under revision. The kit substituting the NEHK is called Interagency Emergency Health Kit (IEHK). • What is in the UNFPA RH Kit For use at primary health care/ health centre level: 10,000 population for three months: • Training and Administration • Condoms • Clean delivery sets • Post-rape management • Oral and injectable contraceptives • STD Drugs

33. Essential health services – sexual and reproductive health standard 2: HIV and AIDS “People have access to the minimum set of HIV prevention, treatment, care and support services during disasters.” imediata.com * What is the specially noted reservation to this standard? (see page 330) (please see page 328 of the 2011 Edition)

34. Essential health services - injury standard 1: Injury care “People have access to effective injury care during disasters to prevent avoidable morbidity, mortality and disability..” Example of triage card How many, or what kinds of services are “appropriate”? (please see page 331 of the 2011 Edition)

35. Essential health services – mental health standard 1: Mental health “People have access to health services that prevent or reduce mental health problems and associated impaired functioning.” (please see page 333 of the 2011 Edition) Refugees who still fear for their lives dwell in Kakuma camp's "protection area," which provides extra security as well as some social and psychological care. – UNHCR photo, G.Beals

36. Essential health services - non - communicable diseases standard 1: Non-communicable diseases “People have access to essential therapies to reduce morbidity and mortality due to acute complications or exacerbation of their chronic health condition.” insulin asthma inhaler (please see page 336 of the 2011 Edition)

37. Conclusions Understand before doing Control problems of disease and its spread (usually caused by failures in other sectors) Provide adequate health care for men, Women, and children Do this in a way that helps build health service capacity in the community