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From Evaluation to Practice: Lessons for Health Emergency Management. Additional module. Learning Objectives. Discuss lessons identified in recent disasters and health emergencies Explore the basic principle in evaluation Identify aspects of health emergency management which need improvement

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learning objectives
Learning Objectives
  • Discuss lessons identified in recent disasters and health emergencies
  • Explore the basic principle in evaluation
  • Identify aspects of health emergency management which need improvement
  • Identify areas for action in health emergency management development
lessons identified or lessons learned
Lessons Identified or Lessons Learned

“the only lesson we learn from disasters is that we don’t learn the lessons from disasters”

questions
Questions

From your own experience, what lessons did you identify from disasters in terms of management?

What are the lessons identified from international experiences concerning public health emergency management?

Why do we, and how can we do evaluations effectively?

Considering these questions and the role of the health emergency manager, what would you see as top-priorities for action?

outline an approach to evaluation
Outline – an Approach to Evaluation

Small group discussions

  • Lessons identified: personal views

Dialogue session

  • Lessons identified: expert views

About evaluations

  • A pragmatic approach to evaluation

Plenary discussion

  • Learning priorities for capacity development: group view
activity
Activity
  • Each group has a different focus: use the guidelines
  • Based on personal experience what lessons did you identify in terms of health emergency management?
  • Compare experiences & build consensus on key lessons identified
  • List on a flipchart your group results
slide7
Synopsis of Evaluations on the Health Response to DisastersKey Lessons Identified for Health Emergency Management
sources
Sources

Guisaugon Landslides (February 2006)

ULTRA Stampede (February 2006)

Guimaras Oil Spill (August 2006)

Typhoon Reming (December 2006)

Other disasters

lessons identified in context of phem
Lessons Identified in Context of PHEM

Risk assessment

Risk reduction

Preparedness

Response

Recovery & Reconstruction

Health information systems

Risk communication

risk assessment
Risk Assessment

Vulnerability indicators should include:

  • Root causes
  • Socio-economic causes
  • Onsite threats

Thailand

  • Locals…migrants…tourists…& industries
  • Ability to recover?
risk reduction early warning systems
Risk Reduction: Early Warning Systems

Capacity & coordination

  • Capacity building is needed
    • Infrastructure & personnel
  • Coordination structures need to be developed

I.e. All affected countries

  • No tsunami warning systems in place
  • Inefficient inter-sector communication in most affected countries
risk reduction measures
Risk Reduction Measures

Integration of prevention and preparedness into the recovery process must be advocated

  • Prevention measures are more cost-effective than damage response

Indonesia, Sri-Lanka, India (Andaman), Thailand

  • Costal buffer zones
  • Tourism, business
  • Housing quality
  • Migrants
  • Health care facilities
policy emergency response
Policy: Emergency Response

Policy without enforcement was powerless

I.e. Thailand & Sri-Lanka

  • Operational problems for NGOs
  • Center for Non-Government Sector
preparedness quality of response
Preparedness: Quality of Response

Disaster preparedness is crucial

I.e. Indonesia –Thailand

  • The quality of response was affected by the degree of preparedness
preparedness coordination communication
Preparedness: Coordination-Communication

Lack of effective coordination

  • Internal-external
  • Policy-practice
  • Sectors-agencies

I.e. All affected countries

  • Reporting formats
  • Chain of command
  • Media
preparedness resource management
Preparedness: Resource Management

Common problems

  • Personnel, finance, partners & logistics

I.e. Countries / international aid

  • Alien consultants, flash appeals, role of army, leadership in health
response standing operating procedures sops
Response: Standing Operating Procedures (SOPs)

SOPs were not existing or out of date, or not used

I.e. All affected countries

  • Expressed need to develop or review SOPs
response logistics
Response: Logistics

Logistics were troublesome

  • Procurement, delivery, maintenance

I.e. Most affected countries

  • Bureaucratic routine
  • Customs
  • Expired drug supplies
  • Inappropriate technology
response health assessments
Response: Health Assessments

Need assessments were dysfunctional

  • Over assessed victims
  • Under informed decision makers

I.e. Indonesia

  • Multi sectors & agencies conduct own assessments
  • Stakeholders did not share enough
response and recovery coordination
Response and Recovery: Coordination

International-national & central-local relationships are crucial

Risk reduction, preparedness & response affect health system functioning

recovery closing the cycle
Recovery: Closing the Cycle

Response + recovery + risk reduction = development

I.e. WHO Sri-Lanka

  • The use of flash appeal funds to support long-term development – Opportunities for change
health information systems diseases
Health Information Systems: Diseases

Relevance?

  • Disease oriented
  • Data vs. decisions

I.e. All affected countries

  • Too much CD focused
  • Dysfunctional
  • Mainly serving central levels
risk communication media relations
Risk Communication: Media Relations

Working with media needs attention

I.e. All affected countries

  • First reports came from the media
  • Soundness of information…
  • Relationships…
how can we define evaluation 1
How can we Define Evaluation? (1)

The classic perspective:

  • Concerned with the achievement of objectives

The broad perspective:

  • Achievement of objectives is a key, but it is only part of what an evaluation might be concerned with
  • Unplanned and unexpected outcomes or processes might be very important and would not be looked for if evaluation were limited to objectives
how can we define evaluation 2
How can we Define Evaluation? (2)

Key elements in defining evaluation are:

  • The need for systematic collection of information
  • The wide range of topics to which evaluation can be applied
  • To be effective, the evaluation results has to be used by someone
  • The wide variety of purposes of evaluations
is there a difference between research evaluation
Is There a Difference Between Research & Evaluation?
  • Research & evaluations use the same toolbox (methodologies)
  • However, for a different purpose
    • Research aims to prove…
    • Evaluation aims to improve…
why do we do evaluations
Why do we do Evaluations?

It’s all about interventions or programs to:

  • Inform planning
  • Define progress
  • Examine efficiency
  • Examine effectiveness or achievement
  • Inform decision-making
how could you find out the purpose of an evaluation
How could you find out the Purpose of an Evaluation?
  • Who asked for evaluation?
  • Who pays for the evaluation?
  • Why do these people want an evaluation?
  • What are the decisions that need to be made?
  • What information is required to facilitate decision-making?
  • Who is going to be affected by evaluation outcomes?
classifying evaluation purposes
Classifying Evaluation Purposes

Needs assessments

  • Before action / response to understand context & needs
  • Examples: risk assessment, capacity assessment, damage assessment, health assessment etc.

Program monitoring

  • Compliance with policy / plan
  • Validity of assumptions & pre-conditions

Formative evaluation

  • Efficiency

Summative evaluation

  • Effectiveness
  • Decision-making on continuation, expansion, reduction, closure, funding
debriefs hotwash review
Debriefs-hotwash-review

What: A during-action (operations) or post-action (i.e. exercise / response) reflection

Who: Individuals, service provider groups and or agencies involved

Why: Highlight lessons identified and take action

How: Identify areas for improvement in procedures, equipment and systems

What not: ≠ a forum for criticizing the performance of others operational debriefs ≠ trauma debriefs

bias and politics of evaluations
Quick and dirty evaluations

Weighty evaluations

Guess evaluations

Personality focused evaluations

Eyewash evaluations

Whitewash evaluations

Submarine evaluations

Posture evaluations

Postponement evaluations

Bias and Politics of Evaluations
what methods can you think of to collect information
What Methods can you Think of to Collect Information?

Quantitative

  • Documentation research
  • Survey interviews
  • Clinical surveys

Qualitative

  • Documentation research
  • Interviews
  • Focus Groups
  • Observations
quantitative data sources methods
Quantitative Data Sources & Methods

Documented information

(e.g. medical records / vital statistics on population samples)

Individual data on samples of a subgroup

(e.g. clinical conditions)

Indirect measures

Observation

Survey interviews

Individual data from samples of a community or subgroup

(e.g. demographics, disease / injury histories etc)

qualitative data sources methods
Qualitative Data Sources & Methods

Behaviour

Community perspective

normative view

Observation

Focus groups

In-depth

interviews

Indirect

measures

Individual interviews

Individual perspective

intra-cultural variation

Key informants

In-depth knowledge

Documented information

about methods
About Methods
  • Questions will tell you what information you can obtain
  • Information needed will tell you what methods could be used
  • Local context & resource limits will tell you what methods are feasible
  • Keep it as simple as possible
in summary
In Summary

To find out something useful about an intervention or program, use whatever you have in your toolbox that will get the job done…

activity plenary
Activity: Plenary

At the end of the day…considering the role of HEM in disasters:

What would you, as a group, see as top-priorities for action?

putting it together 1
Putting it Together-1

Build capacity in risk management & vulnerability reduction

  • Policy & legislation development
  • Develop lines of authority & control
  • Allocate resources for risk mgt & vulnerability reduction

Give attention to health assessments

  • Relevant to decision-making
  • Multi-sectoral
  • Population-based
putting it together 2
Putting it Together-2

Develop benchmarks & standards of practice

  • Vulnerability indicators
  • Surveillance systems
  • Relevant health assessments
  • Indicators on effectiveness, efficiency, costs, & benefits of both preparedness & response

Improve coordination of responses

  • Internal
  • External assistance
  • Policy-practice
putting it together 3
Putting it Together-3

Develop logistics systems

  • Legislation
  • Relevance
  • Capacity building

Foster contribution of other sectors

  • Civil-military liaisons
  • Public-private sector liaisons
  • NGOs’ inclusion not marginalization
putting it together 4
Putting it Together-4

Develop risk communication

  • IEC prior and during disasters
  • Combat disaster myths
  • Guidance on media relations

Developing capacity

  • Health emergency management leadership
  • PHEM capacity at all levels and functions
  • Networking & partnerships
  • Knowledge development
from evaluation to practice key to developing health emergency management
From Evaluation to Practice: Key to Developing Health Emergency Management

Strengthening

Development

Evaluation

Research

Improved Health Outcomes

Awareness

Advocacy

Capacity

Building