SPECIAL SECTION
Review of the Hyogo Framework for Action
Breakout Session 4 Summary: Health Infrastructure and Logistics for Disaster Preparedness, Including Resources and Funding Arturo Pesigan, WHO Country Office for Sri Lanka; and Tom Cullison, Center for Disaster and Humanitarian Assistance Medicine, Uniformed Services University of the Health Sciences
Cross-cutting Principle: Risk of disaster impact = Probability of Hazard Occurring x Vulnerability of the Population
Consultative Theme 1: Safe Hospitals Anticipated Impacts:
∙ Enable facilities to function in emergencies and disaster ∙ Protect health workers and patients ∙ Protect the physical integrity of hospitals Challenges:
∙ Setting practical goals ∙ Measuring achievements ∙ Minimum elements Recommendations:
▪ Ensure integration of recommendations on safe hospitals initiative with recommendations for HFA2 to continue momentum of HFA Develop an assessment report or mapping of safe hospital activities Synchronize regional plans Develop advocacy and communication plans Ensuring that structural, nonstructural and functional elements of hospitals contribute to Disaster Risk Management (DRM) ▪ Acknowledgment that hospitals are critical assets for communities
▪ ▪ ▪ ▪
Consultative Theme 2: Continuity of Health Operations/Logistics in the Event of a Disaster Anticipated Impacts:
∙ ∙ ∙ ∙
Hospitals maintain their function during and after a disaster Workload of medical personnel (doctors, nurses, hospital managers etc) becomes manageable Avoid advancing severity of patients Health conditions in the region can be maintained
Challenges:
∙ Financial constraints to put disaster preparedness capacity in place ∙ Limited number of human resources/experts for disaster preparedness ∙ Limitation of management/administration mechanism 366
Disaster Medicine and Public Health Preparedness
VOL. 8/NO. 4
Copyright © 2014 Society for Disaster Medicine and Public Health, Inc. DOI: 10.1017/dmp.2014.74
Session 4 - Breakout Session Summary
∙ Insufficient knowledge on disaster preparedness and understanding that preparedness is critical for continuity of health operations
∙ Establishment of collaborative mechanism including pre-agreement among hospitals and local government ∙ Difficulty of information sharing of personal data (vulnerable groups) ∙ Strengthening linkage of DRR and health, and integration of health elements to HFA2 Measures/Metrics to Assess Impact:
∙ ∙ ∙ ∙ ∙ ∙ ∙
Continuity of operations plan is established with the guidelines and manual for actual implementation. Regular simulation exercises/emergency drills are conducted. Hospitals have backup communication systems. Pre-agreement are developed with governments, other hospitals and other organizations/agencies. A disaster base hospital and an emergency operation center is established at least in one medical service area. Seriously injured patients can be transferred to a larger hospital outside of affected area/prefecture if necessary. Patients including those with chronic diseases can access to necessary medicines.
Recommendations:
∙ ∙ ∙ ∙
Capacity and risk assessment Facilities: emergency operation center, disaster base hospital, disaster-proof structure Plans/Agreement: business/operation continuity plan with multi-hazards approach, pre-agreement with other entities Coordination: appointment of a disaster medical and public health coordinator, communication network, clear coordination mechanism and a chain of command ∙ Information exchange/communication: emergency medical information system, emergency communication tools ∙ Even during and after an acute stage, public health system needs to be maintained.
Consultative Theme 3: Resources and Funding Strategies for Health-Specific DRR priorities Anticipated Impacts:
∙ More robust baseline community health system ∙ More immediate, efficacious disaster medical response ∙ Leadership focus on other societal needs Challenges:
∙ Difficult business case - increased costs to prepare for an uncertain event ∙ Funding always limited ∙ Disaster preparedness education and training requires personnel diversion from “day job” Measures/Metrics to Assess Impact:
∙ Process Metrics
○ Health funding includes DRR considerations ○ Number of resilient health facilities considered compatible with disaster risk reduction standards ∙ Outcome (Operational and Fiscal) ○ Number of functional health facilities following natural disaster ○ Time to resume normal clinical activities ○ Costs to maintain services in existing facility compared to transporting and establishing expeditionary medical facility and returning fixed facility to operation status ∙ Outcome (Clinical and Societal) ○ Mortality and morbidity compared to similar events ○ Economic performance post disaster Recommendations:
∙ Establish business case for Disaster Risk reduction (DRR) capability in health system strengthening development programs ∙ Develop scientific argument that front-end investment Disaster Medicine and Public Health Preparedness
367
Session 4 - Breakout Session Summary
○ Saves lives ○ Decreases morbidity ○ Less costly ∙ Compare costs of re-establishing or rebuilding to presumed costs of maintaining continuity ∙ Study recent disasters for examples of health facilities rendered incapable by natural disaster ∙ Link DRR requirement to health system infrastructure funding
Consultative Theme 4: Human Resource Infrastructure Primary Considerations:
∙ ∙ ∙ ∙
Human resource infrastructure continuity of local staff, national and near-regional providers, and international assistance Local staff National and Near-regional providers International assistance
Consultative Theme 5: Biological disaster risk reduction Measures/Metrics to Assess Impact:
∙ ∙ ∙ ∙ ∙ ∙
Process Inclusion of general language emphasizing Biological DRR and biological hazards in HFA2 Inclusion of specific language regarding Biological DRR considerations in HFA2 Inclusion of International Health Regulations, One Health, etc… Number/percentage of countries with functional core International Health Regulation (IHR) capabilities Limited compliance to date – linkage to DRR would be mutually reinforcing
Recommendations:
∙ Enhanced emphasis on biological disaster risk reduction in future HFA deliberations would be mutually beneficial to DRR efforts in general and to emerging biological DRR efforts.
∙ Future HFA deliberations should specifically include consideration of biological disaster risk reduction issues, challenges, and efforts and should develop specific, detailed recommendations and indicators for enhancement of global biological disaster risk reduction efforts as a vital component of broader multi-hazard DRR efforts. ∙ The International Health Regulations are a very high-profile successful example of a biological DRR effort that cuts across the HFA Priorities for Action. ∙ The IHR should be specifically designated as a priority area of focus for DRR (along with Safe Hospitals, One Health, and Health System Strengthening) ∙ In addition, specific attention should be given to infrastructure and logistics considerations unique to biological disaster risk reduction (complementary to overall DRR efforts).
368
Disaster Medicine and Public Health Preparedness
VOL. 8/NO. 4
Review of the Hyogo Framework for Action
Breakout Session 4 Summary: Health Infrastructure and Logistics for Disaster Preparedness, Including Resources and Funding Arturo Pesigan, WHO Country Office for Sri Lanka; and Tom Cullison, Center for Disaster and Humanitarian Assistance Medicine, Uniformed Services University of the Health Sciences
Cross-cutting Principle: Risk of disaster impact = Probability of Hazard Occurring x Vulnerability of the Population
Consultative Theme 1: Safe Hospitals Anticipated Impacts:
∙ Enable facilities to function in emergencies and disaster ∙ Protect health workers and patients ∙ Protect the physical integrity of hospitals Challenges:
∙ Setting practical goals ∙ Measuring achievements ∙ Minimum elements Recommendations:
▪ Ensure integration of recommendations on safe hospitals initiative with recommendations for HFA2 to continue momentum of HFA Develop an assessment report or mapping of safe hospital activities Synchronize regional plans Develop advocacy and communication plans Ensuring that structural, nonstructural and functional elements of hospitals contribute to Disaster Risk Management (DRM) ▪ Acknowledgment that hospitals are critical assets for communities
▪ ▪ ▪ ▪
Consultative Theme 2: Continuity of Health Operations/Logistics in the Event of a Disaster Anticipated Impacts:
∙ ∙ ∙ ∙
Hospitals maintain their function during and after a disaster Workload of medical personnel (doctors, nurses, hospital managers etc) becomes manageable Avoid advancing severity of patients Health conditions in the region can be maintained
Challenges:
∙ Financial constraints to put disaster preparedness capacity in place ∙ Limited number of human resources/experts for disaster preparedness ∙ Limitation of management/administration mechanism 366
Disaster Medicine and Public Health Preparedness
VOL. 8/NO. 4
Copyright © 2014 Society for Disaster Medicine and Public Health, Inc. DOI: 10.1017/dmp.2014.74
Session 4 - Breakout Session Summary
∙ Insufficient knowledge on disaster preparedness and understanding that preparedness is critical for continuity of health operations
∙ Establishment of collaborative mechanism including pre-agreement among hospitals and local government ∙ Difficulty of information sharing of personal data (vulnerable groups) ∙ Strengthening linkage of DRR and health, and integration of health elements to HFA2 Measures/Metrics to Assess Impact:
∙ ∙ ∙ ∙ ∙ ∙ ∙
Continuity of operations plan is established with the guidelines and manual for actual implementation. Regular simulation exercises/emergency drills are conducted. Hospitals have backup communication systems. Pre-agreement are developed with governments, other hospitals and other organizations/agencies. A disaster base hospital and an emergency operation center is established at least in one medical service area. Seriously injured patients can be transferred to a larger hospital outside of affected area/prefecture if necessary. Patients including those with chronic diseases can access to necessary medicines.
Recommendations:
∙ ∙ ∙ ∙
Capacity and risk assessment Facilities: emergency operation center, disaster base hospital, disaster-proof structure Plans/Agreement: business/operation continuity plan with multi-hazards approach, pre-agreement with other entities Coordination: appointment of a disaster medical and public health coordinator, communication network, clear coordination mechanism and a chain of command ∙ Information exchange/communication: emergency medical information system, emergency communication tools ∙ Even during and after an acute stage, public health system needs to be maintained.
Consultative Theme 3: Resources and Funding Strategies for Health-Specific DRR priorities Anticipated Impacts:
∙ More robust baseline community health system ∙ More immediate, efficacious disaster medical response ∙ Leadership focus on other societal needs Challenges:
∙ Difficult business case - increased costs to prepare for an uncertain event ∙ Funding always limited ∙ Disaster preparedness education and training requires personnel diversion from “day job” Measures/Metrics to Assess Impact:
∙ Process Metrics
○ Health funding includes DRR considerations ○ Number of resilient health facilities considered compatible with disaster risk reduction standards ∙ Outcome (Operational and Fiscal) ○ Number of functional health facilities following natural disaster ○ Time to resume normal clinical activities ○ Costs to maintain services in existing facility compared to transporting and establishing expeditionary medical facility and returning fixed facility to operation status ∙ Outcome (Clinical and Societal) ○ Mortality and morbidity compared to similar events ○ Economic performance post disaster Recommendations:
∙ Establish business case for Disaster Risk reduction (DRR) capability in health system strengthening development programs ∙ Develop scientific argument that front-end investment Disaster Medicine and Public Health Preparedness
367
Session 4 - Breakout Session Summary
○ Saves lives ○ Decreases morbidity ○ Less costly ∙ Compare costs of re-establishing or rebuilding to presumed costs of maintaining continuity ∙ Study recent disasters for examples of health facilities rendered incapable by natural disaster ∙ Link DRR requirement to health system infrastructure funding
Consultative Theme 4: Human Resource Infrastructure Primary Considerations:
∙ ∙ ∙ ∙
Human resource infrastructure continuity of local staff, national and near-regional providers, and international assistance Local staff National and Near-regional providers International assistance
Consultative Theme 5: Biological disaster risk reduction Measures/Metrics to Assess Impact:
∙ ∙ ∙ ∙ ∙ ∙
Process Inclusion of general language emphasizing Biological DRR and biological hazards in HFA2 Inclusion of specific language regarding Biological DRR considerations in HFA2 Inclusion of International Health Regulations, One Health, etc… Number/percentage of countries with functional core International Health Regulation (IHR) capabilities Limited compliance to date – linkage to DRR would be mutually reinforcing
Recommendations:
∙ Enhanced emphasis on biological disaster risk reduction in future HFA deliberations would be mutually beneficial to DRR efforts in general and to emerging biological DRR efforts.
∙ Future HFA deliberations should specifically include consideration of biological disaster risk reduction issues, challenges, and efforts and should develop specific, detailed recommendations and indicators for enhancement of global biological disaster risk reduction efforts as a vital component of broader multi-hazard DRR efforts. ∙ The International Health Regulations are a very high-profile successful example of a biological DRR effort that cuts across the HFA Priorities for Action. ∙ The IHR should be specifically designated as a priority area of focus for DRR (along with Safe Hospitals, One Health, and Health System Strengthening) ∙ In addition, specific attention should be given to infrastructure and logistics considerations unique to biological disaster risk reduction (complementary to overall DRR efforts).
368
Disaster Medicine and Public Health Preparedness
VOL. 8/NO. 4
