9/13/20151 Using the Minimum Standards in Health 3.4

04/19/23 1

Using the Minimum Standards in Health

3.4

HEALTH ACTION

Essential Health ServicesHealth Systems

Please see page 290 in the 2011 edition

Prioritising services

Cmnicbl diseases

child health

Sexual and RH

Injury Mental Non-cmuncbl

1 1 1 1 1 1

2 2 2

3

1

2

3

4

5

6 Basically divided into two main themes….

04/19/23 3

Health System means:Health System means:““all the organizations, institutions and all the organizations, institutions and

resources that are devoted to producing resources that are devoted to producing health actions” – WHO definition.health actions” – WHO definition.Essential Health Service Essential Health Service

means:means:““preventive and curative health preventive and curative health

services that are appropriate to services that are appropriate to address the health needs of address the health needs of populations affected by disasters.” populations affected by disasters.” – Sphere page 309– Sphere page 309

04/19/23 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.”

( please see page 296 of the 2011 Edition)

Namibian Ministry of Health clinic

04/19/23 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

04/19/23 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

04/19/23 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?

04/19/23 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?

04/19/23 9

HHealth ealth IInformation nformation SSystems ystems include:include:

CMRCMR Under 5 MRUnder 5 MR Proportional Morbidity and MortalityProportional Morbidity and Mortality Cause-specific mortality rateCause-specific mortality rate Incidence rates for most common Incidence rates for most common

diseasesdiseases Health facility utilisation rateHealth facility utilisation rate Number of consultations/clinician/dayNumber of consultations/clinician/day

04/19/23 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

04/19/23 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.”


NSF photo – Turkish earthquake damageWhat do you think this standard is really about? What common problems does it seek to avoid?

IFRC photo

04/19/23 12

Some Basic TerminologySome Basic Terminology

Mortality Exactly the same as death. Mortality is the most solid health concept - understood across all cultures.

Morbidity Sick

Total number of deaths per a period of time and a known population total.Death Rate

Incidence Health event per unit time

Snapshot of a health condition at a single point in time.

Prevalence

04/19/23 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.”


What do these two statements really mean?

Death Rate Calculation (CMR)Death Rate Calculation (CMR)

Deaths/10,000/day =Deaths/10,000/day =

Number of deaths x 10,000Number of deaths x 10,000Days counted x populationDays counted x population

If 21 people have died in one week out of a If 21 people have died in one week out of a total population of 5,000, then what is the total population of 5,000, then what is the death rate?death rate?

Death Rate CalculationDeath Rate Calculation

Number of deaths x 10,000Number of deaths x 10,000 Days counted x populationDays counted x population

21 (deaths) x 10,00021 (deaths) x 10,000 7 (days) x 5,000 (total pop.) 7 (days) x 5,000 (total pop.)

oror6/10,000/day6/10,000/day6/10,000/day6/10,000/day

04/19/23 16( please see page 311 of the 2011 Edition)

Baseline reference mortality data by region (CMR)

0.250.25

0.25

0.16

0.41

0.220.19

0.16

0.33

0.22

0.25Global average

04/19/23 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

04/19/23 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.” ( please see page 314 of

the 2011 Edition)

NIRPHAD photo

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

04/19/23 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

04/19/23 22

Generalized rash lasting more than 3 days and temperature over 38 degrees Centigrade and cough, runny nose or red eyes

More Terminology: Measles

04/19/23 23CDC Illustration – from the New York Times

04/19/23 24

Measles Exanthem Measles Exanthem Day 1Day 1

Measles Koplik Measles Koplik spotsspots

Measles Exanthem Day 2Measles Exanthem Day 2

04/19/23 25

Vitamin A and MeaslesVitamin A and Measles

Measles unmasks underlying Vitamin A deficiency

A synergistic effect

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

04/19/23 26

04/19/23 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.”


A mother cradles her malnourished baby in a field hospital in a refugee camp in Dadaab, Kenya, 2011. Boris Roessler, DPA / Landov

04/19/23 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?

04/19/23 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

04/19/23 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

04/19/23

Major Causes of Maternal Death

Hemorrhage25%

Sepsis15%

Eclampsia12%

Abortion13%

Obstruction8%

Other27%

04/19/23 32

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

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).

04/19/23 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)

04/19/23 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”?

04/19/23

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.”


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

04/19/23 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

04/19/23 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

Documents

9/13/20151 Using the Minimum Standards in Health 3.4