The Road Map for establishment of an effective EPR system for Health Sector in Afghanistan 8/18/2010

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1 The Road Map for establishment of an effective EPR system for Health Sector in Afghanistan 8/18/20100 The document has been developed based on the recommendations from the National Workshop on Planning Emergency Preparedness and Responsee for Health Sector held in Kabul July 2010

2 Introduction Under the leadership of the Ministry of Public Health (MoPH) with technical assistance provided by WHO a workshop on Planning Emergency Preparedness and Response for Health Sector in Afghanistan was held from 10 through 11 July 2010 at Ibn Sina Chest Hospital in Kabul, Afghanistan. The goal of the workshop was to establish a comprehensive program on health emergency management targeting emergency preparedness and response based on an All Hazards Framework. The intended program aims to strengthen mechanisms, systems and capacity of the health sector emergency preparedness and response activities. This action is crucial in ensuring the pre conditions and capacities necessary for the handing over/transitioning of full responsibility for coordinating and implementation of preparedness and response to disasters from WHO (as the lead of health cluster) to MoPH. Over 65 participants including key partners (Government, NGOs, INGOs, Donors, UN Agencies, IFRC, ARCS, ANDMA and other relevant national institutions) participated in the workshop and contributed to the assessment, analysis and formulating final recommendations. A Road Map was developed to facilitate the implementation. An exit strategy for cluster approach will be prepared later on, to identify when and how the transition will take place. Methodology: The key concepts of emergency preparedness and disaster risk reduction in health sector, overview of country s current situation, risk and health risk profiles and the All Hazard Framework approach were presented. Group work was conducted to (1) have a common view on hazards, and vulnerabilities of Afghanistan, (2) to take stock of interest, resources and capacities of all stakeholders and (2) to assess the existing emergency preparedness and response system within health sector of Afghanistan focusing the linkages between national disaster management (led by ANDMA) and health sector emergency management systems. The tentative roadmap/next step was developed based on the recommendations from the participants actively involved in different health sector emergency preparedness and response initiatives. The participants and the MoPH management are aware that the proposed implementation will depend on the situation development, access, and financial resources, as well as political commitment at all levels. GAPS and RECOMMENDATIONS from the assessment in specific areas: 1. Governance and Stewardship Plans and policies are not updated. The roles and responsibilities of all the stakeholders are not clearly defined. No endorsed and disseminated/applied standard operational procedures (SOPs) designating leadership at all levels, as well as structured linkages between the technical units and EPR department. 1

3 No clear coordination frame work (intra and inter sectorial) at all levels. Absence of clear strategy for resource mobilization. No capacity assessment of health services facilities, workforce skills and knowledge, and the impact of disasters on health status of communities living in affected areas No research conducted in emergency preparedness and response to generate evidence. Poor inter and intra sectorial coordination within health sector. Lack of monitoring of ongoing activities. Recommendation: To establish emergency preparedness and response program based on all hazard framework with clear and defined roles and responsibilities of all stakeholders, designating incident command, information management, logistics, networking with monitoring matrix. To develop emergency preparedness and response plan based on thorough risk assessment in health sector (national, provincial and district levels) and linked/in line with the National Disaster Management Plan Developed and implemented by ANDMA. To develop coordination framework focusing intra and inter sectors from national to local levels. To formulate national policy that will support emergency preparedness and response activities to be implemented from national to community levels. To develop a resource mobilization strategy that will highlight the resource allocation for emergency preparedness and response program within MOPH. To invest in operational research to generate evidence base, good practices so as to promote risk reduction and strengthen readiness to response. Initiate developing DRR strategy and program in health sector integrating in all development programs. (Building resilient health facilities, community level intervention, etc) 2. Health Services Delivery: Insufficient operational linkages and common planning with all relevant sectors regarding health sector disaster management. Not clear guidelines and standardization regarding the integration of EPR component into the BPHS and EPHS package; some implementing partners are having a contingency budget allocated and some not, depending of the donor and funding mechanism. The access to these small funds is hampered by heavy procedures take 6 month to one year to have the approval. Inadequate logistic support for emergency management (telecommunication system, warehouses, ambulances, logistic vehicles, etc). 2

4 Lack/obsolete national standards, guidelines, procedures regarding the EPR activities (including outbreak control). Early warning not established for all types of potential hazards. So far, only the DEWS is established in all 34 districts, and there is no plan how to ensure that a long term, sustainable early warning mechanism will be established to replace DEWS (costly and emergency approach). Multiple surveillance systems are not linked leading to duplication and difficult analysis. Detailed risk assessment (at least at district level) is not done, so service delivery is not context specific planned leading to lack of effective integration and resource allocation of EPR into developmental activities. Low capacity of referral system during crisis: inadequate number of ambulances, communication means, pre crisis agreements with other stakeholders such as ANA, Ministry of Transport, ISAF, etc. Lack of pre hospital and hospital care surge capacity able to deal with crisis The activities aiming to build up community resilience to health crisis are fragmented, lack coordination and standardization leading to gaps and overlapping Lack of awareness on health risks at community level Inadequate resource allocation and mobilization. Recommendation: Increase and strengthen ownership of all emergency preparedness and response activities by the government. Ensure adequate policy and resources support for health emergency management and planning, including building in the necessary surge capacity at all levels (pre hospital, hospital, community) to support the implementation of contingency plans (communication, logistic, infrastructure). Establish inter sectorial task forces for response to outbreaks and other hazards at all levels. Sign pre disaster collaborative agreements at highest levels with relevant sector regarding mutual support for preparedness and response to disasters Conduct and regularly updates the district level risk analysis to ensure that planning is evidence based. Revise the BPHS and EPHS package to include a stronger EPR component, ensuring that minimal surge capacity is built in and proportional with the foreseen emergencies specific for each district based on risk assessment. Development, endorsement and dissemination of national standards and guidelines for emergency response including outbreaks and trauma management. 3

5 Ensure that the health workforce has adequate skills and knowledge to deal with emergencies based on newly developed standards and guidelines. Develop and updates provincial and national contingency plans for response to most probable hazards. Design and implementation of a strategy for risk communication Define effective mechanisms for community involvement in service delivery planning and policy development Prioritizing area of capacity development at community level: first aid and MCM 3. Health Workforce Poor commitment from all stakeholders for development of EPR capacity The human resources planning does not take into account the EPR activities The pre deployment induction does not include basis training on EPR including outbreak response. No human resources capacity assessment (quantity and quality) conducted for gaps and needs identification Inadequate EPR curriculum, manuals and modules developed on the basis of capacity assessment and in local languages Lack of HR retention strategy Recommendation: Advocacy and awareness strategy and plan developed to raise the commitment of government, partners and donors Develop standardized Curriculum and training modules for all levels (from high level managers to communities) in coordination with all stakeholders. The National Plan for human resource development to factor in the needs of EPR management, and include effective retention strategy. The pre deployment training does not include EPR module. 4. Emergency Health Information Management Fragmented emergency information management system within different departments of MOPH, and between central and peripheral level that lead to inadequate analysis and dissemination, thus hampering the decision making and planning process. Lack of structured operational level information sharing mechanism with external partners such as the MoRRD, OCHA, ANDMA 4

6 Recommendation: Clearly written plan linked to mainstream health emergency management plan (MOPH, other ministries and ANDMA), including surveillance (HMIS, DEWS), risk reduction and all other areas of work (environmental health, mental health, nutrition, reproductive health, immunization, health promotion etc.) Comprehensive hazard early warning to be integrated in health information system so as to replace DEWS. Strengthening information flow between ministries and within MoPH inter and intra sectorial dissemination of information. Documentation of the information. Integration of emergency health information in the mainstream health information management system. A framework for dissemination of information among partners. 5. Medical Products, Vaccines, Technologies The present Logistic capacity unable to deal with crisis. This includes: warehousing, ambulances, logistic and monitoring vehicles, reliable communication means to cover all areas. Lack of clear plans, arrangements and agreements with other Ministries and organizations for supporting health sector s logistic during emergencies (Ministry of transport, Interior, ARCS, etc). Lack of evidence based yearly planning for contingency stock prepositioning at central and provincial level. Insufficient resources allocated by the MoPH for contingency stocks. So far, most of the stock is provided by external actors. Lack of system for dissemination/updating of emergency stock availability with all stakeholders. Recommendation: Identify resources through (allocation and donors) for strengthening MoPH and partners logistic capacity; communication, warehousing, vehicles. Sign agreement with relevant stakeholders regarding logistic support during emergencies Emergency preparedness and response planning to include evidence based contingency stocks revised after each event Proper allocation of resources for the contingency stock 5

7 Establish with health cluster support a strong information system regarding emergency stock availability with all stakeholders. 6. Health Care Financing Lack of allocation of resources Poor coordination among donors. Insufficient commitment from donors part for building up a self reliant ERP system built in the health system Lack of standardization in integrating funding for EPR/contingency component into BPHS/EPHS: depends on the donor and the way contracts are awarded. For the contracts selected on lowest bid criteria funding for emergency response is canceled. Recommendation: Allocation from government through proper evidence based planning Pool funding / complementary funding with other sectors Standardization of contingency planning into BPHS/EPHS system Advocacy with donors for support in building up the system. Final Recommendation: Institutionalization of Emergency Preparedness and Response in health sector led by MOPH based on All Hazard Framework. National level EPR programmatic structure to be replicated at provincial and local level for better coordination and harmonization with other technical areas for easy operations. In depth risk assessment should be conducted including identification of vulnerable groups. Advocacy and awareness to be strengthened through pragmatic programs at all levels of health sectors. Capacity building (human resources) through need assessment, development of standard curriculum (tool kits), and trainings on EPR at all levels of health sector including national to community levels. Human resource plan including retention strategy addressing job security Development of national emergency response plan with standard operating procedure and implementation of the plan by dissemination, training and simulation and scope of update following every event. 6

8 While developing the health emergency preparedness and response plan all other plans available within other partners should be taken into consideration to make the plan participatory and complementary.. At provincial and local levels there is availability of financial resources only from donors. The health sector partners acknowledged that the allocation from government will ensure sustainability of the activities. 7

9 Next steps: A proposed Roadmap towards strengthening EPR in Afghanistan Health Sector Action 1. Formation of a working group for strengthening EPR with specific ToR 2. Development and adoption of the ToR (based on All Hazard Framework) and organigram for the EPR. 3. Harmonization of ToR of EPR, cental, provincial and ANDMA. 4. Developing a strategy for resource mobilization ensuring allocation for EPR unit in MOPH. 5. In depth risk analysis at provincial and local level. 6. Conduct crisis preparedness assessment at provincial and local level Q 1 Q 20 2Q 4Q 2Q 7. Developing /endorsement health sector emergency preparedness and response plan. 8 Development and revision of contingency plans for natural disasters 8

10 Action 9 Strengthen the surge capacity and mechanism for mass casualty management 8. Developing SOP for response. 9. Developing of action plan and implementation of capacity building. 10. Developing a strategy for advocacy and awareness at all levels of health sector for EPR. (folders, notepads etc.) 11. Adaptation of the technical documents on EPR (assessment tools, guidelines) and training Q 1 Q 20 2Q 4Q 2Q 9

11 10

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