9. The health center

Throughout this manual the health center is referred to as one of the most important sources of information for assessing the impact that floods have on the health sector. In many cases, the health center is also the first contact point between the community and the health system-it certainly gets the largest share of demand on the system. Therefore 8 detailed damage check on the centers is important.

Obviously, the assessment team will not be able to visit every health center in the flooded area; the most critical centers should be selected ("critical" means those with the highest demand or the most severe flood damage). The items that the team should look for are in the following checklist. This checklist, or a similar one, should be on hand in all centers in disaster-prone areas so that center health workers can make their own rapid assessment after the disaster and, as soon as it is feasible, relay this information to the health authorities in the region, by any means of communications available. The data gathered will also be invaluable for programming the center's local disease control measures.

Many of the questions will be unnecessary if there was a disaster plan prior to the disaster. All such plans should include an appraisal of the physical state of the health facilities and an inventory of its resources.

CHECKLIST

Basic Questions

· What physical damage has the center sustained?

· What is the degree of its isolation? (transport, communications)

· Has the flood affected its staff? If so, how?

· What illnesses are on the rise?

· What is the increase in the demand for care? What kind?

· Can the demand be met by staff other than doctors? If so, type (i.e., nurses, paramedics, health aides, health promoters)

· What are the existing supplies (for "x" number of months) of:

- Drugs
- Curative material X-ray material
- Laboratory material
- Basics (such as soap, etc.)

· What are the expected needs for supplies?

Infrastructure

· Physical damage

- Damage to the building
- Describe

* where
* type of damage

· Electricity

- No
- Yes

· Irregular (hrs/day = ____)

· Generator

- No
- Yes

* adequate
* defective fuel sufficient insufficient why?

· Telephone

- No
- Yes

* irregular
* nonfunctioning

· Transceiver

- No
- Yes
- Nonoperative

· Water

- Enough?

* no
* yes

- Responsible company
- Piped inside the clinic
- Piped into the yard
- Water tank

* no
* yes capacity

- Source

* treatment plant
* well (depth= ______)
* other: specify
* chlorinated no yes unknown

- Alternative source

* cistern
* water truck

frequency
storage

type
capacity
covered?

river/gorge
other: specify
treatment system: specify

· Sewage disposal

- Sewerage system

* functioning?
* obvious breaks near the clinic?
* pools of sewage water?

- Latrine

* flooded?
* overflow?

· Solid waste disposal

- Collected?

* responsible agency
* nonoperative
* irregular

- Disposed:

* buried
* burned
* communal container

Health Services

· Population covered by the center

- Directly
- Indirectly (referrals)

· Communications with dependent/referral centers

- Roads

* adequate
* difficult
* impossible

· Ambulance

- None
- Damaged?
- Fuel

* adequate
* insufficient
* none

· Laboratory

- None
- Nonoperative (reason)
- Partially operative

* possibility of performing tests

- Lab material

* Sufficient for_____(period)

· X-ray

- No
- Nonoperative (reason)
- Possibility of performing examinations
- Materials sufficient for_____(period)

· Curative material

- Sufficient for_____(period)

· Basic supplies

- Sufficient for_____(period)

Personnel

· Type	Resident No.	Nonresident No.
- Doctors
- Nurses
- Nurse's aides/auxiliaries
- Technicians
- Statisticians

Statistics

· Daily attendance of children/adults

· Most common conditions

· Percentage of undernutrition

· Percentage of endemic conditions

Immunizations

· Coverage by type

· Attendance since floods

- Same
- Increased
- Decreased

· Any campaign since the beginning of floods?

- Type
- Doses completed (No.)
- Only 1st doses (No.)
- Only 1st and 2nd doses (No.)

· Cold chain

- Refrigerator

* no
* yes

operative
temperature
adequate?

* nonoperative

why?

* if not electric, sufficient fuel?
* vaccine supplies

type	no. of doses

* containers (cold boxes or thermoses)

adequate
insufficient

* ice

no
yes

Pharmacy

· Qualified pharmacist?

No

Yes

· Damage to the supplies?

No

Yes

· Approximate duration of drugs stocked

- Analgesics
- Antihelminthics
- Bactericides
- Antimalarials
- Antianemics
- Dermatologic ointments
- Steroids
- Cardiovascular drugs
- Antiseptic solutions
- Antacids
- Ophthalmic ointments
- Oral rehydration salts
- Water ampules for injection
- I.V. fluids
- Vitamins

General Information About the Center and the Community

· Isolation:

- Transport system to nearest community where supplies can be obtained

* road

little difficulty
difficulty

only 4-wheel-drive
crossing river or flooded gorge

by foot
by boat

mule or similar

* boat only
* helicopter only

· Communications

- Ham operators in community
- Police/army radio

· Food supplies

- Adequate
- Shortage

* type of food

· Fuel

	Gasoline	Kerosene	Other (specify)
- Adequate
- Rationed
- Severe shortage
- None

· Insects/stray animals

		Increase
	No	Yes	Severe

- Mosquitoes

* type (if known)

- Flies
- Rats
- Mice
- Dogs
- Snakes

* poisonous

- Other (specify)

· Observation

- Pools of rainwater
- Pools of sewage water
- Rubbish
- Stray dogs
- Flies
- Mosquitoes Houses destroyed/semidestroyed

· Estimated number of homeless families