Annexes

Annex 1 - Health Information System

In the early stages of an emergency it is essential to collect information on a weekly or monthly basis for the following tables:

Table Number	Table Description
1	Demographic information
2.1 A and B, 2.2	Crude Mortality Rate and Under five years old Mortality Rate Cause-specific-mortality
3.1	Morbidity Incidence
4.1 and 4.2 (set out in Annexes 4 and 5 of chapter 15 on nutrition)	Nutrition, Supplementary and Therapeutic Feeding Programmes
5.2	Main causes of discharge/deaths in In-Patients Departments
7.1	Deliveries: Birth (Total births and birth rate only)
7.4	Cholera/Meningitis/Hepatitis/Micro-nutrients deficiencies

Collection of the information required for the other tables should be progressively introduced as the situation stabilizes.

In order to detect problems and to monitor the impact of any health programme, it is necessary to collect information over time so as to follow trends. The tables below are designed to allow tabulation of information on a weekly or monthly basis. Graphical presentation of the same information will make it easier to detect trends. The tables may need to be adjusted to reflect the needs of actual situations.

1. Demographic Information

Table 1 - Population

Camp/area Names	Male under 5 years	Female under 5 years	Male over 5 years	Female over 5 years	Total Population
Total

Sources of demographic information: registration Estimate Government Other

% of total population which is under 5 =
% of total population which is female =

Note: demographic information does not necessarily have to be reported in a table format. The denominator used for calculation of rates could differ from the official working figure and this should be clarified.

2. Mortality

2.1 Mortality rates

Mortality rates (segregated by age and sex) should be given per 10,000 per day

A. Crude Mortality Rate: CMR

Table 2.1 A

Camp/area Names	Male		Female		Total
	Number of deaths	Death Rate	Number of deaths	Death Rate	Number of deaths	Death Rate
Total

B. Under five years old mortality rates (U-5 MR)

Table 2.1 B

Camp/area Names	Male		Female		Total
	Number of deaths	Death Rate	Number of deaths	Death Rate	Number of deaths	Death Rate
Total

Female / Male ratio:

A graph line (to show trends) for CMR and U-5 MR could be attached.

2.2 Cause-specific mortality

Tables 2.2 (2.2 A for total population and 2.2 B for under-five population).

	Male		Female		Total
	Number of deaths	% of the total number of deaths	Number of deaths	% of the total number of deaths	Number of deaths	% of the total number of deaths
Malaria
Pneumonia
Watery diarrhoea
Bloody diarrhoea
Measles
Meningitis
Cholera
Maternal death (2.2 A only)
Peri/neonatal
Malnutrition
Total		100%		100%		100%

From table 2.2 A and 2.2 B, pie charts could be attached to the report.

The list of diseases is provided as an indication.

Comments on mortality:

3. Morbidity

3.1 Incidence (Number of new cases per 1,000 of the population for the period)

Tables 3.1 (3.1A for total population and 3.1B for under-five population).

	Male	Female	Total
Malaria
Pneumonia
Watery diarrhoea
Bloody diarrhoea
Measles
Meningitis
STDs

The list of diseases is provided as an indication.

3.2 Out-Patient Department (OPD) consultations

Table 3.2 Number of consultations per refugee per year.*

Camp Names	Male	Female	Total
Average

* from the total number of OPD consultations per camp, extrapolate to define the number of consultations per refugee per year. As an example: 10,000 consultations in one month in a camp of 30,000. 10,000 × 12 = 120,000 / 30,000 = 4 consultations/refugee/year.

Comments on morbidity:

4. Nutrition

4.1 Supplementary Feeding Programme Monthly Report

This table is contained in Annex 4 of chapter 15 on nutrition.

4.2 Therapeutic Feeding Programme Monthly Report

This table is contained in Annex 5 of the chapter 15 on nutrition.

4.3 Food basket monitoring

See chapter 15 on food and nutrition. If undertaken, please specify by whom and the results.

Comments on nutrition:

5. In-Patients Department (IPD) Activities

5.1 Activities

Table 5.1 (per week or month)

	Hospital Name	Hospital Name	Hospital Name
A. No. of patients end last week/month
B. No of patients admitted
C. No. of patients end week/month (A+B-D)
D. No. Discharged of which:
D.1 authorized	%
D.2 unauthorized	%
D.3 deaths	%
D.4 transferred	%
No. of beds
Average length of stay (No. Of days)
Occupancy rate	%

5.2 Main Causes of discharge/deaths in IPDs

Table 5.2 (per week or month).

	Hospital Name:		Hospital Name:		Hospital Name:
	Number of cases	Number of deaths	Number of cases	Number of deaths	Number of cases	Number of deaths
Malaria
Pneumonia
Watery diarrhoea
Bloody diarrhoea
Meningitis
Measles

Comments on IPDs:

6. Referral System
6.1 Total number of patients transferred for admission and where:
6.2 Causes of transfer

Table 6.2

	Camp Name:		Camp Name:		Camp Name:
	Number of cases	% of the total	Number of cases	% of the total	Number of cases	% of the total
Obstetrics
Surgery
Paediatrics
Internal medicine
Blood transfusion
Total

Comments:

7. Main Health Programmes
7.1 Reproductive Health
7.1.1 Safe motherhood

a. Deliveries: Birth

Table 7.1.1

Camp names	Number	Crude Birth Rate*
Total A: a1 + a2 + a3

· a1: total # and % of birth in health centre or hospital:

· a2: total # and % of birth assisted by a Trained Birth Attendant (but outside health centre or hospital):

· a3: total # and % of other births (i.e. A - (a1 + a2)):

· total number and % of complicated deliveries:

· total # of cases of neonatal tetanus:

· total # and % of deliveries with adequate Tetanus Toxoid (TT) coverage:

b. Ante-natal care (ANC)

· total # of expected pregnancies per year:
· total # of new ANC consultations (last 3 months) and % compared to expected:
· % of women with three ANC visits at delivery:
· are supplements given to pregnant women? specify criteria and supplements provided:
· RPR test (syphilis test): % of positive tests:

c. Other information

· maternal mortality: # and incidence per 100,000 live birth per year:
· Peri/neonatal mortality: # and incidence per 1,000 live birth per year:
· # of abortions and % per number of pregnancies:
· low birth weight (below 2.5 kg): provide # and percentage per total number of births:
· # and percentage of total number of births having a post-natal consultation:

7.1.2 Sexual and gender based violence

· # of cases of sexual and gender based violence per month (incidence per 10,000):

· is there any special programme for Female Genital Mutilation (where prevalent)? if yes, give brief description:

7.1.3 STDs including HIV / AIDS

· enforcement of universal precautions:
· % of blood tested for HIV before transfusion:
· % of HIV positive among blood tested:
· distribution of condoms, # and percentage of acceptance:

7.1.4 Family Planning (every three months)

· number of new acceptors in last three months, per method:
· total # and % of acceptors per method:

7.1.5 Adolescents

Is there any special programme for adolescents? if yes, give a brief description:

Comments on reproductive health:

7.2 Extended Programme of Immunizations (EPI)

· measles vaccination coverage:
· other antigens coverage:
· are there any vaccine preventable diseases prevalent in the camps?:
· comments:

7.3 Tuberculosis (every three months and not usually during the emergency phase)

· expected number of new cases per year (i.e. prevalence in country of origin):
· treatment protocols:

Table 7.3

	January-March	April-June	July-September	October-Dec.
A. No. under treatment at beginning
B. No. of new cases
C. No. of discharged of which:
C.1 cured	%
C.2 defaulters	%
C.3 deaths	%
C.4 transferred	%
Total at end of period: A+B-C

7.4 Cholera/Meningitis/Hepatitis/Micronutrients deficiencies etc.

On daily, weekly and/or monthly basis: number of cases, number of deaths and attack rate (cumulative) and Case Fatality Rate (cumulative). Graphic representation could be attached to the report.

7.5 Mental health

Provide a description of the mental health programme.

7.6 Training activities

Provide a description of training activities which have taken place during the reporting period: type of training, by whom, to whom, etc.

7.7 Laboratory activities

8. Information on other vital sectors

· availability of potable water: # litres per person per day
· availability of functioning latrines per # of persons
· % of population with adequate shelter
· quantity of soap available per person per month
· specify vector control activities

Annex 2 - Possible organisation of health services in a major emergency Number of births in a year

	Unit/Location	Level	Health staff	Outline of major responsibilities
	· Health Coordinating Committee with all partners, this may be decentralised as appropriate · Refugee Health Unit (with Ministry of Health if possible or as part of UNHCR programme team)	Capital/national level	· UNHCR Health Coordinator or Health professionals, Nutritionist, Pharmacist, Health Administrator	· Planning and monitoring programmes · Preparation and dissemination of guidelines on standard procedures · Overall coordination and supervision · Procurement and supply of drugs and equipment
3rd level	Regional/district Hospital	Regional or district level	· If necessary: say, 1 doctor, 2 nurses to help existing staff (plus material support if required, especially food and drugs) · Cost per patient or per treatment could also be negotiated with the hospital	· Complicated obstetric cases and surgical emergencies on referral from settlement · Reference laboratory
2nd level	Health Centre (with limited beds for overnight stay, as guidance: 1 bed per 2,000 to 5,000 refugees)	Each refugee settlement of about 30,000	· As guidance: 2 doctors, 6-8 nurses, 1 midwife · About 10 health workers (1 health worker per 50 - 70 consultations per day)	· Supervision of settlement health services including training health workers and any selective feeding programmes · Treatment of patients not handled at 1st level · Security, distribution and use of drugs · Basic laboratory · Referral to third level
1st level	1 Health Post or clinic	Section level approximately 5,000 refugees	· As guidance, 1 nurse (from above) and 2-3 refugee or national health workers per section	· Section level services, both preventative and basic curative care · Supervision of outreach services
	The community	Outreach services (organized by section of, say 1 Community Health Worker per 1,000 and 1 traditional birth attendant per 3,000 refugees)	· Refugee Community Health Workers	· Identification of public and individual health and nutritional problems · Referring sick patients to health post · Home visiting · Basic surveillance of mortality and birth