Stage 3: Restoration of essential services

This is the stage in which the national and international responses to the emergency begin to have an impact. Essential needs are increasingly being met. Mortality and morbidity remain high, but implementing agencies are beginning to address a wider range of health problems.

Action indicated: With a degree of stability and reconstruction, relief organizations can begin to design more sophisticated and proactive HIV/AIDS interventions. The following is a potential sequence of activities:

(a) Conduct a situation analysis:

· Assess the infrastructure of the health system. What equipment, supplies and skills are needed for HIV/AIDS work? Where can interventions begin - food distribution sites, supplementary feeding centres, health centres, maternal and child health clinics?

· Establish baseline data. Gather and assess existing information on HIV prevalence and patterns of transmission in the population groups affected; this should include information on the country, region or area of origin, and the host country, region or area since there will be considerable interaction of populations. Information relating to the pre-emergency situation and new data that emerge during the emergency are all useful.

· Undertake formative (qualitative) research, using focus groups and in-depth interviews with key informants; to gather information on potential role behaviours, target groups for intervention, acceptability of preventive measures, etc.

· If possible, design a knowledge, attitude, behaviour and practice (KABP) survey on HIV/AIDS and a survey on the prevalence of sexually transmitted diseases.

· Assess the existing infrastructure of the blood transfusion facilities, i.e. buildings, equipment, technical skills of staff, budget and consumable supplies, in order to continue to build on previous interventions to ensure an adequate and accessible supply of blood and blood products.

(b) Identify HIV/AIDS programme coordinator(s), other staffing requirements, prepare short-term plan for HIV/AIDS work with partner host country authorities, international organization(s), and NGOs. Establish working relationship with refugee community leaders as well as local community leaders. Identify the officer responsible for the blood transfusion services who will undertake to act as the focal point for ensuring that safe blood and blood products are available.

(c) Refine the basic package of HIV/AIDS activities described in stage II, plan and implement additional activities based on what is learnt in the assessment. These might include, for example:

· IEC (information, education and communication) activities in the community aimed at encouraging safer sexual behaviour and the use of condoms;

· Establishing a regular programme for condom supply and distribution to replace the emergency system;

· Identifying the support still required to ensure a supply of safe blood and blood products, which will include maintaining a regular and unbroken supply of materials, reagents and testing assays.

· A programme for the control of STDs including syndromic management and education;

· Clinical care for people with HIV/AIDS, based on established case management protocols.