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close this bookAssessing Needs in the Health Sector after Floods and Hurricanes (PAHO-OPS, 1987, 90 p.)
View the document(introduction...)
View the document1. Introduction
View the document2. Critical decisions
View the document3. Magnitude of the impact
View the document4. Morbidity and mortality
View the document5. Environmental sanitation
View the document6. Vectors
View the document7. Food and nutritional status
View the document8. Evacuation camps
View the document9. The health center
View the document10. Surveillance systems
View the documentBibliography

2. Critical decisions

In emergencies, national health officials and representatives of donor agencies decide what the type of medical and health intervention is required. When a sense of urgency prevails, when political pressure is high, and when information is lacking, these decisions will often be made on the basis of faulty assumptions or expediency. As a result, resources can be wasted and measures needed to safeguard the health of the affected population may not be taken.

The purpose of the assessment team should be to give decision makers the data they require to make sound interventions.

The following list includes some of the most typical decisions that authorities face in floods. Across from the decisions are listed the key indicators on which the decisions should be based.

MEDICAL PERSONNEL/SUPPLIES


Decision

Indicator

1. Send medical/paramedical personnel

1. Increase in demand, etc.

2. Send drugs/medicines

2. Selective increase in frequency of certain illnesses

WATER SUPPLY


1. Establish temporary or emergency alternative water source

1. Total interruption of the normal system or interruption great enough to Jeopardize public health

Type of Source

Factor

1.1 Portable plant(s)

1.1a Size of the population(s) to be served


1.1b Source of the water/turbidity


1.1c Distance from the source


1.1d Cost of plant and transport


1.1e Weight and size of plant


1.1f Means and feasibility of transport


1.1g Expected duration of normal system interruption


1.1h Availability of trained operators and maintenance men


1.1i Power source

1.2 Distribution tank trucks

1.2a Distance of population from water source


1.2b Availability of sufficient fuel and appropriate vehicles


1.2c Feasibility of transportation

1.3 Water bags/containers at key points

1.3a Distance from source


1.3b Number of people to be served and their location


1.3c Means of transportation

2. Initiate small-scale chlorination

2. Poor quality of water at source

3. Recommend chlorination or boiling

3. Poor quality of drinking water at family level (bleach)


Factor


3.a Educational campaign


3.b Availability of bleach and/or fuel

4. Distribute chlorine tablets

Factor


4.a Availability of continual supplies


4.b Cost


4.c System of distribution


4.d Educational campaign and monitoring

5. Provide parts and equipment for system rehabilitation

5. Faulty parts/equipment (determined after detailed survey of the system)

SEWAGE DISPOSAL


Decision

Indicator

1. Provide parts and equipment for system rehabilitation

1. Faulty parts/equipment (determined after detailed survey of the system)

2. Provide alternative methods of sewage disposal

Factor


2.a Estimated rehabilitation time


2.b Severity of problem

SOLID WASTE DISPOSAL


Decision

Indicator

1. Obtain equipment for:

1. Inadequate collection/removal and dumping site

1.1 Debris removal


1.2 Reconditioning of dump


1.3 Garbage collection


HUMAN SETTLEMENTS


Decision

Indicator

1. Provide basic sanitation in settlement

1. Unsanitary living conditions


Factor


1.a Distance to established water source; its hygiene and accessibility


1.b Population density

2. Improve water supply system

2. Unsatisfactory condition of general water supply system

Method

Factor

2.a Connection to main

2.a Proximity to water source

2.b Trucks

2.b Safety of the water

Decision

Indicator

3. Provide sewage disposal system

3. Poor sewage disposal

Method

Factor

3.a Connection to main system

3.a Proximity to main sewerage and state of same

3.b Trench latrines

3.b Level of ground


3.c Depth of water table


3.d Population density

FOOD HYGIENE


Decision

Indicator

1. Provide additional personnel for food hygiene inspections

1. Infrequent inspections (determined after quick surveys)


Factor


1.a Availability of personnel

CORPSES


Decision

Indicator

1. Initiate mass burials

1. Large number of corpses


Factor


1.a Health hazard


1.b Local laws


1.c Local customs

MOSQUITOES


Decision

Indicator

1. Initiate spraying (and larval control)

1. Increase in vector population and breeding sites, and interruption of routine program


Factor


1.a Endemicity of disease


1.b Exposure of human groups to the mosquito

2. Pick best spraying time (and larvicide application)

2. Determination of biological life cycle


Factor

3. Select appropriate insecticide (larvacide)

3.a Sensitivity of the mosquito


3.b Availability


3.c Cost


3.d Familiarity to personnel


Factor

4. Order insecticide

4.a Amounts likely to be used in 6 months


4.b Availability in markets


4.c Cost


4.d Transport facilities


Factor

5. Request equipment

5.a Survey of existing resources


5.b Availability of fuel for vehicle-mounted equipment

OTHER PESTS


Decision

Indicator

1. Start dog-catching campaign

1. Increase in stray dogs reported to be biting

2. Import/bring rabies vaccine

2. Increase in number of dog bites in rabies-endemic areas

3. Import/bring snake venom serum

3. Increase in number of poisonous snakes and/or in proven cases of poisonous snake bites

FOOD AND NUTRITION


Decision

Indicator

1. Establish food aid program

1. Destruction of local crops and stocks; disruption of transport and marketing system and of community's earning capacity


Factor


1.a Previous prevalence of under nutrition


1.b Degree and expected duration of isolation

2. Select appropriate type of food (dry versus cooked, perishable versus stable, variety)

Factor


2.a Food habits


2.b Availability


2.c Cost


2.d Transport facilities


2.e Distribution facilities


2.f Fuel and cooking facilities


2.g Refrigeration

HEALTH CENTERS


Decision

Indicator

1. Provide relief supplies to center

1. Depleted supplies


Factor


1.a Available stock


1.b Present and expected demand

2. Provide laboratory back-up

2. Increased number of suspected disease cases of epidemic potential and no, or inadequate, local laboratory

3. Send additional health manpower

3. Manpower shortage, increased demand, remote referral centers

EVACUATION CAMPS


Decision

Indicator

1. Set up camp

1. Life-threatening conditions in area, destruction of housing and impossibility of providing other shelter on original terrain, and/ or spontaneous migration

2. Dismantle camp

2. Danger of epidemic within camp, danger to life passed, or camp found not Justified

3. Provide health and sanitation services

3. Camp set up and not possible to dismantle quickly, disease out breaks detected or predicted, unsanitary conditions, and/or no access to routine health care