|Disasters Preparedness and Mitigation - Issue No. 38 - April, 1989 (PAHO-OPS, 1989, 8 p.)|
During the last ten years, the countries of Latin America and the Caribbean have collectively established objectives and set goals for emergency health preparedness. Most countries have set up technical programs in the Ministry of Health that are responsible for ongoing, predisaster planning and coordination. These programs are one expression of the countries' commitment to meeting these goals. The investment they have made in training the human resources required for an emergency health response is another.
Today, the level of development of the national health sector disaster preparedness programs varies from country to country. Still, it is not too early to look ahead to tomorrow. How well-developed, sustainable and self-sufficient will these programs be in five, ten or more years? When will international organizations and bilateral agencies be able to phase out their promotional activities?
One way to find out is to develop a mechanism or an instrument that will allow us to objectively and consistently measure and monitor the progress of the national health disaster preparedness programs toward self-reliance.
By developing a list of indicators that measure this progress, we can chart the path of national programs through five phases of program development: promotion or stimulation; initiation of activities; institutionalizing the program; consolidation and phasing out of external support; and optimal self-reliance. Programs pass through these phases in two main areas of development: the strengthening of institutions and the development of human resources.
Strengthening of Institutions
PAHO's Directing Council singled this out as a priority objective when they urged member countries to strengthen their health emergency preparedness programs by allocating the necessary personnel and budget according to their vulnerability to disasters. These two indicators perhaps reveal the most about a country's ability to sustain a viable health preparedness program.
· it is critical for countries to permanently assign their own human resources to carry out health sector activities. If a part-time disaster health coordinator is sufficient in small countries with a low vulnerability to disasters, a complete multidisciplinary team may be required in large countries with sophisticated institutions and a high level risk to natural hazards and technological accidents.
· a budget line in the health sector reflects a country's desire to shift from dependence on external sources of funding to self-reliance. Although it may be difficult to fund a core of activities given the present economic situation in many countries, this step is regarded by the funding agencies and the U.N. as essential to demonstrating commitment and progress toward self-reliance. The minimum amount of money required to sustain a program will obviously vary from country to country.
There are several other indicators that can also be used: emergency preparedness in the health sector should be formally, and legally in some countries, recognized as an integral function of the Ministry of Health. A specific organizational unit must be established to ensure that this function continues despite periodic changes of administration. The unit should have direct access to the policy level of decisions and, administratively, it should be placed at a level high enough to allow for coordination with other departments and institutions.
· the national program should address the entire array of emergency situations - natural, technological and manmade - and also include refugees and displaced persons where applicable.
· the emergency preparedness program in the Ministry of Health should deal with the needs of the entire health sector. It is essential to exercise leadership while maintaining close links with other health institutions, such as social security.
Human Resources Development
In designing strategies for human resources development, countries must include several groups as targets of their national training programs:
· the health services at the national level must be able to support and coordinate the institutional response to a disaster at the central level.
· the quality of the response to a disaster depends on the readiness and qualifications of the first responders, local leaders and the health services in the affected communities. The better prepared the local health services are, the better the overall national response will be.
· environmental health services, particularly water and sewerage agencies which do not fall under the jurisdiction of the Ministry of Health, should be included in multidisciplinary training activities.
· the private sector and non-governmental organizations, particularly the national Red Cross societies, are critical to a coordinated and effective response to disasters.
· the general public must also be a target of training activities. It is of paramount importance to enlist the participation of the mass media. Their influence on national and international relief activities and attitudes cannot be underestimated.
Several other indicators that reveal the level of development of national programs are:
· the production of training and educational material by the country. National training activities should become progressively independent of regional material produced by outside organizations. The production and use of local material is an important indicator of progressive self-reliance.
· the relationship that exists among institutions and among sectors in a country will influence the level of cooperation and sponsorship in designing, organizing and funding training activities. Institutions outside the health sector should not only be the target or beneficiary of training activities, they should also be full partners in developing the training program. The commitment of social security institutions, civil defense, and fire and police departments, for example, also indicates the stability of a national health program.
· the degree to which emergency health preparedness is included in the curriculum of teaching institutions that offer undergraduate and postgraduate training in areas such as medicine, nursing and engineering is also indicative of a country's long-term commitment.
The forecast provided by these indicators can only be a rough estimate and must be revised periodically - economic, social and political factors also have an impact on the development of national programs. But the sum total of these indicators will provide a realistic picture of what can be expected in terms of the number of years needed to reach the consolidation stage and the phasing out of regional or international cooperation. At this point the program will have a permanent staff, committed financial resources, and external expertise and resources will be needed only to complement national efforts.
Photo: Julio Vizcarra/PAHO