Briefly Noted is a short PAHO/WHO monthly bulletin containing disaster news and notes. Please feel free to share this message with colleagues. To subscribe, send your name, organization and e-mail address to disaster-newsletter@paho.org.

Our print newsletter, Disasters: Preparedness and Mitigation in the Americas, will now come out twice a year, allowing time and space for in-depth articles, interviews and other material in support of disaster management. The next issue will be out at the end of September.

Communicators Prepare to Join
PAHO/WHO Response Team

More than two decades ago, at the request of the Directing Council, PAHO/WHO created a Regional Emergency Response Team composed of experts with varied backgrounds in public health and disasters. Over the course of time, PAHO/WHO recognized the need to incorporate communications and media experts into the team to act as a bridge between technical and public information in emergency situations and to clearly demonstrate the health impact of disasters. To fill this important gap, experts in the field of communications and information management (including journalists) participated in a workshop on methodology and tools for disaster communicators (5-7 August 2008, Lima, Peru).

The objectives of the workshop were to:

1. Strengthen the Response Team by identifying and training communicators to assume this special role in disaster situations.
2. Review and approve procedures, methodologies, tools and strategies for communications and information management in emergencies.

During the workshop, the participants focused on the following topics:

• Policy and technical priorities and challenges in communication and information management, taken from experiences following the 2007 earthquake in Peru.
• Principles of crisis communications, based on regional lessons learned.
• Tools for decision-making: damage and needs assessments, Emergency Operations Centers, health situation rooms, etc.
• The media: how can we work together more efficiently and effectively before, during and after disasters?
• The myths and realities of disasters—communications strategies for dispelling these myths.
• Public health priorities in emergencies

Two modules deserve special attention. In the first, the 25 participants took part in an exercise that simulated an earthquake in a fictitious country. The exercise was designed to bring to light the political as well as technical challenges that unfold in the aftermath of many large-scale emergencies, many of which can be resolved with well-developed communications and information management strategies.

During a subsequent work session, participants reviewed and made recommendations to improve guidelines on communications and information management in emergency situations. Once all recommendations are consolidated, these guidelines will be published and incorporated into the PAHO/WHO Emergency Response Team Manual.

Mexico Already Committed to Many Aspects of a
Safe Hospitals Program

Since 2006, Mexico’s Civil Protection System (SINAPROC) has been at the helm of a national Safe Hospitals Program, with support from public and private health agencies. Several key components of this Program are contributing to Mexico’s significant advances, the first of which is a National Committee for the Assessment, Diagnosis and Certification of health facilities. This structure is replicated at the state level, where state committees are responsible for conducting an initial safety diagnosis of the most important health facilities in highly at-risk areas.

Another important component of Mexico’s Safe Hospitals Program has been the training provided to those charged with evaluating the safety of health facilities. These professionals, representing a variety of disciplines from different institutions, have taken part in formal training—part of which is web-based—and upon passing an exam, are accredited by SINAPROC as a ‘Safe Hospitals Evaluator.’ To date, 980 people have been trained and 336 certified as evaluators. More information in Spanish on the course is available at www.imss.gob.mx/curso/hospitalseguro/.

Mexico has also expanded its commitment to safe hospitals by enlisting the support of other internationally-known institutions. The Mexican Hospital Association, a strong supporter, made this the central focus of the 2008 International Congress, where the theme was ‘Safe Hospitals—a Strategy for Protection and Quality.’ Some 900 national and international participants learned of advances in planning, organization and training for emergency situations and vulnerability reduction in health facilities, highlighting the many positive aspects of work that is currently underway, which spans institutions and disciplines.

Other congresses later this year (Mexican Academy of Emergency Medicine and the Committee for Heart and Trauma Care) will also incorporate sessions on safe hospitals, with a view toward the functional aspects of emergencies, disasters and pre-hospital care. Mexico is clearly taking important steps to safeguard the nation’s health facilities while at the same time contributing to the World Disaster Reduction Campaign ‘Hospitals Safe from Disasters.”

Recommendations of the WHO/World Bank
Post-earthquake Mission to China

A World Health Organization/World Bank team evaluating the health impact of the May 2008 earthquake in Sichuan province, China, made a number of recommendations including recommendations protect hospitals and health facilities from the impact of future disasters. The following is an excerpt from a report by WHO Consultants Dr. Jose Luis Zeballos and Eng. Tony Gibbs.

Recommendations for public health

Efforts are needed to:

• Fully finance with public funds, essential public health programs for populations in earthquake-affected areas; these programs should be scalable to include a more comprehensive range of preventive, promotive and rehabilitative public health programs.
• Streamline the delivery of public health programs and public health institutions in accordance with the changed population profile and burden of disease and disability.
• Promote data integration across stakeholders involved in health system reconstruction for coordinated care, monitoring and evaluation and operational research purposes.
• Evaluate and strengthen the early warning alert and response system and event-based surveillance using a risk-based, all-hazards approach, in addition to the long-term monitoring of the earthquake affected population and responders for the health consequences of hazardous exposures.
• Develop all-hazards preparedness plans for the health sector (and beyond) and test the plans through drills and exercises.
• Provide individual and community-based mental health services to the affected population and earthquake responders.

Recommendations for health services

• Early retrofitting or reconstruction of primary health facilities (i.e. village health stations/clinics, township health centers) should be given top priority. Essential medical equipment/devices, medicines and other medical supplies should be made available as soon as possible down to the primary health facility level.
• Robust assessments of healthcare needs, damages to health facility infrastructure and functions, and the appropriateness of the health workforce should be carried out in a timely fashion to inform planning. The strategy should balance the short versus longer-term needs and should include a transitional strategy to bridge between the emergency phase and the reconstruction phase.
• The reconstruction strategy should include rationalization plans for health facilities at the county and provincial levels to meet new needs. Some facilities and laboratories could be closed or merged to reduce unnecessary competition and redundant spending, and to focus on service provision.
• The environmental impact of clinical waste should be addressed in the transitional period and during the planning of new facilities.
• National and local governments should revise their strategies for health service capacity building to address the changing needs of health care, particularly with respect to disability and mental health services, and losses to the health workforce due to the disaster. Services should be reviewed and revised around the changing demographic, epidemiological and burden of disease profiles.
• In the phasing out of free healthcare after the emergency period, the government, particularly at the national level, should increase the funds earmarked for medical financial assistance (MFA) to the poor and vulnerable groups to ensure equitable access to essential healthcare. An improved benefits package should be made available. MFA should be well integrated into the new rural cooperative medical scheme and funds pooled into the new urban resident medical health insurance schemes.
• In the reconstruction of the health system in the affected areas, acceleration of universal coverage of essential healthcare, an aspiration of China's new health system reform plan, should be seriously considered by the government. While public health functions and services should be fully financed by the government, funding essential clinical services could combine payment by health insurance schemes, government subsidies (e.g. MFA) and out-of-pocket payments, aimed at less than 20% of out-of-pocket expenses for the general population. Poor and vulnerable groups should have access to free or almost free health care.

Recommendations for infrastructure

• Set up a technical working group to advise on the future relocation of health infrastructure, land use planning and microzoning studies before construction of health facilities.
• Recognize the special requirements of hospitals. Embrace the Safe Hospitals Initiative of the WHO, which require hospitals (especially secondary and tertiary facilities) to remain functional after earthquakes.
• Ensure that essential, supporting infrastructure, such as water supply, access to transport systems, telecommunications, and electricity, can function after earthquakes.
• Carry out vulnerability assessments of all healthcare facilities in Sichuan (for the short and medium term) and in the rest of China (for the medium and long term). All affected health facilities should be reconstructed or retrofitted and re-equipped using standards that make them seismically safe. Consider using the Hospital Safety Index in carrying out the vulnerability assessments.
• In the design of new facilities, focus on favourable building concepts and favourable structural configurations.
• Consider using base isolation and other energy absorbing techniques as economical methods for achieving functioning facilities after earthquakes.
• Employ independent reviewers (review consultants) for the design of all healthcare facilities.
• Share the information from post-earthquake diagnostic surveys of damage with the construction community in China and the rest of the world.

Andean Community Networks
Virtual Information Centers

Four web-based information centers now form a network of virtual information centers for disaster risk reduction. The network is called BiVa-PaD (the Spanish acronym for Virtual Library for Disaster Prevention and Response). The Andean Region’s Strategy for Disaster Prevention and Response calls for improving the quality of and access to technical and scientific information related to risk management. CAPRADE is the lead implementer of this strategy. BivaPAD has been developed with resources from the PREDECAN Project (Support to Disaster Prevention in the Andean Community), technical and financial support from PAHO/WHO and ISDR, and technical execution from CRID.

The joint efforts of the four countries involved– Bolivia, Colombia, Ecuador and Peru—have led to the creation of network of professionals committed to disaster risk reduction and mitigation, strengthening alliances and improving the flow of information on risk reduction.

The BiVa-PaD network has a coordinating center in each country:

• BiVa-PaD Bolivia
  www.bivapadbolivia.org.bo
  Viceminister of Civil Defense
  Orlando Sanjinés Vargas
  Email: orlando_sanjines@yahoo.es
• BiVa-PaD Colombia
  www.bivapadcolombia.org
  National Disaster Prevention and Response Directorate
  Hugo Gamba Sánchez
  Email: hugog@dgpad.gov.co
• BiVa-PaD Ecuador
  www.bivapad.gov.ec
  Technical Secretary for Risk Management
  Elsie Magdalena Andrade Pesantez
  Email: elsie.andra@yahoo.es
• BiVa-PaD Peru
  www.redbivapad.org.pe
  Nationaql Civil Defense Institute
  Paúl Zamora Torres y Ruth Sarmiento Santos
  Email: pzamora@indeci.gob.pe; rsamiento@indeci.gob.pe

The BiVa-PaD network offers a wide variety of services:

• Databases and access to more than 4,000 electronic full-text documents and bibliographic references related to risk management.
• A collection of 200 multimedia resources (VHS, DVD, CD-Rom).
• A directory of more than 800 institutional contacts working in this field in the Andean Region and more than 300 related web sites.
• Information on academic opportunities in the field of risk management.
• Educational material for use in schools, workshops, etc.
• An overview of what the Andean Virtual Library has to offer – available on CD-ROM—grouped by country. Each country section contains a sampling of the documents available and lists of national contacts and web pages.