Health Cluster Meeting April 3, 2008 WHO office, Dushanbe

Health Cluster Response Plan Based on the needs analysis the immediate priorities in the health sector focused on the three following components, classified as immediate humanitarian needs: Sustaining basic energy supply to priority health facilities; Provision of essential medicines and supplies to key hospitals; Hygiene and sanitation in key health facilities.

Health cluster response and update At present the state health sector receives aid assistance provided by 5 UN agencies, 16 NGOs and some 5 major donors in the country. The main health aid assistance have been equal for all country oblasts and districts and covered a total of 85 main hospitals in the country (or 65% of all country inpatient facilities), including: 29 central hospitals in Sogd oblast or 11 organisations 8 central hospitals – in GBAO or 7 organisations 18 central hospitals – in Khatlon or 18 organisations 14 central hospitals – in RRS or 9 organisations

Main aid components The main health aid components included distribution of generators, various types of health kits, essential medicine and non-food items: Generators – 120 generators have been provided to the country through WB, Care, WHO, UNFPA, UNCIEF, Mercy Corps, KfW, NRLC covering the electricity needs for some 1/3 of all main inpatient health facilities. In addition, some 350 (various size) generators are available locally through previous state assistance. Interagency Emergency Health Kits (IEHK), Primary and Reproductive Health Kits (distributed by WHO, UNICEF and UNFPA) enabled to: provide health care services to 70,000 people in the next 3 months through the main 4 oblast hospitals (WHO kits); 1/3 of all PHC facilities have been covered by UNICEF 800 kits; and 12 main MCH facilities through UNFPA. Non-food items to hospitals – the assistance with blankets, stoves, clothes, etc – have been provided to almost all central inpatient facilities throughout the country through ACTED, Caritas, CHAP, Save the Children, Mercy Corps and Focus. Supply of essential drugs/medical instruments and equipment – have been conducted through UNICEF, UNFPA and 5-6 NGOs (Caritas, Project Hope, Mercy Corps, CHAP and ADB.

Remaining needs The results of latest health cluster organisations need assessments throughout the country illustrated that: Health care facilities continued provision of essential and specialised medical services to population facing a number of problems common to “pre- and post-crisis” situation such as: poor infrastructure conditions, limited access to utility services (water and electricity), inadequate state funding for drugs supply; outdated medical equipment, poor laboratory services, low level of preparedness to emergency situations, insufficient quality of medical workers training. The immediate health interventions are suggested for Khatlon oblast (districts of Farkhor, Vaksh, N.Rumi, Vose, Bokhtar, Evon) and Sogd oblast (Bobochon Gafuron, Panchakorn, Isfara, Spitamen and Zaforobod). There is a special need to address the needs of mother and child health care problems throughout country health facilities (pediatric and obstetric-gynecological services). There is a remaining need to focus on the needs of PHC and reproductive health facilities. The health needs of PHC facilities are increasing and “forgotten”. The results of poor state response indicate the need for more and regular assistance in terms of drugs and essential laboratory services, especially in Khatlon area where certain pre-disposition of stocks should take place in the. Distribution of 2000 kits for typhoid testing in Dushanbe and Kulyab areas have not been sufficient and require additional assistance in strengthening laboratory services. Further systematising of assistance to health care facilities with disinfecting materials will be required as present response is not sufficient. There are large unmet needs in areas of hospital water and sanitation system rehabilitation and improvement utility access.

Health cluster co-ordination tools Health cluster distribution list Health cluster meetings Ad hoc meetings with MoH and cluster partners Strong vs. weak feedback/open discussions of where we are standing! How do we define the situation as of April 3!

Health cluster health information management Health cluster organisations provide a regular update to “Who is doing What and Where in health sector in Tajikistan” database maintained by WHO of health cluster response to “energy” crisis. The update is being disseminated on a regular basis to all health sector partners, including 100 addresses (with more than 50 organisations operating health related programmes). Health cluster organizations provide a regular update to “Who is doing What and Where in health sector” database maintained by WHO as per classification of aid and based on state health facilities in country oblasts and districts.

Health cluster health information management WHO informed about plans to provide GIS mapping of health aid assistance by WHO WHO thanked organisations providing the update back to WHO and requested the ones which have not, including UNFPA and UNICEF to send back the updates. WHO suggested to have priority reflection of activities responding to the current "energy" crisis. At the same time considering the systemic nature of the crisis situation in this country it will be useful and important to reflect also "development related health projects" if targeting particular and specific health facilities. The same is relevant to all activities taken place on community level and covering PHC facilities.

OCHA support team in the country WHO informed about OCHA support team: Mr. Michael Stone, Emergency Programme Coordinator Ms. Kashka Huyton, Humanitarian Affairs Officer. Production of Situation Report No. 6 – Tajikistan – Cold Wave/Compound crisis (1 April 2008), based on information provided by the Rapid Emergency Assessment and Coordination Team (REACT), the Committee of Emergency Situations and the Office of the UN Resident Coordinator in Tajikistan.

Spring thaw disaster and health impact Potential health impact in regards to the spring thaw disaster scenarios developed by NFI cluster. Selection of three regions in Tajikistan for preposition of stocks for spring thaw disasters.

Damage Needs Assessment/RRT The Damage Needs Assessment/RRT working group meeting is scheduled for 10;00, today on 3 April 2008 at the UNICEF conference room. The agenda: 1. Review of past meetings. 2. Review of the Rapid Response Team TOR 3. Review of the DNA forms. 4. Next Steps.

Updates of Assessments/Surveys ANY NEW UPDATES IN THE LAST TWO WEEKS? WHO informed about on going analysis of hospital survey undertaken earlier in late 2007 and covering a total of 102 inpatient facilities in the country. WHO will share the results of the survey upon completion of work. Interested organizations can request WHO CO office to share the templates of questionnaires used for this hospital survey. Oxfam shared with health cluster the results of the typhoid situation assessment report in Kulyab town. WHO informed about the distribution of the results of latest rapid health assessment conducted at the GBAO Regional Hospital (Khorog), infectious district hospital, district hospital and emergency care hospital in Kulyab area. WHO nutrition experts in co-operation with national counterparts carry out assessment activities in GBAO and Khatlon area following regular programme calendar. The MoH has been carrying a variety of activities as response to energy crisis including rapid needs assessments largely on access to utilities and population access to MCH departments. The assessment results illustrated a worsening situation with access to basic utilities services throughout the country, especially highlighted problems in Kulyab and Khudzhand as follow up of critical situation in water and sanitation lead to water born diseases in the next few months. UNFPA informed about the availability of 2007 developed template for identifying needs for basic medical instruments and equipment for PHC facilities. WHO requested UNFPA to share the document. April/May: WFP jointly with FAO and UNICEF will conduct Emergency Food Security/Livelihood/Nutrition Assessment in April /May in Tajikistan.

Updates by agencies ACTED ADB AKDN/FOCUS CARE Caritas CHAP FSD GTZ KfW Mercy Corps Mission East NLRC Oxfam Project Hope PSF Save the Children UNICEF UNFPA WFP WHO World Bank