First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman Health Workforce in Emergency

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman Health Workforce  all persons currently participating in the health labor market or health care delivery Health Workers  all people engaged in actions whose primary intent is to enhance health Physician, Nursing and midwifery personnel dentistry personnel pharmaceutical personnel laboratory health workers environmental and public health workers community and traditional health workers other health service providers health management and support workers

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman Public health workforce  is diverse and includes all those whose prime responsibility is the provision of core public health activities, irrespective of their organizational base  they are central to the performance of health systems, very little is known about its composition, training or performance.

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman Front-line health workforce  consists of all actors supporting and strengthening the health, safety and resilience of communities to emergencies at the local level including community- based health workers, mid-level health workers and volunteers such as those affiliated with Red Cross/Red Crescent societies, civil society and actors from other relevant sectors  essential component of the health workforce

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman Front-line health workforce  Nurses and midwives play a significant role in emergencies and are often at the front line at the community-level  Direct emergency risk management  They play critical role in training, supervising and equipping community-based health workers for their role in emergencies  reduce health related risks and limit the impact of emergencies on communities along with other key sectors

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman Roles of the front-line health workforce in Risk Reduction 1.Health risk assessment.  Identify the hazards and vulnerabilities that will form the basis of planning 2.Epidemiology functions.  Maintain and improve the systems to monitor, detect, and investigate potential hazards, particularly those that are environmental, radiological, toxic, or infectious. 3.Public engagement.  Educate, engage, and mobilize the public to be full and active participants in public health emergency preparedness.

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman Roles of the front-line health workforce in Risk Reduction 4.Mitigation strategies.  Develop, test, and improve community mitigation strategies (ex isolation, quarantine, social distancing) 5.Public information and communication  Develop, practice, and improve the capability to rapidly provide accurate and credible information to the public in culturally appropriate ways 6.Resource Management  Identify critical resources for public health emergency response and practice and improve the ability to deliver these resources throughout the supply chain

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman Roles of the front-line health workforce in Risk Reduction 7.Operations  Ready workers and volunteers with skills and capabilities to perform in health emergency 8.Leadership.  Local leaders to mobilize resources, engage the community, develop interagency relationships, communicate with the public 9. Provide accurate and credible messages to the public during a crisis

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman Roles of the front-line health workforce in emergencies  providing critical front line health services  key actors in conducting: i.health education and promotion, ii.social mobilization, iii.delivery of health services, iv.community-based risk assessments, v.emergency health operations, vi.first aid, basic life support, vii.support to epidemic control, among others

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman FHW contributes to safe/resilient community 1.Improving health outcomes on a routine basis (reducing underlying vulnerability)  Prevention and management of common illnesses  Promotion of key family practices and health promotion for disease prevention,  Provide selected essential newborn and sexual and reproductive health intervention  Support facility-based health promotion, prevention and management of chronic illnesses  Support essential trauma care at basic facility level  Providing community-based rehabilitation for people with disabilities

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman FHW contributes to safe/resilient community 2. Prevent, mitigate and prepare for emergencies  Conducting risk assessment(hazards, vulnerabilities and capacitates)  Help detect, prevent, and manage diseases of epidemic or pandemic potential  Contribute to climate change adaptation (CCA) activities through reducing vulnerability of communities, short term forecasting and working closer with other key sectors  Providing risk awareness and health promotion messages including health education and social mobilization  Contribute to emergency preparedness for families, communities and health systems

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman FHW contributes to safe/resilient community 3.Responding to and recovering from emergencies  Continue priority essential health services at the home and in the community  Provide first aid and basic life support  Provide psychosocial services and community support through community participation, providing information to reduce anxiety and psychological first aid  Support mass casualty management including essential trauma care at basic facility level and essential surgical care

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman 4.Play vital role in achievement of the health related Millennium Development Goals (MDGs) 4, 5 and 6 5.They are component of well functioning health systems to deliver lifesaving services 6.During emergency they perform health service delivery at household and community levels reducing the demand for health facility-based services and can improve access to services when health systems are destroyed, disrupted or overwhelmed FHW contributes to safe/resilient community

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman Thank You

Capacity Building for Health Workforce First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman Learning Objectives By the end of this module, the participant should be able to:  Describe the elements of capacity to manage health risks of emergencies  Identify key elements of capacity for specific health service delivery functions  Describe the role of a health emergency manager in health emergency management systems and in developing health emergency management capacity

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman Defining Capacity Sum of: capability resources relationships Within community organization country region world Aims – Reducing illness, disability and death from risks – Promoting health, safety and security

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman Defining Capacity System definition of capacity Capacity includes capability (knowledge, attitude and skills) of the component parts, the resources (financial, equipment) which support the system, and the relationships which together form the system. Capacity is a quantitative measure Measurement of human and material resources i.e. number or volume or size. For example, the capacity of the hospital is 500 beds

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman Health Workforce  all persons currently participating in the health labor market or health care delivery Health Workers  all people engaged in actions whose primary intent is to enhance health Physician, Nursing and midwifery personnel dentistry personnel pharmaceutical personnel laboratory health workers environmental and public health workers community and traditional health workers other health service providers health management and support workers

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman Risk ∞ Hazard x Vulnerability Capacity In managing Risk: Capacity is needed to: Reduce Hazard Reduce vulnerability Increase Capacity Relevance of Risk Management to HEM Capacity Development

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman Health Emergency Management Capacity Capacity to perform the following functions:  Reduce hazard  Reduce vulnerability  Respond to reduce and manage Response consequences  Recover and reconstruct for better Recovery Preparedness

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman Disaster Risk Management Framework (Capacity utilization) (Capacity building) (Capacity rebuilding for better) (Capacity to Reduce/prevent Hazard) (Capacity to Lessen Impact of hazard) Response Recovery Preparedness Mitigation Prevention

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman ANATOMY OF COMMUNITY RISK MANAGEMENT hazard community vulnerability readiness multisectoral, all hazards Community risk indicators: probability scale/magnitude/ strength/intensity spread duration biological hazards: season, infectivity, latency, transmission resistance, etc. natural phenomena famine diseases of epidemic potential events/crowds intoxification infestations transport accidents structural failures industrial accidents chemical accidents pollution refugees war terrorism Prevention & Mitigation Programme   = = People: access to health care measles vaccination under 5 nutrition under 5 mortality access to clean water access to sanitation adequate housing employment/ income female literacy Property: health infrastructure vehicles medical supplies Services: curative care services ambulance services public health services health info system Environment: water/soil/air quality Vulnerability Reduction Programme policy, plans, procedures knowledge, skills, attitudes resources legislation national & sectoral policy administrative procedures response & recovery plans preparedness plans technical guidelines management structure institutional managements information systems warning systems human resources material resources financial resources simulations & training education public information community participation research publications Emergency Preparedness Programme risk of: death injury (mental/ physical) disease (mental/physical) loss of life displacement loss of property loss of income secondary hazards breakdown in security damage to infrastructure breakdown in services Contamination Community Risk Management

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman Legal framework Policies Guidelines Procedures Resources Plans Knowledge Attitude Skills Organizations Systems People Preparedness Capacity to manage risks of emergencies 1.Provide necessary tools

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman Service Delivery Health Workforce Information Medical Products, Vaccines & Technologies Health Financing System Leadership/Good Governance 2. Health System Development Preparedness Capacity to manage risks of emergencies

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman 3. Human Resource Development Programme Categories of Stakeholders  Leaders  Managers  Operation Center Staff  Responders  Community  Trainers

4. Governance First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman  Policy, planning, priorities and political commitment  Legal and regulatory systems  Integration with development policies and planning  Integration with emergency response and recovery  Institutional mechanisms, capacities and structures; allocation of responsibilities  Partnership  Accountability

4. Risk Assessment First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman  Hazards/Risks data assessment  Vulnerability and impact data assessment  Scientific and technical capacities and innovation 5. Knowledge and Education  Public awareness, knowledge and skills  Information management sharing  Education and training  Cultures, attitudes, motivation  Learning and research

6. Risk Management and Vulnerability Reduction First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman  Environment and natural resource management  Health and well being  Sustainable livelihoods  Social protection  Financial instruments  Physical protection; structural and technical measures  Planning regimes

7. Disaster Preparedness and Response First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman  Organizational capacities and coordination  Early Warning Systems  Preparedness and contingency planning  Emergency resources and infrastructure  Emergency response and recovery  Participation, volunteerism, accountability

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman StakeholdersPreparednessResponseRecovery 1. Leaders 2. Managers 3. Hospital Responders 4. Public Health Responders 5. OPCEN Staff 6. Community Stakeholders Training Needs Analysis (Roles and Functions)

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman StakeholdersPreparednessResponseRecovery 1. Leaders 2. Managers 3. Hospital Responders 4. Public Health Responders 5. OPCEN Staff 6. Community Stakeholders Training Needs Analysis (core competencies to carry out functions)

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman StakeholdersTraining TitleTraining Content 1. Leaders 2. Managers 3. Hospital Responders 4. Public Health Responders 5. OPCEN Staff 6. Community Stakeholders’ Training Program  Training Title  Training Content

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman Response Teams for immediate deployment ICS Support Team Rapid Assessment First Aid Search and Rescue EMS (transport and logistics) Evacuation Center Evac. Center Team EMS Team First Aid Team SAR Team RHA Team

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman Response Operation at Evac. Center Medical Team Nutrition Team WASH Team Hospital Team As needed Surveillance Team Logistics Management Team MHPSS Team Response Teams for further Deployment (After 24 hours)

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman Health Roles in Managing Risks Over Time stage time- frame general needshealth needs immediate first 24 hours search and rescue evacuation / shelter food water public information system first aid triage primary medical care transport / ambulances acute medical and surgical care emergency communication, logistics and reporting systems (including injury and disability registers) short- term end of first week security energy (fuel, heating, light, etc.) environmental health services for: vector control personal hygiene sanitation, waste disposal etc. emergency epidemiological surveillance for Vector Born Disease, Vaccine Preventable Disease, Diseases of Epidemic Potential control of disease of public health significance control of acute intestinal and respiratory disease care of the dead general curative services nutritional surveillance and support (including micronutrient supplementation) measles vaccination and Vitamin A

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman Health Roles in Managing Risks stage time- frame general needshealth needs medium term end of first month protection (legal and physical) employment public transport public communications psychosocial services (re) establishment of the health information system restoration of preventive health care services such as EPI, MCH, etc. restoration of priority disease control programmes such as TB, malaria, etc. restoration of services of non-communicable diseases / obstetrics care of the disabled long termend of 3 months education agriculture environmental protection reconstruction and rehabilitation specific training programmes health information campaigns / health education programmes disability and psychosocial care conclusioncompensation / reconstruction evaluation of lessons learned restitution / rehabilitation revision of policies, guidelines, procedures and plans prevention and preparedness upgrade knowledge and skills, change attitudes

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman Response Teams for further Deployment Considerations:  Need to establish health system  Need to support the treatment of injuries  Need to support the medical cases  Provision of public health services to include disease surveillance  Support for resource management  Support risk communication  Provide protection and safety of victims and responders

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman Evacuation Site Scenario: Typhoon Poor environmental sanitation No access to safe water Inadequate sanitary toilets No community surveillance system Disrupted basic health services Foul smell of decomposing bodies Severe depression of the bereaved and other health workers

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman Evacuation Site Scenario Damaged lifelines Overcrowding Poor environmental sanitation No access to safe water Inadequate sanitary toilets Health workers are direct victims Disrupted basic health services

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman Group Activity 1 In your group, address one of the following: 1.Poor environmental health condition 2.Disrupted communicable disease services 3.Poor management of the dead and the missing 4.Lack of mental health and psychosocial support Assess the risk and identify capacity needed in terms of organization, systems and people. Write your answers on a flip chart for presentation. RisksServices/ Functions Capacities needed OrganizationSystemPeople

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman Environmental Health in Evacuation Center Environmental health risks are assessed, including: Water supply services Waste handling and disposal Food safety Garbage disposal Local Capacity ( laboratory services, sampling, diagnosis and analysis; equipment etc.) Inventory of organizations with environmental health roles and responsibilities (laboratories, surveillance, chemical industries, water supply services, waste disposal services, fire service, etc.) Availability of supplies, reagents, medicines

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman Environmental Health in Evacuation Center Environmental health risks: Food and water borne diseases Environmental Capacity Environmental assessment, surveillance Environmental teams Environmental logistics including systems of distribution Laboratories and other confirmation devices Reporting, monitoring, evaluation

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman Communicable Disease Communicable health risks are assessed including: Diseases of Epidemic Potential Vaccine Preventable Diseases Vector Born Diseases Diseases of Public Health Significance Considerations: Health status Local capacity, program implementation Inventory of Organizations Availability of health services, facilities Availability of drugs, medicines, supplies, vaccines

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman Communicable Disease Communicable health risks: Epidemic and Outbreak Communicable Disease Capacity Surveillance System in place in evacuation centers Surveillance teams available Case definition etc.. Epidemiological investigation logistics including systems of distribution Laboratories and other confirmation devices Reporting, monitoring, evaluation Networking and referral system

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman Management of the Dead and Missing MDM Issues: Identification of the Dead Cultural Considerations Final Disposal of the Dead Management of the Relatives Considerations: Legal framework, functioning coordination mechanisms and organizational structure in place for health emergency preparedness and response Local capacity Inventory of Organizations Mortuary System

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman Management of the Dead and Missing MDM health risks? Myths and realities about dead bodies Mass burial MDM Capacity Organizational/Institutional Arrangements; roles and responsibilities; management structures Procedures (identification, keeping of records, fingerprinting, dental records, DNA and photographing) Provisions for notification of relatives (next of kin) Logistics Reporting, monitoring, evaluation Networking and referral system

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman Mental Health and Psychosocial Support Psychosocial health risk assessment: Coverage Silent victims, Family displacement Medical Responders/Leaders Early identification and referral Considerations: Local capacity for emergency provision of essential services and supplies Inventory of organizations, health facilities, Availability of drugs, medicines, supplies, Availability of training modules and trainers

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman Mental Health and Psychosocial Support Psychosocial health risks: Long lasting; affects rehabilitation and recovery (children, responders, etc.) Psychosocial Capacity Policies and Plan Training modules, pool of trainers ; range of services Advocacy and awareness through education, information management and communication Health facilities, drugs and medicines Reporting, monitoring, evaluation Networking and referral system; Inter and Intra sectoral coordination Local capacity for emergency provision of essential services and supplies

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman Legal framework Policies Guidelines Procedures Resources Plans Knowledge Attitude Skills Organizations Systems People Elements Of capacity To manage Health risks of emergencies

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman EPIDEMIC EMERGENCIES OUTBREAK Specific morbidity and mortality - in the community - in health facilities Risk for health and lab workers Difficult access Agent unknown RESPONSE CAPACITIES Case definition Admission criteria Case confirmation Case management Discharge criteria Contact tracing Vector control Environmental controls Surveillance system Referral system Professional education Public Information and awareness Laboratory plans Hospital plans Supplies and equipment Borders control Quarantine Animal culling Commerce/ trade NEEDS

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman General or Cross-cutting Functions  Communication and transport  Information management  Health surveillance  Mental health  Reproductive health  Environmental health  Food safety, emergency feeding and nutrition  Water supply management  Waste management

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman Specific Emergency Response and Emergency Recovery Functions  First aid, self-aid and first-responder health assistance  Incident site management  Assessing needs  Mass-casualty management  Decontamination  Epidemiological investigation

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman Specific Emergency Response and Emergency Recovery Functions  Forensic investigation  Management of the dead and the missing/ fatality management  Shelter and temporary accommodation (including evacuation shelters)  Community support  Longer-term issues (health effects, recovery, rehabilitation, reconstruction)

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman Role of the Health Emergency Manager Determine the risk and plan to manage it Identify the capacity needed in terms of Organization, Systems and People Determine strategies to reach the goals set Determine resource requirements (Compare from what is available to what is required and what is the gap) Look for resources, identify partners, co share Determine a point person, time frame and indicators Monitor and evaluate

First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman Thank You