1. NINTH INTER-REGIONAL TRAINING COURSE ON PUBLIC HEALTH AND EMERGENCY MANAGEMENT IN ASIA AND THE PACIFIC PHEMAP 9 HEALTH ASSESSMENTS module 9

2. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 2 Learning Objectives By the end of this module, the participant should be able to: Discuss the role of the Health Emergency Manager in Health Assessment Discuss the purpose of Health Assessments including the need for phased assessments corresponding to the different phases of health emergencies Describe the components of a Rapid Health Assessment tool and the process of conducting health such assessments Discuss the benefits and problems associated with health assessment processes, methods and technologies

3. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 3 Group Activity Work in groups to discuss the data sheet handout. It is data from a recent earthquake in an Asian country.

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5. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 5 Group Activity Work in groups to design the outline of a Rapid Health Assessment form for local staff to use in the scenario you have been assigned. The form is one that must be designed to collect information that can be submitted within 48 hours. At the end of the session, groups will work to revise and present their forms.

6. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 6 The Purpose of Assessments Q&A: What is the purpose of conducting assessments in emergencies?

7. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 7 The Purpose of Assessments To give decision makers information that will allow them to make timely and appropriate interventions to: save lives minimise injury and illness prevent escalation of the emergency (increased severity) prevent spread of the emergency to other areas support response and recovery planning

8. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 8 Phased Assessments One assessment cannot collect all the information needed to manage all the phases of response, recovery and reconstruction Additional assessments are needed to determine the priorities and targets for immediate response, early relief and recovery, and longer-term recovery and reconstruction BUT to enable effective decision-making and to avoid duplication and ‘assessment fatigue’ coordination is crucial.

9. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 9 Health Assessments are part of the HIS Assessment is the first step in a continuous information gathering process that includes: Assessments of damage and analysis of needs (of the population and the responding agencies) Emergency Reporting system  Morbidity and Mortality reporting (by age, sex, location and cause of death)  Surveillance of communicable disease, injury, nutritional status, water quality and disability  Ongoing monitoring of the effectiveness of relief services (health and non-health activity reports) Evaluation of the operation

10. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 10 Health Needs Assessments (DANA, RHA) Reporting + Surveillance Hospitalscough + fever Clinics and Health Centersdiarrhea + fever Laboratoriesheadache + fever PHC Programmes:rash + fever nutritionmyalgia + fever IMCI - epi, ari, cdd etcother fever water and sanitationmalnutrition <5s vector controltrauma, disability MCH, safe motherhoodDEP, VBD, VPD, DPHS, PUCD ? workload? investigation expected needsunexpected needs ? enough supplies? new supplies ? enough staff? new staff ? referral system working? new referral system institution focusdisease focus are we meeting the needs? daily

11. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 11 Common Approach to Assessment Methodologies Methodologies should be based on standard health indicators Health assessments should take account of health status of population before the disaster Health indicators can be used in Health Emergency Management for: Assessing disaster impacts and needs Monitoring and evaluating programme implementation and outcomes

12. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 12 Different Types of Indicators Most indicators are expressed in terms of absolute numbers, rates, proportions, averages or categorical variables (i.e. presence or absence) E.g. for reproductive health in recovery Type of indicatorUnit of measurementExample NumberAbsolute number in geographical area or defined population Number of different types of health facilities providing essential obstetric care RateRate per unit of population per unit of time Neonatal deaths per 1000 live births per month or year ProportionProportion at a point in time (often expressed as a percentage) Clients appropriately managed for STDs, in a given month, divided by all clients attended in that month AverageAverage at a point in timeSize of population in a defined locality CategoryCategorical measure at one point in time Existence of a policy addressing reproductive health

13. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 13 A Policy on Assessments Defines the general purpose of assessments  Defines the data to be collected Defines the classification of victims Defines the classification of damage Defines the format for the collection Defines the reporting schedule Defines the assessment roles and responsibilities of agencies and departments in preparedness and response Defines the knowledge and skills needed for assessments

14. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 14 The All Hazards Approach and Assessment 80% of what we do in emergencies is generic – we do it for every emergency – the all hazards approach  No need to wait for field information to do this 15% is specific to the hazard  Much can be done before field data is available but an assessment is needed to provide the quantitative data 5% is unique to the event – the people, the place and the time  The assessment will provide all of this data

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16. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 16 Multi-sectoral assessments

17. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 17 Damage Assessment and Needs Analysis (DANA) A multi-sectoral, team activity that uses standard protocols to collect data that is analysed to define: the causative factors of problems  what needs to be done? the extent of the problem  how much of which resources are needed?

18. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 18 Damage Assessment and Needs Analysis (DANA) the likely trends  for how long? constraints (climatic, geographic, political, social, logistical, organisational etc.) priorities and targets over the relief and recovery period

19. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 19 Group Activity Work in your groups to answer the following questions: What are the benefits of the health sector being involved in a multi-sector DANA? What can be some constraints to a multi- sectoral approach?

20. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 20 Which Information? The basic needs: food water shelter energy / fuel security acute medical care hygiene and sanitation etc. The population: demography, culture, geography, climate baseline causes of morbidity and mortality The support systems: information flows logistics coordination communication resource flows

21. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 21 Pre-assessment Information any existing demographic information any existing national, provincial or district emergency profiles local risk assessments local capacity assessments inventory of resources and deficits maps directory of local staff and experts (government and NGO) lists of emergency materials and supplies logistics arrangements for emergencies standing orders and administrative guidelines

22. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 22 Why Assess Damage? Guides the setting of relief priorities:  Needs caused by damage: Direct needs e.g. treat the injured – will the damages affect this? Indirect needs – caused by damage e.g. loss of access to water supply  Function and safety issues –– can a service be delivered, is a building safe (building “triage”) Evacuate or not ? Can people access the service? Repair or provide a temporary service? Guides planning for repair, rebuilding and reconstruction

23. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 23 Factors Determining Damage and Needs the vulnerabilities of the affected communities and of different individuals and groups within those communities the readiness of response agencies the gaps in essential resources, including logistics capacities the impact, extent and duration of the hazard

24. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 24 General and Health Needs Vector Born Disease, Vaccine Preventable Disease, Diseases of Epidemic Potential, Diseases of Public Health Significance, Potentially Unstable Chronic Disease) StageTime-frameGeneral NeedsHealth Sector Responsibilities Immediate first search and rescuesafe extraction, resuscitation and first aid 24 evacuation / sheltertriage and transport system hours foodprimary medical care waterdetoxification / decontamination public information systemacute medical and surgical care (first line and referral) emergency coordination, communication, logistics and reporting systems (including injury and disability registers) Short term end of securityemergency epidemiological surveillance for VBD, VPD, DEP, DPHS first week energy (fuel, heating, light etc.)treatment and control of cases of VBD, VPD, DEP, DPHS, PUCD environmental health services:strengthen blood banks and laboratories (diagnosis, confirmation, referral) * vector controlstrengthen burns, spinal / head injury, orthotics / prosthetics, dental services * personal hygienestrengthen referral system - curative, mental health and obstetric services * sanitation, waste disposal etc.nutrition surveillance and support (including micronutrient supplementation) dead and missing(emergency measles vaccination and Vitamin A) Medium end of protection (legal and physical)(re) establishment of the health information system term first month employmentrestoration of preventative health care services such as EPI, MCH, etc. public transportrestoration of priority disease control programmes such as TB, malaria etc. public communicationsrestoration for services of non-communicable diseases / obstetrics psychosocial servicescare of the disabled (mental and physical) Long term end of educationreconstruction and rehabilitation 3 months agriculturespecific training programmes environmental protectionhealth information campaigns / health education programmes disability and psychosocial care Conclusion compensation / reconstructionevaluation of lessons learned restitution / rehabilitationrevision of policies, guidelines, procedures and plans prevention and preparednessupgrade knowledge and skills, change attitudes and practices

25. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 25 Categories of Information The assessment involves the collection of two key categories of information: Analysis of the needs of the victims  Immediate needs arising from the situation  Future needs arising from damage / disruption to services / infrastructure Analysis of the damage to:  Critical resources  Critical infrastructure and fixtures  Critical services

26. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 26 Information on Victims A report describing the impact of a hazard will provide: Number of casualties killed; injured; sick; disabled; by age, sex, location and probable cause of death Number of affected total affected; severely affected; critically affected;

27. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 27 Classification Based on Severity The following criteria are used to describe the severity of the impact on people: affected  all those living within the geographical area involved severely affected  those who have lost one or more of their lifelines critically affected  those who have lost all of their lifelines  OR who have been displaced i.e. those totally dependent on others to support them

28. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 28 Critical Services - Basic Needs and Lifelines Basic needs are the minimum requirements needed for the survival of the affected population (also called “pre-requisites for health”). Q&A:What are the basic needs for survival of a population?

29. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 29 Critical Services – Basic Needs and Lifelines Basic needs for survival: water food shelter (and clothing in cold climates) energy (fuel) (acute medical care)

30. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 30 Critical Services – Basic Needs and Lifelines Lifelines are services that are needed to deliver the basic needs. Q&A: What lifelines can you identify that would enable the meeting of these basic needs?

31. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 31 Critical Services – Basic Needs and Lifelines Critical lifelines: Utilities (water, electricity, gas) – sources and networks Communications systems Transport networks (air, sea, road) Distribution systems

32. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 32 Critical Services – Basic Needs and Lifelines First priority of the government: To restore lifelines and meet basic needs

33. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 33 Assessing Facilities and Services For each facility or service in the affected area, the assessment grades function according to a pre- defined scale: For example: destroyed / no function possible more than 50% reduction in capacity less than 50% reduction in capacity undamaged / full function

34. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 34 Health Assessments

35. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 35 What is a Rapid Health Assessment? “collection of subjective and objective information in order to measure damage and identify those basic needs of the affected population that require immediate response” Rapid Health Assessment protocols for emergencies, WHO, 1999

36. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 36 Public Health Consequences of Disasters temporary population displacements increased numbers of deaths and injuries new cases of disease and disability exacerbation of and increased numbers of cases of psychological and social behaviour disorders food shortages and nutritional deficiencies

37. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 37 Public Health Consequences of Disasters - cont. environmental disruption causing hazards – vectors, waste management, sanitation destruction of infrastructure disruption to routine health services disruption to routine disease surveillance and control services diversion of capital investment funds to emergency relief and the rehabilitation or reconstruction of essential infrastructure

38. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 38 Emergencies and Health VULNERABILITIES CAPACITIES EMERGENCY INDIRECT IMPACTS DIRECT IMPACTS HEALTH RESPONSE search and rescue first aid triage medical evacuation primary care disease surveillance and control curative care blood banks laboratories referral system special units (burns, spinal) evacuation centres shelter water food and nutrition energy security environmental health primary health care care of the dead psychosocial care disability care recovery reconstruction ASSOCIATED FACTORS Climate / weather / time of day Location Security situation Political environment Economic environment Socio-cultural environment Morale, solidarity, spirit Competence, corruption Damage and Needs Community

39. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 39 Objectives of Rapid Health Assessments Collection objectives identify existing and potential public health needs identify gaps and problems in meeting urgent medical needs assess existing and potential environmental risk factors assess resource and logistics needs identify managerial, coordination and organisational gaps, overlaps and problems

40. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 40 Objectives of Rapid Health Assessments Analysis objectives set priorities for response / relief set priorities for information dissemination and communication identify resources needed to meet priorities – external and internal identify additional information needs for the response and for planning recovery and reconstruction

41. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 41 Questions Answered by a Rapid Health Assessment Is there an emergency or not? What is the existing response capacity? What decisions need to be made? What information is needed to make these decisions? What are the sources of that information?

42. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 42 Data Collection Methods * Mid Upper Arm Circumference; Knowledge Attitudes and Practices) TYPEWHENWHATHOW Rapid Reconnaissance immediately after a disaster a quick, preliminary inspection of the disaster area satellite imagery flights mapping drive / walk through Rapid Health Assessment As soon as it is possible to go to the area a quick collection of information to confirm the emergency, measure the impact, identify health needs and guide response visual inspection analysis of records interview of key informants rapid surveys (MUAC*, etc.) SurveysWhen the situation stabilises and response has been activated A detailed study in which information is systematically collected in a sample of population (morbidity, mortality, nutrition, KAP*) Probability sampling Non-probability sampling

43. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 43 Hypothetical Timeframe Alert Decision 1 What happened? Where? Rapid Health Assessment? When? Pre- assessment Sitrep ?? Preparation To do what? (TOR) Which team? Where? How? ( methods) How? (logistics) hours Rapid Health Analysis Decision 2 Emergency? Y/N What needs? What constraints? What local resources? Response? Which resources? What evolution? 1-2 days Emergency 0 Action? If yes, which one, which resources required? Reference values Sitrep Presents main findings Gives recommend actions: What to do? Why? By whom? 1 day Action Decision 3 Who does what? When? How? With whom? ?? Political / financial considerations

44. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 44 Categories of Information The assessment involves the collection of three key categories of information: Analysis of the damage to:  critical resources  critical infrastructure and fixtures  critical services Analysis of the needs of the response agencies  immediate needs arising from the situation  future needs arising from damage / disruption to services / infrastructure Analysis of the needs of the victims  immediate needs arising from the situation  future needs arising from damage / disruption to services / infrastructure

45. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 45 Rapid Health Assessment task The first task is to assess functioning of all the health facilities in the area (hospitals, clinics, laboratories, warehouses, blood banks, administration): a.Staff – dead, injured, missing, absent b.Access – can staff / people reach the facility c.Buildings – damages, safety, loss of electricity / gas / water, loss of fuel (diesel) d.Supplies and equipment damaged or lost, including vehicles

46. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 46 Rapid Health Assessment tasks - cont. The next task is to assess needs arising from loss function : a.Temporary services needed? b.Repairs needed? c.Replacements needed (staff and materials)?

47. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 47 Rapid Health Assessment tasks - cont. The next task is to assess urgent health needs of the population: a.Overview of actual and potential causes of morbidity and mortality, and numbers of cases The final report will make recommendations on: a.Resource needs b.Personnel needs c.Management and organisational needs d.Logistics and communication needs

48. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 48 Use the Coordination Mechanism It is not necessary to go to the field to collect detailed information from other sectors At the daily coordination meetings, reports and assessments from other sectors are shared – these can be sent as ANNEXES to health sector reports The Emergency Reporting System should take over from assessments as soon as possible

49. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 49 Planning a Rapid Health Assessment Set the assessment objectives, team skill needs and time frame Collect the data:  reviewing existing information  inspecting the affected area  interviewing key people  carrying out a rapid survey Analyse and interpret the findings Issue orders and instructions Disseminate the report and communicate the findings

50. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 50 Preparing for an Rapid Health Assessment What information should I collect before going to the field? What collection methods are appropriate given:  the specific context of the emergency, and  weather, security, time, logistics, technical, cultural constraints? What will be the main sources of information? Is an interpreter needed?

51. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 51 Preparing for an Rapid Health Assessment - cont. What is the composition of the team and the role of each team member? What are the security, logistics and communication needs of the team? What equipment to take – maps, contact information, forms, specimen bottles, paper / pens, personal items

52. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 52 Q&A Does your country have a policy and guidelines, protocols, standard forms for Rapid Health Assessment? Are people trained in health assessment? What are the common weaknesses of rapid health assessments?

53. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 53 Rapid Health Assessment: Common Mistakes No policy or guidelines on assessment No standard collection formats No training in assessment skills Different sectors use different terms and methods Data cannot be consolidated Too much irrelevant/duplicate data collected Too much time taken – accurate is better than precise Those collecting the data don’t know how it will be used and don’t have the opportunity to improve the assessment system

54. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 54 Rapid Health Assessment - Common Mistakes The biggest mistake in forms used by the health sector is that they focus too much on collecting (unavailable or unreliable) morbidity and mortality data rather than health sector function information

55. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 55 Health Assessments - lessons learned How governments manage assessments and coordinate with other agencies conducting their own evaluations has an impact on the end result and the level and quality of humanitarian assistance. External assessment teams often have a broad range of skills and experience that are not necessarily found in one single country. Countries can turn these skills and experience into assets by working together with external assessment teams in a coordinated fashion.

56. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 56 Health Assessments - lessons learned How to maximise the benefits brought by external assessment teams: Be transparent and build confidence (question data) Focus on unmet needs that the outside world can realistically meet Integrate external assessment experts (e.g. UNDAC personnel) into the national assessment system Facilitate the work of country/NGO teams BUT insist they share their detailed findings with all stakeholders Coordinate and assign specific responsibilities to external teams Work with rather than against the media DON’T WAIT to have all the data to provide guidance on what is and is not needed!

57. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 57 Resources for planning assessments

58. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 58 WHO

59. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 59 What is Available in the EHA Webpage? Short introduction with objectives Sitrep Template Instructions Reference Values

60. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 60 Reference Values

61. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 61 Activity Based on what you have just learned, work in your groups to review and revise the form you developed in the first exercise

62. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 62 Q&A Is it possible to develop one single form that covers the assessment needs for all possible emergencies?

63. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 63 Health Sector Assessments by Hazard Class 1.Natural Hazards focus first on recording damage to health sector, then on the needs of the health facilities to restore some function, then on the meeting needs arising from actual and potential causes of morbidity and mortality 2.Technological Hazards focus on capacity to meet the needs arising from the actual and potential causes of morbidity and mortality

64. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 64 Health Sector Assessments by Hazard Class 3.Biological hazards focus on capacity to meet the needs arising from the actual and potential causes of morbidity and mortality 4.Societal Hazards In conflict - focus first on recording damage to health sector, then on the needs of the health facilities to restore some function, then on the meeting needs arising from actual and potential causes of morbidity and mortality In other situations - focus on capacity to meet the needs arising from the actual and potential causes of morbidity and mortality

65. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 65 Different Needs, Equal Opportunities The Right to Health: International Covenant on Economic, Social & Cultural Rights: Article 12: “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health…”

66. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 66 Different needs, equal opportunities Q&A: Does a focus on equal opportunities and equal access to health imply that individuals or groups have the same needs and that these needs should be met in the same way? What differences between individuals or groups might lead to different needs and might have to be taken into account in health assessments?

67. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 67 Different Needs, Equal Opportunities Differences between individuals and groups can lead them to having different types and degrees of need(s), which might have to be met in different ways. Examples of differences between individuals and groups: Age Sex/gender Wealth Social status, caste Geographic location Legal status Ethnicity, race Religion

68. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 68 Different Needs, Equal Opportunities Data on the population affected by a crisis should always be broken down by age, sex and other relevant factors => without information on who is affected and who is most at risk, interventions may be off-target. Data on who benefits from assistance in an emergency should also be reported by age, sex and other relevant factors => without this information, it is impossible to ascertain if assistance is reaching those most in need, if certain individuals / groups are marginalised, etc.

69. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 69 Different Needs, Equal Opportunities “Being counted shows that each individual is recognised and included and can exercise his / her rights” E.g.: Nutrition needs of pregnant or lactating women in Sri Lankan refugee camps, after the Tsunami Different needs Different ways of meeting needs => Equal opportunities

70. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 70 Different Needs, Equal Opportunities Lessons identified from this case study: incorporating gender into assessments 1.Base assessments on data disaggregated by sex (quantitative information) 2.Ask about the differences between men and women’s experiences (qualitative information) 3.Incorporate gender considerations into the assessment process (information collection methodology) I.Undertake participatory assessments with women and men separately and together II.Ensure the participation of male and female staff in the health assessment

71. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 71 Recap: the Purpose of Assessments To give decision makers information that will allow them to make timely and appropriate interventions to: save lives minimise injury and illness prevent escalation prevent spread support recovery planning

72. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 72 Advantages of a Standard Template prepared for the people who need to use the information (managers, decision makers) controls what kind of information is collected  standardised protocols for data collection  standardised terminology, technologies, methods and procedures  enforces “Zero” reporting facilitates preparation of consolidated reports facilitates rapid analysis and dissemination

73. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 73 Disadvantages of a Standard Template prepared by the people who need the information  those collecting the information have no input into design controls what kind of information is collected  non standard information cannot be included standardises the terms used  qualitative information might not be captured

74. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 74

75. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 75 Health Needs Assessments (DANA, RHA) Reporting + Surveillance Hospitalscough + fever Clinics and Health Centersdiarrhea + fever Laboratoriesheadache + fever PHC Programmes:rash + fever nutritionmyalgia + fever IMCI - epi, ari, cdd etcother fever water and sanitationmalnutrition <5s vector controltrauma, disability MCH, safe motherhoodDEP, VBD, VPD, DPHS, PUCD ? workload? investigation expected needsunexpected needs ? enough supplies? new supplies ? enough staff? new staff ? referral system working? new referral system institution focusdisease focus are we meeting the needs? daily

76. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 76 Learning Objectives By the end of this module, the participant should be able to: Discuss the purpose of Health Assessments including the need for phased assessments responding to the different phases of health emergencies Describe the components of a rapid health assessment tool and the process of conducting health assessments Discuss the benefits and problems associated with health assessment processes, methods and technologies Discuss the role of the Health Emergency Manager in Health Assessment

77. MODULE 9HEALTH ASSESSMENTSPHEMAP 9 77 THANK YOU