1. MODULE TITLE PHEMAP 9 1 MODULE TITLE INTER-REGIONAL TRAINING COURSE ON PUBLIC HEALTH AND EMERGENCY MANAGEMENT IN ASIA AND THE PACIFIC RECOVERY AND RECONSTRUCTION ROLE OF THE HEALTH SECTOR

2. MODULE TITLE PHEMAP 9 2 Learning Objectives By the end of this course, the participant should be able to: Describe health needs, risks and services in disaster recovery and reconstruction Discuss processes for recovery and reconstruction of health services and infrastructure within the larger context of community recovery and reconstruction plans Discuss the opportunities presented for health risk reduction and health systems capacity development during disaster recovery and reconstruction Describe the roles of an HEM in managing health in disaster recovery and reconstruction

3. MODULE TITLE PHEMAP 9 3 Disaster Recovery Recovery “... focuses on how best to restore the capacity of the government and communities to rebuild and recover from crisis and to prevent relapses. In so doing, recovery seeks not only to catalyze sustainable development activities, but also to build upon earlier humanitarian programs to ensure that their inputs become assets for development.” (source: United Nations Development Program 2001)

4. MODULE TITLE PHEMAP 9 4 Q&A What are the factors in recovery and reconstruction that might provide opportunities for long-term capacity development?

5. MODULE TITLE PHEMAP 9 5 Q&A Some examples of factors offering opportunities for development (of health systems): additional financial resources (national / international) additional human resources (national / international) lessons learned from experience, including gaps in health system demonstration and opportunities for training needs reconstruction but “build back better” social pressure and political will to reduce risk and enhance capacity

6. MODULE TITLE PHEMAP 9 6 Warning Indicators (Flash Points) WARNING PHASE Months / Weeks / Hours EMERGENCY PHASE Days / Weeks Mitigation Preparedness Search & Rescue Emergency Relief Rehabilitation Reconstruction Ongoing Development Rapid / Detailed Assessment Sudden Impact Rehabilitation / Recovery Many Months TIME ACTIVITY 1 2 3 4 5 Emergency Response and Recovery

7. MODULE TITLE PHEMAP 9 7 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

8. MODULE TITLE PHEMAP 9 8 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

9. MODULE TITLE PHEMAP 9 9 1. Saving Lives 2. Emergency Aid 3. Short term Intervention 4.Emergency Funding 5. Providing for the Community. 6. Emergency (Relief) Aid. 7. Spontaneous Interventions 8. Consumption Subsidy 9. Politicization of Emergencies. 10. Short Time Frame used advantageously. 1. Saving Livelihoods 2. Support to rehabilitation 3. Longer term planning 4. Combined Funding Proposals 5. Working with the community 6. Integration of Relief Aid & Developmental Support 7. Appropriate Interventions 8. Building of Assets 9. Political Competence 10. Strengthening of Coping Strategies 1. Building Livelihoods 2. Building Communities 3.Long Term Development 4. Developmental Funding 5. Understanding the community 6. Developmental Support 7. Planned strategies. 8. Investment Subsidy 9. Political Proficiency 10. Sustainability TRANSITION RESPONSE SUSTAINABLE DEVELOPMENT Recovery - from Response to Development

10. MODULE TITLE PHEMAP 9 10 From Response to Recovery and Reconstruction If there is no clear cut boundary between responses and recovery processes… this means: Don’t wait, think ahead! Build on the momentum of response to anticipate longer-term recovery and reconstruction.

11. MODULE TITLE PHEMAP 9 11 Medium-term Health Considerations for the Recovery Process Some key health effects from disasters: contamination of food and water supplies, emotional stress, epidemic diseases - diarrhoea, measles, etc. endemic diseases reduced health levels decline in nutritional status

12. MODULE TITLE PHEMAP 9 12 Long-term Health Considerations for the Recovery Process Psychosocial Concurrent problem due to disaster: decrease in mental health services, increase in incidence of common mental health problems Psycho physiological Behavioral Emotional Cognitive Emergency health care system addresses acute cases and initiate long-term plan for community- based psychological interventions.

13. MODULE TITLE PHEMAP 9 13 Long-term Health Considerations for the Recovery Process Gender and Health Equity and diversity Discrimination Family planning and reproductive health services Safety of women and children Inclusion of women in reconstruction planning Chronic Illnesses Monitoring for delayed / long term impacts Continued health care services for long-term disabilities from the events

14. MODULE TITLE PHEMAP 9 14 Long-term Health Considerations for the Recovery Process Emergent and Re-emergent illness Monitoring for delayed / ongoing health impacts Surveillance for potentially emergent and re-emergent endemic diseases or areas Environment Clean-up, hazard reduction and environmental management of the incident site Housing Permanent Accommodation  Access to regular Services Resettlement and / or Repatriation  Worst possible plan is to resettle

15. MODULE TITLE PHEMAP 9 15 Health Recovery and Reconstruction Within Community Recovery and Reconstruction Plans Community recovery and reconstruction addresses essential infrastructure and services: Building and permanent installations living Energy Water Food Waste disposal Education Health

16. MODULE TITLE PHEMAP 9 16 HEALTH - A Systemic approach It is crucial to consider ‘health’ in recovery and reconstruction as a system, operating in collaboration with other systems. A systemic approach to health draws attention to: Facilities and infrastructure Health care resources (medicines, PPE, supplies, etc) Financial resources Human resources

17. MODULE TITLE PHEMAP 9 17 HEALTH - A Systemic Approach A systemic approach to health enables: 1.Adequate strategies Understanding and enhancement of capacity of health system to meet the health needs of population Understanding of and mitigation of system’s main vulnerabilities Understanding and filling of gaps in system - for instance, inclusion of surge capacity considerations 2.Appropriate allocation of resources throughout the health care system 3.Lessons learned from disaster in own or other countries to be incorporated into health system recovery and reconstruction

18. MODULE TITLE PHEMAP 9 18 Principles of Health Recovery Plans 1.Look at the big picture 2.Be country-owned and backed by political commitment 3.Ensure community participation People begin almost immediately to re-house themselves and re-establish their social and economic networks after a disaster - build upon, don’t supplant community initiatives! People have good ideas of what they want to do to rebuild their lives - take their views into account when planning for recovery! 4.Take into account the overall context and the changes in this context (political, economic, social and military) 5.Establish partnership with ALL key stakeholders

19. MODULE TITLE PHEMAP 9 19 Principles of Health Recovery Plans 6.Use a ‘zoom approach’ (medium / long-term time frames, with short-term cycles) 7.Assess the functional health system elements of the affected community in relation to the community’s health needs 8.Develop and formalise arrangements for the effective management of the recovery process 9.Facilitate the rehabilitation and improvement of affected infrastructures as quickly as possible 10.Facilitate the recovery of affected individuals (physical, social) 11.Ensure general understanding of planning process and programme (agencies, authorities and communities)

20. MODULE TITLE PHEMAP 9 20 Principles of Health Recovery Plans 11.Describe organisational networks and structures appropriate to recovery process (different types and scale events) 12.Be reviewed on a regular basis 13.Incorporate performance indicators and measurable results into the plan, in order to readjust the strategy to the outcomes. 14.Set out appropriate resourcing arrangements 15.Define responsibility for the range of specific services to be provided And… ALWAYS CONSIDER LONG-TERM CAPACITY DEVELOPMENT AND RISK REDUCTION!

21. MODULE TITLE PHEMAP 9 21 Considerations for Recovery Disasters change social, political, economic and even demographic realities reveal weaknesses, provide an opportunity for new voices to be heard After disasters Often creation of new legislation, institutions, programs, codes, land use regulations and early- warning systems. Can also create conflicts and long term grievances. Recovery is a long term, slow and difficult process

22. MODULE TITLE PHEMAP 9 22 REMEMBER!!! The goal of recovery is to restore and strengthen health systems in the long term => vulnerability reduction and capacity enhancement to “cope better next time”

23. MODULE TITLE PHEMAP 9 23 Recovery, Capacity Development and Risk Reduction - Some Examples Reducing population vulnerabilities  improving access to basic resources  reducing exposure to disease vectors and pests.  improving knowledge of health risks and mitigation strategies Improving factors affecting public health  housing, water supply, sanitation, food safety, nutrition, dietary security, personal hygiene. Developing health system capacities  stronger, better located & equipped facilities  better training for staff  addressing systemic weaknesses

24. MODULE TITLE PHEMAP 9 24 The Disaster Recovery Plan - Key Components Validated documentation and data Identification of issues, needs, priorities and strategies Guidance and instructions Action Plans Roles and responsibilities Timeline.

25. MODULE TITLE PHEMAP 9 25

26. MODULE TITLE PHEMAP 9 26 Steps in the Planning Process Q&A What do you consider to be the main steps in the recovery planning process?

27. MODULE TITLE PHEMAP 9 27 Steps in the Planning Process 1.Obtain Commitment 2.Establish an all inclusive planning committee (leader) 3.Document the Hazards and Risks. 4.Discuss the findings. 5.Establish priorities 6.Determine Recovery Strategies 7.Organize and develop the plan 8.Develop a budget 9.Obtain resources (develop a funding proposal) 10.Develop monitoring criteria and procedures 11.Implement the plan 12.Review and amend the plan as appropriate

28. MODULE TITLE PHEMAP 9 28 Recovery Planning - Baseline Questions what? vulnerabilities, available capacities & resources, support who? target group & beneficiaries how much / many?needs and limitations who? responsible, involved, support, where? co-ordination lines - (coverage, prevent duplication of services) overlapping of subdistricts

29. MODULE TITLE PHEMAP 9 29 Recovery Planning - Baseline Questions how & when? appropriate response, reactive and / or proactive how long? continuity & sustainability - (training, supervision, ownership, integration, financing), reconciliation, resettlement. what type? policy, guideline or good will. why? understand Root Issues and what is being done to address them?

30. MODULE TITLE PHEMAP 9 30 Recovery Planning - Health Assessment Identify new vulnerability to future disasters or make existing vulnerability worse. Failure to recover, or partial recovery, can make people more vulnerable.

31. MODULE TITLE PHEMAP 9 31 Recovery Planning - Community Capacity Identify capacities and coping mechanisms that will help with recovery. Requires:  True community involvement in planning and implementation.  Close consultation between planners, policy makers, and communities concerned.  Use of local initiatives and self help activities

32. MODULE TITLE PHEMAP 9 32 Recovery Management The Process Begins from the moment of the disaster impact Continues throughout the development process. Links to other processes Considers existing activities Takes into account services and structures. Should aim to restore emotional, social, financial and physical wellbeing Reflects on social processes as well as physical reconstruction Is best when treated as a developmental activity

33. MODULE TITLE PHEMAP 9 33 Policy Considerations for Recovery Management 1.Consultation and full participation of ALL stakeholders. 2.Respect for religion, culture and customs and differing effects / needs for different communities / individuals 3.Transparency and communication. 4.Grievances processes (to and from local mechanisms). 5.Maximize contributions to economic recovery by harnessing local capacities.

34. MODULE TITLE PHEMAP 9 34 6.Coordination and integration of services. 7.Programs must strive to reduce future vulnerabilities to emergencies. 8.Reconstruction and resettlement priorities. 9.Planned and timely withdrawal and sustainable programming 10.Accountability, flexibility, adaptability and responsiveness Policy Considerations for Recovery Management

35. MODULE TITLE PHEMAP 9 35 Factors Inhibiting Recovery Process Q&A What are some common problems facing recovery processes?

36. MODULE TITLE PHEMAP 9 36 Factors Inhibiting Recovery Process There are several stresses challenging recovery : to stick with the past (those whose circumstances were favourable before the disaster) others see recovery as an opportunity to achieve long-cherished goals or rectify inequalities the re-emerging old structure comes in conflict with the developing new one Dealing with the ‘ripples of response’.

37. MODULE TITLE PHEMAP 9 37 Factors Inhibiting Recovery Process Knowing the right moment for the right need and service in a rapidly-changing environment high levels of both acute and ongoing stress, trauma and exposure to intense emotions highly charged personal work environment and sometimes brittle inter-agency relationships intense scrutiny of work performance (often by politicians and the media) Different strategies and priorities.

38. MODULE TITLE PHEMAP 9 38 Factors Inhibiting Reconstruction Processes Q&A What are some common problems of facing reconstruction processes?

39. MODULE TITLE PHEMAP 9 39 Factors Inhibiting Reconstruction Processes Standard-setting Selection of locations Selection of designs Funding availability & distribution History and heritage Availability of construction materials and personnel

40. MODULE TITLE PHEMAP 9 40 Factors Inhibiting Reconstruction Processes Decision-making delay Achieving a balance between speedy approvals and need to avoid mistakes Achieving a balance between agency, community and individual interests Profiteering Disagreement with decisions

41. MODULE TITLE PHEMAP 9 41 Guidelines for Delivery of Recovery Services 1 maximise the flow of information make programs that enable the affected persons to actively participate in programs which affect their future maximise the use of local resources, groups and individuals (local suppliers and services) ensure effective liaison (recovery teams, volunteer resources and CBO’s). encourage practice that allow for self- determination and community involvement in restoration planning

42. MODULE TITLE PHEMAP 9 42 Guidelines for Delivery of Recovery Services 2 make use of the existing structures, resources and local formal and informal networks ensure recovery workers are given ongoing support, debriefing, relief and rest aim at keeping families together (evacuation, temporary accommodation or resettlement) plan withdrawal of external recovery resource whilst ensuring continuity of the recovery process

43. MODULE TITLE PHEMAP 9 43 Roles and Tasks of the HEM in Health Recovery and Reconstruction. Q&A Based on your experience, as well as what you have learned in this module, what are the roles and tasks of a health emergency manager in health recovery and reconstruction?

44. MODULE TITLE PHEMAP 9 44 Roles of the Recovery Manager Ensure  appropriate strategies are in place  maximum community involvement  immediate & long-term individual and community needs Facilitate  acquisition, allocation of material Identify  staff and financial resources Promote  planning at all stages of the emergency cycle.

45. MODULE TITLE PHEMAP 9 45 Tasks of the Recovery Manager organise and manage  resources, staff and systems. advocate (behalf of the affected community)  with government departments  voluntary agencies,  the wider community,  Business.  other organisations liaise and consult (if necessary, coordinate) participating agencies, groups, authorities in order to achieve the most effective and appropriate recovery

46. MODULE TITLE PHEMAP 9 46 Tasks of the Recovery Manager provide information mediate where conflicts occur. develop relationships be partially distanced from the immediacy of the event to provide guidance  overall recovery process  establishing priorities  anticipate future requirements

47. MODULE TITLE PHEMAP 9 47 Learning Objectives By the end of this course, the participant should be able to: Describe health needs, risks and services in disaster recovery and reconstruction Discuss processes for recovery and reconstruction of health services and infrastructure within the larger context of community recovery and reconstruction plans Discuss the opportunities presented for health risk reduction and health systems capacity development during disaster recovery and reconstruction Describe the roles of an HEM in managing health in disaster recovery and reconstruction

48. MODULE TITLE PHEMAP 9 48 THANK YOU