Ensuring the health of African communities affected by emergencies and disasters, through Disaster Risk Management for health

An emergency is  defined as “a threatening condition that requires urgent action” (1), and it can escalate into a disaster that is defined as a “serious disruption of the functioning of a community or a society, causing widespread human, material, economic or environmental losses exceeding the ability of the affected community or society to cope using its own resources” (1). Disasters are known for their negative impact on the health of affected populations, especially as a consequence of the destruction of health systems, and of other social determinants of health, with resulting increases in diseases, injuries, physical and psychosocial disabilities and deaths.

Disasters may happen in any country at any time, and they are categorized as natural (e.g. floods, droughts, earthquakes/landslides), biological (e.g. disease outbreaks), technological (e.g. transport crashes/accidents) and societal (e.g. wars/conflicts/terrorism with internally displaced persons and refugees) (2). Sub-Saharan African (SSA) countries have recorded a significant number of disasters in the last ten years, including the 2007 and 2010 post-election violence in Kenya and Cote d’Ivoire respectively, the 2008 cholera outbreak in Zimbabwe, the 2009 drought in the Horn of Africa, the 2010/2011 floods in nine Southern African countries, and the 2011/2012 socio-political and nutritional crises in 9 countries in the Sahel (1). The very recent and ongoing outbreak of Ebola across West Africa, and the ongoing political crisis in the Central African Republic are wreaking havoc in their sub-regions. All these disasters have affected millions of people, causing the displacement of hundreds of thousands within and across countries, and the extensive destruction of agricultural and social infrastructure (including health facilities). Disasters have also resulted in increased illness and death in communities. It was

estimated that between 2007 and 2011, an average of US$3.2 billion was spent annually by African countries to respond to emergencies and disasters, and  of this amount, US$288 million was for the health sector response alone (1).

In 2012, almost half of all the countries in SSA were burdened by one or more disasters, affecting millions of people, displacing hundreds of thousands, making tens of thousands severely ill and killing thousands (Table 1).  In view of the scope, intensity and repetitive nature of most of these disasters, it was obvious that African countries were not learning enough lessons from past disasters, and that inadequate attention was being given by countries to prepare for, respond to and mitigate the effects of disasters, as well as recover from and build community resilience post-disaster. The World Health Organization African Regional Committee (WHO/AFR/RC), the annual meeting of the 54 SSA countries of the WHO African Region, as well as the World Health Assembly (WHA), the annual meeting of the 194 Member States of the WHO, recognized the need to also address the risks associated with disasters, as defined by the Hyogo Framework for Action 2005-2015 (4), instead of just the disasters themselves. A resolution of the 64th WHA of 2011 therefore urged Member States to strengthen health emergency and disaster risk management programmes in all countries. In line with the 2011 WHA resolution, and to strengthen disaster risk management within the health sector of African countries, the WHO African Region developed a strategy that was adopted by all 54 Member States attending the 2012 AFR/RC in Luanda, Angola, and for which a resolution was also approved and adopted.

Table 1: Countries affected by emergencies/disasters in sub-Saharan Africa in 2012 (3)

Disease

Outbreaks

Natural

Disasters

Multiple

Emergencies

Socio-political crises (conflicts

resulting in refugees/IDPs influx)

Accidents
  1. Angola
  2. Burkina Faso
  3. Benin
  4. Cameroon
  5. Cape Verde
  6. Chad
  7. Congo
  8. DR Congo
  9. Guinea
  10. Guinea Bissau
  11. Ivory Coast
  12. Liberia
  13. Mali
  14. Mauritania
  15. Niger
  16. Nigeria
  17. S.Leone
  18. Senegal
  19. Togo
  20. Uganda
  21. Zimbabwe
  1. Angola
  2. Cameroon
  3. Chad
  4. Comoros
  5. Ethiopia
  6. Madagascar
  7. Mozambique
  8. Niger
  9. Nigeria
  10. Senegal
  11. Uganda
  1. Angola
  2. Cameroon
  3. Chad
  4. DRCongo
  5. Niger
  6. Nigeria
  7. Senegal
  8. Tanzania
  9. Uganda
  1. Central African Rep
  2. DR Congo
  3. Kenya
  4. Mali
  5. Rwanda
  1. Congo
  2. Tanzania

The DRM Strategy for the health sector in the WHO African Region

Traditionally, the health sector has focused mainly on the response to emergencies and disasters when they occur. However, Disaster Risk Management (DRM) for health should be multi-sectoral and involving a wide range of partners and stakeholders even outside the health sector, to ensure that health services are not disrupted during a disaster.  DRM should also comprise the following elements: prevention and mitigation of health risks (through assessments of local hazards and community vulnerabilities); preparedness for disasters; response to disasters; and recovery from disasters. The African Regional strategy is accompanied by technical documents and tools for facilitating the appropriate implementation of DRM in the Region. Figure 1 is an inter-locking diagramme that depicts the contribution of the different supporting tools developed to ensure the success of the strategy (3).

Health DRM Guidance Tools/Documents
Figure 1: Health DRM Guidance Tools/Documents (3)

DRM guidance tools

  1. CCA (Country Capacity Assessment) is a checklist to ascertain whether a country has enough capacity to deal with risk reduction, emergency preparedness, response and recovery.
  2. VRAM (Vulnerability Risk Assessment and Mapping)/HSI (Hospital Safety Index) is a tool for the assessment and mapping of risks to the population’s health and to health systems in a community. HSI is for determining the safety of hospitals and other health facilities, in order to ensure that they be made safe enough and well prepared to respond to disasters when they occur. Surveillance and monitoring of these potential risks and threats provide vital data for early warning and for swift action by the population, by the heath sector and other sectors.
  3. SOPs (Standard Operating Procedures) are detailed in a manual that clearly describes the actions the health sector and other partners should take in a given emergency/disaster.
  4. The Recovery manual outlines actions to be undertaken to ensure that a community bounces back sufficiently well after a disaster, to maintain meaningful livelihoods and adequate health. 
  5. Core competencies in all health disciplines that may be involved in a disaster are required by health personnel at all levels (community, sub-national and national). For this reason, the AFRO strategy has proposed guidelines for developing DRM training programmes for health personnel, at basic, intermediate and degree levels. These programmes are currently being field tested in universities in several countries in the Region (including the University of Pretoria School of Health Systems and Public Health), and the guidelines will be finalized when the results of the field testing are obtained.

The future of DRM for health in the African Region

Disaster risk management in health in the sub-Saharan African region needs a major boost from, and coordinated action among all partners and stakeholders in all sectors involved in tackling disasters at all levels.  The correlation of action for prevention, mitigation, preparedness, response and recovery between national and community levels has to be bi-directional, and must be everyone’s business. Identifying disaster risks in communities, monitoring them and reporting early warning signs is the duty of community members, but they need the support of health systems for basic health services and health infrastructure. Primary Health Care (PHC) cannot be over-emphasized for improving the health status of a community, and to increase community resilience. Only a fully functional PHC system that caters for child health, maternal and newborn health, sexual and reproductive health, water, sanitation and hygiene, nutrition, management of common diseases and trauma, health education, mental health and psychosocial support at community level can provide a community with the necessary foundation to adequately prepare for and respond to disasters. If needed, then more specialized health measures such as mass casualty and mass fatality management and measures for highly specialized emergencies can be provided by levels higher than PHC. The 54 Member States that in 2012 approved the Regional Strategy and adopted the accompanying resolution are duty-bound to ensure that the strategy is implemented in their respective countries, for the health and well-being of their populations. Although the 2013 WHO/AFRO annual report is still awaited, earlier reports and anecdotal evidence would suggest that only a limited number of  African countries have put in place those structures that will facilitate the implementing the regional DRM strategy (5). Disaster risk management for health is a long-term process that will not be achieved overnight. However, disasters are unforgiving, and will continue to ravage countries that do not learn from past experiences. The time to act is now.

Note that the views expressed in this article are those of the author and do not necessarily represent the views of  PHASA.

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