3.4
Using the Minimum
Standards in Health
4/13/2015
1
HEALTH ACTION
Health Systems
Prioritising
services
Essential Health Services
1
Cmnicbl
diseases
child
health
Sexual
and RH
Injury
Mental
Noncmuncbl
2
1
1
1
1
1
1
3
2
2
2
4
3
5
6
Please see page 290
in the 2011 edition
Basically divided into two main themes….
Health System means:
“all the organizations, institutions and
resources that are devoted to producing
health actions” – WHO definition.
Essential Health Service means:
“preventive and curative health services
that are appropriate to address the
health needs of populations affected by
disasters.” – Sphere page 309
4/13/2015
3
Health systems standard 1: Health
service delivery
“People have
access to
effective, safe and
quality health
services that are
standardized and
follow accepted
protocols and
guidelines.”
Namibian Ministry of Health clinic
4/13/2015
(
 please see page 296 of the 2011 Edition)
4
Health systems standard 2: Human
resources
Community health workers can identify
vulnerable groups, detect trends in disease
patterns and provide early warning for rapid
response to emergencies. – WHO photo - 2009
4/13/2015
(
“Health services are
provided by trained
and competent
health workforces
who have an
adequate mix of
knowledge and
skills to meet the
health needs of the
population.”
 please see page 301 of the 2011 Edition)
5
Health systems and infrastructure
standard 3: Drugs and medical supplies
“People have
access to a
consistent
supply of
essential
medicines and
consumables.”
UNHCR photo
4/13/2015
(
 please see page 302 of the 2011 Edition)
6
Health systems standard 4: Health
financing
“People have
access to free
primary
healthcare
services for the
duration of the
disaster”
British Council photo
How would you measure this standard?
(
4/13/2015
 please see page 304 of the 2011 Edition)
7
Health systems standard 5: Health
information management
“The design and
delivery of health
services are guided
by the collection,
analysis,
interpretation and
utilisation of relevant
public health data. ”
K. Foster photo - Malawi
How would you measure this standard?
(
4/13/2015
 please see page 305 of the 2011 Edition)
8
Health Information Systems include:
CMR
 Under 5 MR
 Proportional Morbidity and Mortality
 Cause-specific mortality rate
 Incidence rates for most common diseases
 Health facility utilisation rate
 Number of consultations/clinician/day

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Health systems standard 6: Leadership
and coordination
St. Mary’s Hospital – LACOR UGANDA
4/13/2015
(
“People have
access to health
services that are
coordinated
across agencies
and sectors to
achieve
maximum
impact.”
 please see page 307 of the 2011 Edition)
10
Essential health services standard 1:
Prioritising health services
“People have access to
health services that are
prioritised to address the
main causes of excess
mortality and morbidity.”
IFRC photo
NSF photois
– Turkish
earthquake damage
What do you think this standard
really
about? What common problems does it seek to
avoid?
4/13/2015
(
 please see page 309 of the 2011 Edition)
11
Some Basic Terminology
Mortality
Exactly the same as death. Mortality is
the most solid health concept understood across all cultures.
Morbidity
Sick
Death Rate
Total number of deaths per a period of
time and a known population total.
Incidence
Health event per unit time
Prevalence
Snapshot of a health condition at a
single point in time.
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12
Some key indicators….
“The crude mortality rate (CMR) is maintained at, or
reduced to, less than double the baseline rate
documented for the population prior to the disaster.”
“The under -5 mortality rate (CMR) is maintained at,
or reduced to, less than double the baseline rate
documented for the population prior to the disaster.”
(
 please see page 310 of the 2011 Edition)
What do these two
statements really mean?
4/13/2015
13
Death Rate Calculation (CMR)
Deaths/10,000/day =
Number of deaths x 10,000
Days counted x population
If 21 people have died in one week out of a
total population of 5,000, then what is the
death rate?
 Death


Rate Calculation
Number of deaths x 10,000
Days counted x population

21 (deaths) x 10,000
7 (days) x 5,000 (total pop.)

or

6/10,000/day
Baseline reference mortality data by region (CMR)
0.25
0.25
0.33
0.16
0.16
0.22
0.22
0.19
0.41
0.25
0.25
Global average
4/13/2015
(
 please see page 311 of the 2011 Edition)
16
Essential health services - control of
communicable diseases standard 1:
communicable disease prevention
“People have access to
information and services
that are designed to
prevent the communicable
diseases that contribute
most significantly to excess
morbidity and mortality.”
IRC photo
(
 please see page 312 of the 2011 Edition)
4/13/2015
17
Outside a Kabul
health post
involved in the
UNICEF-supported
measles
immunization
campaign, a sign
provides directions
for families seeking
vaccinations for
their children
UNICEF photo
4/13/2015
18
Essential health services - control of
communicable diseases standard 2:
Communicable disease diagnosis and
case management
“People have access to
effective diagnosis and
treatment for those
infectious diseases that
contribute most
significantly to
preventable excess
morbidity and mortality.”
NIRPHAD photo

(
please see page 314
of the 2011 Edition)
19
Essential health services - control of
communicable diseases standard 3:
Outbreak detection and response
“Outbreaks are
prepared for,
detected,
investigated and
controlled in a
timely and
effective manner.”
Bangladesh carries out the largest mass measles
vaccination campaign ever – WHO photo
(
 please see page 316 of the 2011 Edition)
20
Essential health services – child health
standard 1: Prevention of vaccinepreventable diseases
“Children aged 6 months to
15 years have immunity
against measles and access
to routine Expanded
Programme on Immunization
(EPI) services once the
situation is stabilised.”
Child with measles –
CDC photo
(
 please see page 321 of the 2011 Edition)
4/13/2015
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More Terminology: Measles
Generalized rash lasting
more than 3 days and
temperature over 38
degrees Centigrade and
cough, runny nose or red
eyes
4/13/2015
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4/13/2015
CDC Illustration – from the New York Times
23
Measles Exanthem Day 1
Measles Koplik spots
Measles Exanthem Day 2
4/13/2015
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Vitamin A and Measles
A synergistic effect
Measles
unmasks
underlying
Vitamin A
deficiency
Vitamin A deficiency
(even sub-clinical)
increases the
morbidity and mortality
of measles infections
Vitamin A alone administered to the high risk target population can
significantly reduce measles associated morbidity and mortality
4/13/2015
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4/13/2015
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Essential health services – child health
standard 2: Management of newborn and
childhood illness
“Children have access
to priority health
services that are
designed to address
the major causes of
newborn and childhood
morbidity and mortality.”
A mother cradles her malnourished
baby in a field hospital in a refugee
camp in Dadaab, Kenya, 2011. Boris
Roessler, DPA / Landov
4/13/2015

(
please see page
323 of the 2011 Edition)
27
Essential health services – sexual and
reproductive health standard 1:
Reproductive health
“People have access to the
priority reproductive health
services of the Minimum
Initial Service Package
(MISP) at the onset of an
emergency and
comprehensive RH as the
situation stabilises.”
What’s in the MISP?
(
 please see page 325 of the 2011 Edition)
4/13/2015
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What’s the MISP?
•
Minimum
•
Basic, limited RH
•
Initial
•
for use in emergency, without
site-specific needs assessment
•
Service
•
services to be delivered to the
population
•
Package
•
supplies and activities,
coordination and planning
4/13/2015
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Reproductive Health includes:
•
•
•
•
Safe motherhood, including
emergency obstetric care
Sexual and gender-based violence
prevention & response
Prevention and care of STDs/HIV
Family planning
4/13/2015
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Major Causes of Maternal Death
Hemorrhage
25%
Other
27%
Obstruction
8%
Sepsis
15%
Abortion
13%
4/13/2015
Eclampsia
12%
The WHO New Emergency Health Kit for 10,000 people for 3
months … * The original New Emergency Health Kit (NEHK)
was last updated in 1998 and is currently under revision. The
kit substituting the NEHK is called Interagency Emergency
Health Kit (IEHK).
What is in the UNFPA RH Kit For use at primary health
care/ health centre level: 10,000 population for three months:
• Training and Administration
• Condoms
• Clean delivery sets
• Post-rape management
• Oral and injectable contraceptives
• STD Drugs
4/13/2015
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Essential health services – sexual and
reproductive health standard 2: HIV and AIDS
“People have access
to the minimum set
of HIV prevention,
treatment, care and
support services
during disasters.”
imediata.com
* What is the specially noted
reservation
to this standard? (see page 330)
(
4/13/2015
 please see page 328 of the 2011 Edition)
33
Essential health services - injury standard 1:
Injury care
“People have access to
effective injury care
during disasters to
prevent avoidable
morbidity, mortality and
disability..”
Example of triage card
How many, or what kinds of
services are “appropriate”?
(
 please see page 331 of the 2011 Edition)
4/13/2015
34
Essential health services – mental health
standard 1: Mental health
“People have access to
health services that
prevent or reduce
mental health
problems and
associated impaired
functioning.”

(
please see
page 333 of the
2011 Edition)
4/13/2015
Refugees who still fear for their lives
dwell in Kakuma camp's "protection
area," which provides extra security as
well as some social and psychological
care. – UNHCR photo, G.Beals
Essential health services - non communicable diseases standard 1: Noncommunicable diseases
“People have
access to essential
therapies to reduce
morbidity and
mortality due to
acute complications
or exacerbation of
their chronic health
condition.”
(
insulin
asthma inhaler
 please see page 336 of the 2011 Edition)
4/13/2015
36
Conclusions
Understand before doing
Control problems of
disease and its spread
(usually caused by
failures in other sectors)
Provide adequate health
care for men, Women,
and children
Do this in a way that
helps build health service
capacity in the
community
4/13/2015
37