Emergency Preparedness and Response in Myanmar
Assignment: 25 April -23 July 2005
Report 25 April - 15 June 2005
Dr. Stefania Pace-Shanklin, Short-Term Consultant1
1
Emergency Humanitarian Action (EHA) Consultant
1. Purpose of assignment:
To provide technical support to the Myanmar Ministry of Health for strengthening
its disaster preparedness and response capacity.
Expected outputs
1. To advise the Ministry of Health in developing a national disaster plan
including policies, strategies, and priority activities for disaster risk
management, preparedness and response.
2. To develop protocols for risk assessment, hazard mapping in relation to
different settings, and post-disaster impact assessments.
3. To facilitate the preparation and development of advocacy tools and
information, education and communication materials to improve
knowledge, practices and response options.
4. To help develop an overall training and capacity building plan for MOH,
and act as resource person for trainings and simulation exercises
5. To contribute to needs assessments and response, in event of actual
disasters.
6. To act as de facto Emergency Coordinator/Manager for WHO Country
Office, when the Operations Room is activated, in event of a major
disaster.
7. To support coordination and dialogue with and among health actors, and
with wider disaster preparedness and response community.
2. Background
Myanmar was only marginally affected by the Indian Ocean tsunami of 26
December 2005 that devastated parts of several other countries in the region.
The general response to the disaster was fairly good and comprehensive
although it showed a few problems, mostly in coordination and communication.
WHO provided technical assistance to the Ministry of Health focusing on
reducing the risk of disease outbreaks and morbidity by supporting disease
surveillance and providing emergency medical supplies as requested. WHO
technical support was also given to the coordination groups through interaction
with members and dissemination of relevant WHO documents.
The disaster, and the subsequent response to it, has highlighted the need for the
country to have a comprehensive disaster preparedness and response plan in
the broader context of development and disaster reduction.
The UN system itself, including WHO, faced some challenges mainly due to the
absence of an established mechanism for disaster response cooperation
including standardized operational procedures.
The tsunami disaster generated an intense national, regional, and global interest
in early warning and preparedness. This was reinforced by a formal request to
WHO from the Ministry of Health for assistance in improving national disaster
preparedness and response.
3. Activities Undertaken
Given the short time of the assignment, after consultation with the WR, Dr
Agostino Borra, it was decided to concentrate mostly on expected outputs (EO)
n. 1, 2, 4, and 6, and, if needed, further expand on 5 and 6.
A country work plan (EHA 2004-2005) was developed subsequent to the
tsunami. Although not mentioned in the TOR, the understanding was that the
consultant would also follow-up most of the foreseen activities.
Expected Output n. 7 (coordination among all actors involved in emergency
preparedness) is assured from the close relationships the consultant has with
other UN Agencies, IFRC and ICRC and NGOs.
EO 1: to advise the Ministry of Health in developing a national disaster plan
including policies, strategies, and priority activities for disaster risk management,
preparedness and response.
Activities being implemented to achieve this result are:
 Meetings with national counterparts (Central Epidemiological Unit,
International Health Division, Department of Medical Care, Yangon
General Hospital Medical Superintendent, National Nutrition Center,
Director of Planning of the Department of Health, and various Heads of
Department at the Institute of Medicine);
 Meetings with international organizations (ICRC, IFRC, UN Agencies
NGOs); Documents reading;
 Field visits to Ayeyarwaddy Division, Hinthada and Ingapu Townships,
and visit to the Yangon General Hospital.
Comments: the current disaster plans, both at public health level and at medical
care/mass casualty level, have not yet been translated into English.
Nevertheless, the extensive talks, had with the relevant counterparts, offered a
fairly comprehensive picture of the content of the plans.
The vulnerability assessment, reportedly done by the Ministry of Health, is not
translated either and could not be seen.
The Yangon General Hospital has a mass casualty plan, which is activated when
the number of serious casualties (T1 and T2) is above 10. This plan was
extensively tested on May 7th during the bombing incident that took place in
Yangon, and it proved effective, given the circumstances, in quickly re-establish
order and assigning each casualty the proper level of care. The presence of a
highly competent medical superintendent certainly fostered the apparently
successful implementation of the plan. Only a detailed review of the response
and the evaluation of case management and patients’ outcome could obviously
prove the response’s effectiveness.
Informal talks and site visits, evince that, after the tsunami, simple, communitylevel plans have been developed in most parts of the country. Their effectiveness
is driven by the level of commitment of the local community and of the officer in
charge.
In the rural areas visited (all flood-prone townships), there is a disaster plan in
place, which indicates roles and responsibilities for each member of the disaster
management committee and identifies vulnerable groups, who will be affected by
the flood, and safe heavens to shelter them.
Last year an extensive flood had quite a repercussion in many of the vulnerable
areas, and, although the townships did not have then a formal plan, the response
was effective and smooth.
Great strength for Myanmar seems to be the National Health Committee, an
intersectoral and multidisciplinary committee, which discusses the health
problems rooted in the various sectors and that is replicated at State/Division and
Township level. The recognition that health is an intersectoral issue greatly
enhances collaboration among the various Cabinets.
The Disaster Management Committee has similar structure and membership,
and also replicates at State and Division and Township level.
While the ministerial memberships of the Health Committee at national level may
differ from the one of the Disaster Committee, at local level they are always the
same. The township health committee, which meets quite often, is the same as
the disaster management (which in most countries only meets when there is a
disaster) and this greatly helps the development and the maintenance of the
plan.
In order to overcome the absence of translated plans and to foster collaboration
with the national counterparts, two disaster plan checklists (one for Mass
Casualty Incident - MCI and one for a more comprehensive plan) were
developed from existing guidelines and given to the Ministry of Health. These
checklists will be reviewed with the national counterparts soon and will be
attached to the final report.
EO 2: to develop protocols for risk assessment, hazard mapping in relation to
different settings, and post-disaster impact assessments.
Work is in progress with the technical counterpart to review current protocols (not
translated) and integrate them with the ones recommended by WHO.
EO 4: to help develop an overall training and capacity building plan for MOH, and
act as resource person for trainings and simulation exercises
Part of the work plan 2004-05 is the conduction of two workshops on disaster
management; discussions were conducted with technical counterparts on the
TORs of these workshops. It was agreed that: a) the 1st workshop, to be held
towards the end of July, will draw from lesson learned from previous disasters
and will aim at having a new draft preparedness plan based on experience; b)
both workshops will focus on managing the health aspects, but other main actors
will be invited to improve interaction with the health sector and coordination. A
working group could facilitate finalization of the preparedness plan; and c) the 2nd
workshop will have the purpose of reaching a consensus and of finalizing a
public health disaster preparedness plan with intersectoral linkages.
While waiting for fellowship applications from the MOH, international training
courses on Disaster Management have been identified and recommended to the
national counterpart. It was agreed that 7 people (4 medical officers and 3
paramedics) will go to the ADPC course in Bangkok in November 2005.
For the surveillance course, the best fitting course seems to be the first
introductory part of the longer Field Epidemiology Training Program -FETP in
Bangkok; unfortunately, the course is taking place in June – July this year and,
presumably, around the same time next year. As it stands now, this timing makes
it impossible for the two epidemiologists to attend this course as funds must be
spent by the end of the current year. To overcome this problem, the Myanmar
office will ask the collaboration of the Fellowship Office in Delhi for placement,
once the fellowship applications are received.
EO 6: to act as de facto Emergency Coordinator/Manager for WHO Country
Office, when the Operations Room is activated, in event of a major disaster.
In the hope that Myanmar will not have another major disaster in the foreseeable
future, the activities have concentrated in WHO Office preparedness. This
includes:
a) operation room (OR) set up: pre-identification of suitable staff, who could act
in emergency situation as front line staff while waiting for new resources from
outside; procurement of supplies for the OR; books have been ordered (two
emergency book kits, one for WHO OR and one for MOH OR) and guidelines are
being downloaded, printed and organized in reference shelves.
Training issues have been discussed with the RO and are still pending; country
office training is being organized in Nepal and, depending on the results, could
be replicated in other offices in the region.
b) preparedness for emergencies related to WHO personnel: After the
bombing incident of May 7th, the need for a better understanding of the
availability of acute medical care facilities has arisen. To this avail, a survey of
available facilities was conducted to assess which one could provide reliable
intensive care and patient stabilization prior to medical evacuation to Bangkok.
At the same time, an assessment of the various health care facilities for ordinary
levels of care is also being conducted jointly with the other UN agencies.
Following the issuance of the WHO Contingency Plan for Pandemic Influenza
from the HQ Health and Medical services Department, time is devoted also to
plan the various actions necessary to reach a satisfactory level of preparedness
in the country for WHO and UN staff in general.
4. Conclusions and Recommendations
This is an intermediate report and it must be considered as such. The remaining
part of the assignment and the further (proposed) three months will be spent
working closely at the updating of the disaster plan(s) with the national
counterpart(s) on the basis of the checklists produced, and in enhancing WHO
office capability to respond to a disaster in the country.
It is noticeable that the level of awareness of the country to the issue of disaster
preparedness is fairly good; however, gaps are still there and need to be filled.
Notwithstanding the absence of a comprehensive and detailed risk assessment
for the entire country, the vulnerability analyses (mostly based on previous
events) at local levels seem sufficient to prepare for “ordinary”, re-occurring
disasters. It is only in exceptional events that the gaps in preparedness and,
above all, the current problems within the under-funded, under-developed health
system will dramatically surface.
Disaster Reduction programs (comprehensive of preparedness, mitigation,
response and recovery), should be considered in the broader context of the
development of the health system and of the country.
At the same time, elements of disaster management could be introduced at all
levels in the educational curricula of the health professions and of other
professions as well. This would assure a common, basic understanding of
disaster preparedness while the country proceeds towards its own development.