SEA/EHA/A1
Gujarat Earthquake Relief Mission
Third Report of WHO Activities following the Earthquake
(1 August 2001 - 31 January 2002)
World Health Organization
WORLD HEALTH ORGANIZATION
Gandhinagar, Gujarat (India)
May 2002
Gujarat Earthquake Relief Mission
Contents
Page
Backdrop
1
Health Sector Coordination
4
Operation Health, Kachchh
15
Malaria Outbreak in Kachchh District- a Case Study
15
District Disease Surveillance Task Force
18
Public Health Laboratory at Bhuj
19
Strengthening of Water Quality Surveillance for Kachchh District
24
Water Quality
25
Capacity Building through Training and Awareness Programmes
27
Water and Sanitation Sector Review Workshop,
Ahmedabad, 13 October 2001
29
Inter-State Meeting on “Gujarat Earthquake: Health Sector
Perspectives”, Ahmedabad, 6-9 November 2001
31
Expansion of WHO Activities in other Earthquake-affected
Districts of Gujarat
39
Report of WHO Activities, 1 August 2001 - 31 January 2002
Gujarat Earthquake Relief Mission
Backdrop
The devastating earthquake that hit the Kachchh district of Gujarat on 26 January 2001
affected 37.8 million people. Housing, schools, roads, communication systems and
power lines were all completely destroyed which resulted in a loss of livelihoods as
well as lives. The Government of Gujarat and the national and international community
responded quickly to this disaster with emergency relief services. The emergency phase
lasted until mid-March 2001. Since then, the rehabilitation phase began, keeping in
mind the long-term goal of sustainable development. The United Nations Disaster
Management Team (UNDMT) in India prepared a comprehensive report on the UN
System response. WHO was designated as the focal agency for the health sector
response and a cooperating agency for water, sanitation, food and nutrition. From the
beginning, WHO was instrumental in acting as a link between the Government and
NGOs, and coordinating activities to minimize overlap and maximize available
resources. WHO played a vital role in protecting and promoting the health of the people
through improving the quality of water supply and establishing a disease surveillance
system.
The first quarterly report from 26 January - 30 April 2001, and the second report
covering the period 26 January - 31 July 2001 were brought out earlier. This is the third
report in the series for the period 1 August 2001 - 31 January 2002.
Report of WHO Activities, 1 August 2001 - 31 January 2002
1
Gujarat Earthquake Relief Mission
The main areas of activity of WHO in the last six months were:
(1)
To support the re-establishment and rehabilitation of health services in the
earthquake-affected areas with special attention to primary health care;
(2)
To provide technical advice to the Government, UN agencies, bilateral agencies
and NGOs on priority public health issues in the aftermath of an earthquake;
(3)
To collaborate in the health sector coordination;
(4)
To support the Government in establishing disease surveillance in the
earthquake-affected areas, including an early warning system and capacity
building for rapid response to epidemics;
Report of WHO Activities, 1 August 2001 - 31 January 2002
2
Gujarat Earthquake Relief Mission
(5)
To provide technical support for emergency repairs of water distribution system,
water treatment and temporary distribution, sanitation and solid waste disposal,
food safety, vector and zoonoses control; and
(6)
To expand all WHO activities in other earthquake-affected districts.
WHO Team in Bhuj (October 2001)
Designation
Number
Team Leader
1
Disease Surveillance Coordinator
1
Water and Sanitation Specialist
1
Surveillance Officers (NUNVs)
6
Administrative Assistant
1
Logistics Assistant
1
Information Technology Assistant
1
Data Entry Operator
1
Drivers
7
•
Technical advice and coordination in the health response to the emergency
situation, disease surveillance, water and sanitation to the Government of
Gujarat and other UN agencies.
•
Working closely with international and local NGOs to support their
activities and assist with coordination within the health sector.
Report of WHO Activities, 1 August 2001 - 31 January 2002
3
Gujarat Earthquake Relief Mission
Health Sector Coordination
WHO was requested by the United Nations Disaster Assessment and Coordination
(UNDAC) Team to support public health and health sector coordination in Gujarat
through restoration of public health services as soon as possible following the
earthquake, and to maintain its presence in the state to help ensure that public health
care was given adequate attention in the period of time after immediate relief and
before complete restoration of the health services. WHO is the lead agency to support
health sector coordination and cooperation amongst international agencies.
•
Good coordination between WHO, Government, UN agencies, national
and international NGOs.
•
Thirteen meetings of Health Sector Coordination Group held during the
period of six months.
•
Sub-sector group meetings held regularly every fortnight.
•
Weekly coordination meetings at Taluka level in four most affected talukas,
viz. Anjar, Bhachau, Bhuj and Rapar.
The first health sector coordination meeting was held on 5 February 2001 in the field
headquarters of the International Federation of the Red Cross and Red Crescent
Societies Field Hospital at Lallan College. Till 30 April 2001, ten health sector
coordination meetings had been held, while during the period of six months from 1
May to 31 October 2001, a total of 13 meetings took place.
During the second and third quarters, as the need for intensive coordination decreased,
the meetings were taking place fortnightly instead of weekly. The district government
health officials regularly attended the meetings. Attendance at the meetings decreased
towards the end of the third quarter as many agencies finished their work and left the
area.
Report of WHO Activities, 1 August 2001 - 31 January 2002
4
Gujarat Earthquake Relief Mission
Meeting Days in Bhuj
Month
Number
Dates
May
2
10, 24
June
2
7, 21
July
2
5, 19
August
3
2, 16, 30
September
2
13, 27
October
2
11, 25
November
1
29
December
1
20
WHO is responsible for the health sector meeting minutes and the e-mail system was
used effectively to communicate them to government officials in the state headquarters,
all the agencies attending the meetings and even to those organizations whose
representatives were unable to attend the meetings.
During the third quarter, with the initiative of the Collector and District Development
Officer of Kachchh, an executive committee was established. The responsibility of
NGO coordination was assigned to UNDP, while the responsibility of health sector
coordination continued to remain with WHO.
Meetings at Planet Bollywood, International Federation of
Red Cross and Red Crescent Societies (IFRC), Bhuj
Health Sector Meetings on Thursday
Time
Psychosocial support
9.00 A.M.
Reproductive and child health
11.00 A.M.
Rehabilitation and prosthesis
2.00 P.M.
Health promotion
4.00 P.M.
General health sector
6.00 P.M.
Report of WHO Activities, 1 August 2001 - 31 January 2002
5
Gujarat Earthquake Relief Mission
The health sub-sector groups of psychosocial support, reproductive and child health,
rehabilitation and prosthesis and health promotion have maintained their schedule of
regular fortnightly meetings throughout the six months.
The sub-groups of hospitals and infrastructure restoration were dissolved. The nutrition
group was separated and the responsibility for coordination was taken by WFP.
Organizations attending the meetings:
Abhiyan
Action Aid
American Red Cross
FICCI - CARE
CESVI (World Aid from Italy)
Catholic Relief Services (CRS)
Government of Gujarat (GoG)
Handicap International
Health Services, Bhuj
Hospital for Mental Health, Bhuj
International Federation of Red Cross and Red Crescent Societies (IFRC)
Kutch Vikas Trust (KVT)
Life Line Express
Merlin
Oxfam, India
Oxfam, UK
Save the Children Fund (SCF), UK
Self-Employed Women's Association (SEWA)
UNDP
UNICEF, Gujarat
Voluntary Health Association of India (VHAI)
WHO, Bhuj
Report of WHO Activities, 1 August 2001 - 31 January 2002
6
Report of WHO Activities, 1 August 2001 - 31 January 2002
Handicap
International
13
13
UNICEF
Restoration of
Health
Infrastructure
Prosthetic and
Orthotic
Rehabilitation
Oxfam
3
UNFPA /
Integrated
Population &
Development
(IPD)
Reproductive and
Child Health
Health Promotion
11
American Red
Cross (ARC)
13
Meetings
Psychosocial
Support
Title of Sub-group Lead Agency
1. Training of teachers and health volunteers.
2. Innovative activities like painting and essay writing.
3. Diagnostic and counselling camps with the involvement
of psychiatrists from the Civil Hospital.
4. Psychosocial Support workers' directory prepared by the
lead agency.
5. Extension of activities to other districts.
1. Ten mobile vans provided by UNFPA. The activities
include preventive, promotive, and curative health services.
2. Training of traditional birth attendants (TBAs) by various
agencies. Focus on increasing institutional deliveries.
3. Adolescent girls' fair: an innovative tool.
4. Planning for Pulse Polio 2001-2002.
5. Growth Monitoring Campaign linked with measles,
immunization and vit.A supplementation.
This group was dissolved in July 2001. Revived again in
November 2001. Weekly meetings held to assess the
progress construction.
1. Stress on community-based rehabilitation.
2. Attempt to collect trauma-related data from different
agencies, though the quality of data was not good.
3. The compiled data handed over to government authorities
for further validation.
4. SAFARI camps to provide care to the needy people.
5. Training activities.
1. Colourful posters and handouts developed in local
language carrying health messages about malaria and
personal hygiene.
2. Use of electronic media, religious platforms, street plays.
3. Presence at public fairs.
4. Training activities.
5. Demonstrations, e.g. chlorination.
Key Issues
Gujarat Earthquake Relief Mission
7
Report of WHO Activities, 1 August 2001 - 31 January 2002
100
0
PATAN
BHAVNAGAR
100
AMRELI
VADODARA
200
VALSAD
NAVSARI THE DANGS
SURAT
BHARUCH NARMADA
ANAND
DOHAD
PANCH MAHAL
MAHESANA
SABAR KANTHA
SURENDRA NAGAR ADMEDABAD KHEDA
RAJKOT
JUNAGADH
PORBANDAR
JAMNAGAR
KACHCHH
BANAS KANTHA
Gujarat State
W
S
N
E
ADMEDABAD
AMRELI
ANAND
BANAS KANTHA
BHARUCH
BHAVNAGAR
DOHAD
JAMNAGAR
JUNAGADH
KACHCHH
KHEDA
MAHESANA
NARMADA
NAVSARI
PANCH MAHAL
PATAN
PORBANDAR
RAJKOT
SABAR KANTHA
SURAT
SURENDRA NAGAR
THE DANGS
VADODARA
VALSAD
Gujarat Earthquake Relief Mission
8
Gujarat Earthquake Relief Mission
Communicable Disease Surveillance and Response
Highlights
•
Sustained active involvement of private sector due to regular meetings,
transparency in data and consistent feedback.
•
Weekly epidemiological summary with data analysis and use of
Geographical Information System (GIS), also available on the WHO
website.
•
Training of medical officers and paramedical staff for disease surveillance
and diseases of public health importance. (Provided technical inputs on
biochemical warfare, also).
•
Epidemic preparedness and adequate response ensured at the district and
sub-district level.
•
Coordinated response to malaria outbreak - mobilization of medicine,
fogging and spraying machines, and manpower (Operation Health,
Kachchh).
•
Regular situation review meetings with the health department officials and
district administrators.
•
Development of a platform for crucial review during malaria outbreak
through field coordination meetings by WHO.
•
Provision of equipments and necessary support to establish the Public
Health Laboratory at Bhuj.
Report of WHO Activities, 1 August 2001 - 31 January 2002
9
Gujarat Earthquake Relief Mission
Immediately after the earthquake, experienced surveillance medical officers already
working under the National Polio Surveillance Programme of WHO (NPSP) in the state
and neighbouring areas were mobilized to the worst earthquake-affected district of
Kachchh. With technical guidance and direction from the NPSP coordinator of the West
Zone, these surveillance officers established an immediate disease surveillance system.
Mobile medical teams (approximately 450) mobilized from all over the state were the
main reporting units. Very soon PHCs/ CHCs and hospitals became functional in tents
and also started reporting.
A surveillance format was agreed upon with the government in the local language, with
the assistance of NPSP state surveillance officer located at the state HQ. It was a daily
syndromic reporting system and aggregate data were analyzed at the sub-district and
district levels. With the same sources and methods for data collection functional all
over the district of Kachchh, a regular weekly epidemiological summary (disease
surveillance report) was released/published in the health sector coordination meeting.
This practice continued in the second and third quarter, which was very well
appreciated by all including the senior government officials.
In the second quarter, a new multi-disease standard surveillance format was prepared in
consultation with the government counterparts, with inputs from international NGOs.
This was a mixed approach in many contexts. It was a disease-specific and a syndromic
approach, combining both institutional and field surveillance. It collected aggregate
secondary data and primary case-based data in certain identified diseases of public
health importance. It involved the fixed and mobile medical institutions of both the
state and central governments. It also collected data from short-listed private
practitioners and all NGO/Trust hospitals of the district. In addition, international
NGOs camped in the field for medical services were also included in the reporting
network. This new weekly surveillance system was expanded to include all the state
government institutions of the district, i.e. all ten talukas of district Kachchh.
Report of WHO Activities, 1 August 2001 - 31 January 2002
10
Gujarat Earthquake Relief Mission
WHO standard case definitions were accepted in consultation with the Government of
Gujarat and treatment protocol advocated. The WHO surveillance unit conducted an
exhaustive training programme of all medical officers of reporting units and private
practitioners. The topics included were:
v
Concepts, principles and methods of epidemiology;
v
Disease surveillance - reporting and analysis;
v
Outbreak investigation and epidemic preparedness;
v
Acute respiratory tract infections;
v
Diarrhoeal diseases;
v
Malaria;
v
Dengue fever; and
v
Biochemical warfare.
Senior district and state level government officials from the health department, experts
from the Regional Family Welfare Centre of the Government of India, Ahmedabad, and
independent renowned consultants participated as resource persons in this training
programme. This WHO initiative was very well converted into a Continuous Medical
Education programme by good coordination between WHO, government and
international NGOs. Many NGOs made use of the WHO established training platform
for various training programmes on health and nutrition, mental health, prosthesis and
rehabilitation.
Report of WHO Activities, 1 August 2001 - 31 January 2002
11
Gujarat Earthquake Relief Mission
Training Category
No.
PHC medical officers
36
MOs - State dispensary
40
MOs - Mobile team
124
MOs - Community Health Centre
16
MOs - Civil / Referral hospitals
8
Sub-district public health professionals
22
Paramedics / ICDS workers
160
MLVs
245
Private practitioners
57
Presentation by WHO staff of Malaria case study
at Bhuj
Training course for Medical Officers of Rapar
Taluka PHCs at Rapar in Kachchh district
These training programmes were very interactive, with group work and exercises. All
the participants took very active interest in them. Through this, medical officers
(government and private) were sensitized for epidemic preparedness and trained in
reporting, investigation procedures and rapid response.
National United Nations Volunteer (NUNV) doctors with the government counterparts
met and convinced the identified private practitioners for the regular reporting. They
assisted in collection, compilation and analysis of these weekly reports. They
continuously nurtured the system by providing the regular feedback, training and
Report of WHO Activities, 1 August 2001 - 31 January 2002
12
Gujarat Earthquake Relief Mission
technical material, chlorine tablets, ORS, IV solutions, chloroquine and primaquine
tablets, and chloroscopes. The state government or international NGOs working in the
aftermath of the earthquake provided all these medical supply items and equipments
with WHO coordination efforts.
In India, private practitioners of a district reported for the first time, throughout the last
nine months, in the aftermath of the earthquake. National UNV doctors provided all
necessary reporting formats and trained them in the various procedures. Regular
technical meetings in the evening using the platform of Indian Medical Association
were organized. WHO ensured the participation of senior government officials in this
meeting to provide feedback to the private reporting units. The 'Action' component of
the surveillance was given proper emphasis in these meetings. Private practitioners
extended full support and cooperation to the health department and very much
appreciated WHO's efforts to bring the two together. In addition to reporting of diseases
of epidemic potential, private practitioners also assisted the government in
immunization campaigns, cleanliness drives, health education and hygiene promotion.
Their role in controlling the malaria epidemic was very important and appreciated by
the government health department. They helped in radical treatment, drug resistance
and G6PD deficiency studies, public acceptance of insecticide spraying and fogging,
and malaria talks on TV and Radio. WHO ensured proper and timely feedback to all
these private reporting units and ensured complete transparency in the data and
reporting.
After regular reporting from all over the district, baseline data for certain common
syndromes and diseases were worked out. Non-availability of the previous year's data
and uncertain/unknown denominator made it very difficult, but in consultation with the
state level health officials, the figures used in the last pulse polio immunization
campaign (January 2001) were considered as authentic population figures.
Report of WHO Activities, 1 August 2001 - 31 January 2002
13
Gujarat Earthquake Relief Mission
Syndrome / Disease
A*
B**
Bloody diarrhoea
0.48
0.16
Watery diarrhoea
4.63
1.35
Gastroenteritis
0.13
0.05
ARI
13.33
4.43
URTI
11.03
3.61
LRTI
2.30
0.82
Fever
4.02
1.74
Malaria
0.21
0.11
* Weekly incidence rate per 1 000 children below five years of age in Kachchh District
** Weekly incidence rate per 1 000 persons (all age groups combined) in Kachchh District
An early warning system was established, based on weekly data comparison against
this baseline data for the ARI, fever and diarrhoeal diseases. A regular system of
weekly situation review meeting with the district officials was established. WHO
surveillance officers provided detailed information where action was necessary to
prevent/control the rising trend of a particular illness or syndrome.
Hepatitis E in Rapar, food poisoning in Mandvi and Bhuj, cholera in Gandhidham,
outbreak of fever in Abdasa and Nakhatrana, and malaria in Rapar and Anjar, are few
examples of the use of early warning system. In all cases, proper and timely
information to the district authorities and prompt action significantly reduced further
morbidity and mortality.
Once the disease surveillance system became fully established, its integration with the
polio Acute Flaccid Paralysis (AFP) surveillance, TB control programme, and malaria
control programme was worked out in consultation with the concerned officials. Each
and every case of AFP got reported immediately and the concerned SMO/NPSP was
informed of it.
Report of WHO Activities, 1 August 2001 - 31 January 2002
14
Gujarat Earthquake Relief Mission
With the guidance of ISM/WHO/SEARO, an efficient Geographical Information
System (GIS) was established. Every week, WHO and GoG jointly released
geographical maps in relation to disease distribution (ARI, diarrhoea, and malaria) as a
component of weekly epidemiological summary, which became very well known to all
including the district administrators. For medical officers and others, it became an
important tool for decision and action.
With the help of WHO/HQ, Health Mapper, customized software was also introduced.
An exposure-cum-orientation programme was conducted at Bhuj (district HQ) and
Gandhinagar (state HQ) for the officials of concerned departments.
Operation Health, Kachchh
This was a Government of Gujarat initiative. It mainly looked after the epidemic
preparedness and diseases of public health importance. Practically, it was a mirror
image of WHO's disease surveillance mechanism, but with more field staff to
implement various surveillance activities. Under this initiative, the Government of
Gujarat deputed a public health expert, Taluka liaison officers and Epidemiologist-cumSanitary Supervisor in all four worst affected Talukas and approximately 400 malaria
link volunteers. The operation facilitated smooth transition of WHO surveillance
system (in the emergency) to the government-owned surveillance mechanism. WHO
surveillance officers worked in close cooperation with the government officers for
outbreak investigation, reporting, and analysis.
Malaria Outbreak in Kachchh District - a Case Study
In mid-July 2001, the disease surveillance system started giving early warning signals
for the impending outbreak of malaria. The analysis also correlated the cyclical
epidemiological pattern of the malaria outbreaks in the district, particularly in relation
to the rainfall. The district and state officials were alerted and the whole system was
charged to tackle the problem well in time. Operation Health, Kachchh officials were
Report of WHO Activities, 1 August 2001 - 31 January 2002
15
Gujarat Earthquake Relief Mission
immediately identified as the focal points at the district and sub-district HQ. WHO
conducted a rapid training programme of all medical officers and private practitioners
regarding epidemiology of malaria, epidemic preparedness, parasitology and biological
control, standard treatment including radical treatment, drug resistance (in certain areas
of the district) and Early Diagnosis and Prompt Treatment (EDPT).
The weekly surveillance system continued to pinpoint efficiently the problem areas.
Government medical officers reported confirmed malaria cases on daily basis over
telephone. The weekly reports became a very crucial tool to monitor the epidemic
situation. Weekly Taluka field coordination meetings became the platform for malaria
situation review. Health field staff, integrated child development service (ICDS)
workers and malaria link volunteers (MLVs) working under the Operation Health,
Kachchh did effective field surveillance and ensured radical treatment (RT) to all
positive patients.
National UNV doctors (WHO surveillance officers) collected positive blood
smears/slides from the private practitioners. Trained laboratory technicians of the
district malaria control programme verified and cross checked these slides. Field
workers provided radical treatment to all positive patients.
The problem started actually due to migrant labourers coming from malaria endemic
districts of the state, for the reconstruction work in the earthquake-affected areas. Their
screening and fever radical treatment (FRT) and mass radical treatment (MRT)
programmes were implemented, with the help of construction contractors and district
administrators.
WHO played a very vital role in coordinating the response to this malaria outbreak.
Private practitioners were provided with chloroquine and primaquine tablets and were
requested to follow National Malaria Eradication Programme (NMEP) treatment
guidelines, to ensure complete treatment and avoid drug resistance. The District
Malaria Programme of the Government of Gujarat asked for WHO assistance to
Report of WHO Activities, 1 August 2001 - 31 January 2002
16
Gujarat Earthquake Relief Mission
compensate for the shortage of insecticide spraying and fogging machines. WHO,
understanding the urgency, itself procured and provided five portable thermal fogging
machines immediately. WHO convinced IFRC and Oxfam for the same, and they
provided many spraying and fogging machines.
National UNV doctors functioned as the backbone of the outbreak investigation and
rapid response teams.
During August 2001, an outbreak of fever was investigated in Kurbai village. Serum
samples were collected for dengue virus, which ultimately tested positive. But due to
timely and proper control measures, a simultaneous outbreak of dengue fever could be
prevented.
To tackle the malaria situation during the months of September-October 2001, extra
personnel from other parts of the state were called in. Special teams attached to the
respective PHCs (under direct supervision and direction of PHC medical officer)
looked after each positive case, particularly amongst the camps of migrant labourers.
At the request of the Health Secretary, WHO also coordinated a health education
campaign regarding control of malaria. Regular data input and analysis continuously
evaluated this campaign. All international agencies including Oxfam, Merlin, CARE,
IFRC, and other partners in the field contributed for this programme with the technical
guidance provided by WHO and necessary support by the Government of Gujarat.
Weekly Incidence of Malaria in Kachchh
Post-Disaster Week
Report of WHO Activities, 1 August 2001 - 31 January 2002
17
Gujarat Earthquake Relief Mission
The malaria control programme had several gaps in the form of shortage of manpower,
insecticides and fogging machines. WHO surveillance officers addressed these
problems very well in respective Taluka coordination meetings. In Rapar, even
intersectoral coordination mechanism was developed for malaria control. Every week,
the disease surveillance unit provided detailed linelist of slide positive (P. falciparum
and P. vivax) cases to urban malaria control personnel and followed-up to ensure that
radical treatment is given to all. WHO, in consultation with the National Anti-Malaria
Programme, also advocated prophylactic treatment of malaria for the pregnant women
in the district.
With the overall well coordinated response generated by the efficient surveillance
system, malaria incidence showed a downward trend. The number of new cases
decreased rapidly by November 2001.
District Disease Surveillance Task Force
In view of sustainability of the surveillance mechanism, a task force needs to be
established to ensure efficient and sensitive data collection process, epidemic
preparedness and timely response. The Chief District Health Officer (CDHO), Chief
District Medical Officer (CDMO) and other senior district health officials, renowned
private practitioners, representatives of Indian Medical Association (IMA) and Indian
Academy of Paediatrics (IAP) would constitute this task force. District Development
Officer and Collector would also play a vital role in this task force. The surveillance
officer of WHO would provide the technical expertise. The necessary steps are being
taken in this direction.
WHO has now established its Kachchh District Disease Surveillance Unit (DSU) in the
campus of the District Development Officer's Office. It serves as a common platform
for senior government officials for technical guidance, updates and liaison. One can say
that practically all health sector activities in response to the earthquake are centred in
this WHO office.
Report of WHO Activities, 1 August 2001 - 31 January 2002
18
Gujarat Earthquake Relief Mission
Public Health Laboratory at Bhuj
To support the disease surveillance system established in the aftermath of the
earthquake in Kachchh district, WHO established a very well equipped public health
laboratory in a pre-fabricated structure at Bhuj. WHO provided the structure,
equipments, reagents and other supplies and technical guidance. The Government of
Gujarat agreed to provide the manpower to look after day-to-day functioning of the
laboratory. Due to this initiative of WHO, confirmatory diagnosis of diseases of public
health importance would become possible at Bhuj. The medical college laboratories and
the private sector laboratories were also involved in the surveillance activities.
WHO-Gujarat's Water and Sanitation (WATSAN) division and Disease Surveillance
division worked in close cooperation with the water and health department of the state
government, which resulted in very effective coordination between these two linked
departments.
Epidemiological data has also been used for evaluating interventions in health
education and hygiene promotion, sustainable water quality control. For example, the
Disease Surveillance Unit staff have conducted regular checking of free residual
chlorine in drinking water in the field, maintained records and provided feedback to the
concerned authorities.
A very effective liaison and coordination resulted in - No Epidemics even after such a
devastating earthquake. This was very well appreciated by the health and water
department which requested WHO to expand/replicate the Kachchh district model in
other earthquake-affected districts.
GIS (Geographic Information System) developed by WHO was a very effective
decision-making tool.
Report of WHO Activities, 1 August 2001 - 31 January 2002
19
Report of WHO Activities, 1 August 2001 - 31 January 2002
World Health Organization (WHO)
> 5 case
3 - 5 case
< 2 case
Source: Disease Surveillance Unit, WHO Bhuj
The boundaries shown on his map do not imply official endorsement or acceptance by WHO
N
Taluka: Rapar
Confirmed P. Falciparum Cases
Post Disaster Week No: 38 Period: October 15 to October 21, 2001
Weekly Epidemiological Summary, Kachchh District, Gujarat
Gujarat Earthquake Relief Mission
20
Report of WHO Activities, 1 August 2001 - 31 January 2002
World Health Organization (WHO)
> 5 case
3 - 5 case
< 2 case
70
0
70
W
E
140 Miles
S
N
Source: Disease Surveillance Unit, WHO Bhuj
The boundaries shown on his map do not imply official endorsement or acceptance by WHO
Rann of Kachchh
Confirmed Malaria Cases
Post Disaster Week No: 43 Period: November 21 to November 25, 2001
Weekly Epidemiological Summary, Kachchh District, Gujarat
Gujarat Earthquake Relief Mission
21
Gujarat Earthquake Relief Mission
Technical Support for Water and Sanitation Services
Highlights
•
Continued WHO support to the Government and local authorities in
improving water and environmental sanitation services to achieve
sustainable level.
•
Expansion of activities to seven more earthquake-affected districts.
•
Appointment of one more national UNV (WATSAN Engineer).
•
Emphasis on monitoring of quality of water supply.
•
Monitoring of rural chlorination on daily basis and regular review.
•
Awareness and health promotion drive through public fairs and religious
platforms.
•
Supply of chlorine solution to 200 villages and four towns.
•
Upgrading water-testing facilities for earthquake-affected districts
other than Kachchh.
•
Training activities in water quality and sanitation facilities in
coordination with government departments and local NGOs.
•
Strengthening water quality surveillance for the Kachchh District.
•
MOU with German Federal Agency for Technical Relief (THW) for
chlorination of rural water supply.
Report of WHO Activities, 1 August 2001 - 31 January 2002
22
Gujarat Earthquake Relief Mission
The water supply and sanitation facilities were very badly damaged due to the
earthquake.
Considering the promotion of health as the main objective, WHO
continued to extend support to the Government and local authorities in improving water
and environmental services to the sustainable level. The water and sanitation experts
worked closely with the Gujarat Water Supply and Sewerage Board (GWSSB).
Coordination at district and taluka levels is well established. In addition to the sanitary
engineer provided to undertake an assessment of the damage to the water supply and
sanitation systems in the affected area, two more public health engineers joined the
team as UN volunteers to strengthen the field activities.
Since December 2001, WHO has expanded its water and sanitation activities to seven
more districts in addition to Kachchh. The WHO office for state activities has been
shifted to Gandhinagar, the state capital, to have close linkage and coordination with
government machinery. During the course of time, two more national UNVs have been
recruited to cope with the increased work. One UNV each looks after KachchhSaurashtra and central-north Gujarat region.
WHO's main support included the following:
v
Strengthening of water quality surveillance for Kachchh district;
v
Monitoring of water quality through testing chlorination;
v
Upgrading water-testing facilities for earthquake-affected districts other
than Kachchh;
v
Capacity building through training and awareness programmes;
v
Coordination with Government, NGOs and other actors in the sector;
v
Technical advice and counselling; and
v
Health promotion through various activities.
Report of WHO Activities, 1 August 2001 - 31 January 2002
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Gujarat Earthquake Relief Mission
Strengthening of Water Quality Surveillance for Kachchh District
The State Government through the Gujarat Water Supply and Sewerage Board
(GWSSB) has been making commendable efforts to supply water to the affected
villages. UNICEF has been supplementing their efforts by providing hardware support.
However, water quality surveillance and monitoring was one area which was
adequately attended by WHO.
Considering the health significance attached to the quality of water, it was felt essential
to provide support to the District Water Laboratory of GWSSB at Bhuj. A project worth
US$ 93 000 has been taken up for providing following support to strengthen the water
quality surveillance and monitoring activities in the Kachchh district:
a. Manpower to carry out surveillance and water testing;
b. Mobile water testing laboratories mounted on utility vehicles;
c. Field-testing kits;
d. Chemicals, glassware and miscellaneous items;
e. Training of staff; and
f. Strengthening and furnishing of laboratory building.
Under the project, checking of drinking water samples from all villages on regular basis
by scientific staff, who will be provided vehicles to move in the field is envisaged. The
findings of the visit and analysis will be reported to the concerned authorities for
remedial action. The project is also expected to improve data bank and information
dissemination.
Report of WHO Activities, 1 August 2001 - 31 January 2002
24
Gujarat Earthquake Relief Mission
Water Quality
The quality of drinking water is essential to the health of communities. Hence, WHO
has accorded priority attention to the monitoring of water quality in the earthquakeaffected Kachchh district. Chloroscopes were distributed to the government and local
agencies during the first quarter.
Chlorination is considered to be the most essential operation in water treatment to
prevent any morbidity related to drinking water, more so, in an earthquake-affected
area. WHO, therefore, established a network for monitoring of chlorination in the four
worst affected Talukas (sub-districts) of the district, through the support of the health
department, Gujarat Water Supply and Sewerage Board (GWSSB) and German Federal
Agency for Technical Relief (THW).
THW provided about 50 chlorination plants for villages, which were being managed
through the Gram Panchayats. WHO entered into an agreement with THW to monitor
the working of the plants. THW has withdrawn from the field since September 2001,
and WHO is looking after the performance and providing technical guidance in troubleshooting. As a result, chlorination in rural areas has appreciably improved and is
regularly reviewed in the weekly health coordination meetings. This has helped to a
great extent in preventing any water-borne disease so far.
WHO had provided 1 250 chloroscopes to field staff for measurement of residual
chlorine and also imparted necessary demonstrations and training. The health staff in
the field is regularly checking the residual chlorine in villages and reporting the
performance in weekly coordination meetings held at the Taluka level. On an average,
more than 85% samples show presence of chlorine. The representative of GWSSB
present in the meeting takes note of the shortfalls and reports compliances in the next
meeting. WHO surveillance officers persuade follow-up action during the following
week.
Report of WHO Activities, 1 August 2001 - 31 January 2002
25
Gujarat Earthquake Relief Mission
Good understanding and working relations prevail between the Water and Health
Departments due to advocacy by WHO. The quality surveillance mechanism has been
appreciated by the State Government and it has requested for its replication in other
earthquake-affected districts. WHO has considered this request under its future
expansion plan that has become operational since December 2001.
Severe effects of the earthquake were reported in Kachchh district where WHO has
been paying maximum attention. However, other districts suffered moderate to heavy
damages, which included water services also. The districts other than Kachchh affeced
by the earthquake were mainly Rajkot, Jamnagar, Surendranagar, Ahmedabad,
Banaskantha, Mahesana and Patan. The district laboratories for these districts are
located at Rajkot, Gandhinagar and Palanpur. At the request of GWSSB, WHO also
provided laboratory equipment for testing of water samples at these district
laboratories. Chlorination practices on the lines of Kachchh district are planned to be
taken up in other earthquake-affected districts also.
Demonstration of chlorine measurement in water
supply by WHO staff
Online chlorine check by staff of
district water laboratory at Bhuj
Report of WHO Activities, 1 August 2001 - 31 January 2002
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Gujarat Earthquake Relief Mission
Capacity Building through Training and Awareness Programmes
It was essential to develop the manpower that would take up the new challenges posed
by the situation. In these circumstances, WHO took up an extensive programme to
provide training to the professional staff and create awareness among the user
communities.
WHO
took up training programmes for pump operators, linemen, water supply
supervisors, health workers, PHC and sub-centre staff, village head and Panchayat
members, conservancy staff of municipalities and representatives of NGOs. There are
several Government agencies and NGOs working in the water and sanitation sector.
Each agency has got its own mandate of work. To avoid duplication of work and to
share the information, a sub-group on WATSAN activities was formed which meets
regularly (initially weekly, then fortnightly and now monthly) to review and take
follow-up action. WHO has been playing an active role in organizing such meetings
and taking follow-up action. WHO also maintains regular contacts with other NGOs
and UN agencies for concerted efforts.
Health message through religious platform
at Anjar in Kachchh district
Report of WHO Activities, 1 August 2001 - 31 January 2002
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Gujarat Earthquake Relief Mission
Review mission of Dr Dennis Warner, WHO Short-term Consultant, who visited Bhuj
in the month of June 2001. In his extensive report, the work of WATSAN sector is
appraised.
Chlorination Status in Kachchh District
from August to December 2001
Source: WHO Water and Sanitation, Gujarat
Report of WHO Activities, 1 August 2001 - 31 January 2002
28
Gujarat Earthquake Relief Mission
Water and Sanitation Sector Review Workshop,
Ahmedabad, 13 October 2001
As recommended by Dr Dennis Warner, WHO Short-term Consultant, in his review
mission report of July 2001, a one-day workshop was organized at Ahmedabad on 13
October 2001. The objectives of the workshop were:
(1)
To review the activities of the WATSAN sector in Kachchh, and
(2)
To invite suggestions for planning future activities.
The workshop was inaugurated by Hon'ble Mr Narottambhai Patel, Minister for Water
Supply, Government of Gujarat, and was presided over by Mr SK Nanda, Secretary
(Health), Government of Gujarat.
More than 50 participants from the Departments of Health and Water of the
Government of Gujarat, NGOs and other UN Agencies participated in the workshop.
The Hon'ble Minister, in his inaugural address, lauded the role of WHO. He appreciated
the joint efforts of WHO, the Department of Health and the Gujarat Water Supply and
Sewerage Board (GWSSB) due to which major outbreaks of water-borne diseases could
be contained. The Hon'ble Minister stressed the need for monitoring the disposal of
domestic wastewater, and protection of the sources of the public water delivery system.
More attention needed to be paid to chlorination of water and the water quality
monitoring network required strengthening. He further said that the WHO activities
should be replicated and expanded to other earthquake-affected parts of the State.
Mr SK Nanda, Secretary (Health), Government of Gujarat, said that a disease
surveillance model linked to the water quality surveillance should be developed and
more technical inputs provided to control the malaria menace. The information,
education and communication (IEC) activities should be strengthened to decrease
water-borne morbidity and mortality. The constraints in the sanitary facilities should be
Report of WHO Activities, 1 August 2001 - 31 January 2002
29
Gujarat Earthquake Relief Mission
removed through R&D activities, and adequate water supply and sanitation facilities
ensured at all health infrastructures. He suggested that WHO should plan for long-term
assistance to the State.
At the conclusion of the workshop, the following recommendations were made :-
A.
Drinking Water Supply
(1) Priority must be accorded to monitoring of drinking water quality.
(2) Community-based approach should be encouraged.
(3) Capacity building exercise should be made an ongoing programme.
(4) WATSAN activities should be expanded to other affected districts and
coordination between health and water supply departments established
as done in Kachchh.
(5) Documentation of data and experience gained should be ensured.
(6) Support should be provided to water quality monitoring in urban areas.
(7) Programmes to provide sanitary protection to the water supply sources
should be undertaken.
(8) WATSAN committees should be motivated.
B.
Environmental Sanitation
(1) Help must be extended to urban bodies in the treatment and disposal of
wastewater.
(2) Proper procedures for disposal of biomedical waste should be
established.
(3) Training manuals in Gujarati language should be developed.
(4) Intersectoral coordination must be promoted.
(5) Water and sanitation awareness programmes should be initiated.
Report of WHO Activities, 1 August 2001 - 31 January 2002
30
Gujarat Earthquake Relief Mission
Inter-state Meeting on “Gujarat Earthquake: Health Sector
Perspectives”, Ahmedabad, 6-9 November 2001
With technical and financial support from WHO, the Government of Gujarat organized
an Inter-state Meeting on “Gujarat Earthquake: Health Sector Perspectives” at
Ahmedabad, from 6-9 November 2001. The purpose of the meeting was to introspect
some of the policy, managerial and operational issues related to emergency response
and preparedness.
50 senior government officials from Delhi, Gujarat, Himachal Pradesh, Manipur,
Punjab and Rajasthan participated in the meeting, besides the Indian Army officials.
From Gujarat, the Health Commissioner, the Health Secretary and senior government
officials took active part in most of the deliberations.
The meeting was inaugurated by Hon’ble Dr Vallabhbhai Kathiria, Minister of State for
Heavy Industries and Public Enterprises, Government of India. Hon’ble Mr Ashok
Bhatt, Minister of Health and Family Welfare, Government of Gujarat, along with Mr
SK Nanda, Health Secretary and Mr Joy Cheenath, Health Commissioner, also attended
the inaugural session. In addition, the Health Minister also participated in the
deliberations of the meeting on a number of occasions.
Inaugural session of the Inter-State Meeting on "Gujarat Earthquake: Health Sector Perspectives"
held in Ahmedabad, from 6-9 November 2001. The meeting was inaugurated by
Hon'ble Dr Vallabhbhai Kathiria, Union Minister of State for Heavy Industries and Public Enterprises
Report of WHO Activities, 1 August 2001 - 31 January 2002
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Gujarat Earthquake Relief Mission
Various NGOs which were actively engaged in the earthquake-affected areas took part
in the deliberations of the meeting. Amongst the UN agencies, UNICEF and UNFPA,
besides WHO, participated in the meeting.
The Government of Gujarat organized a two-hour session through the state-owned
remote sensing satellite for close interaction with those districts level officials who
could not attend the meeting due to ceiling on the number of participants which was
enforced to make the meeting more effective. In this session, the WHO team consisted
of Dr Abdul Sattar Yoosuf, Director, SDE/WHO/SEARO; Dr Tej Walia, WHO Public
Health Administrator, WHO Representative's Office, New Delhi; Dr Luis Jorge Perez,
EHA/WHO/SEARO; Dr Lin Aung, STP-EHA/WHO/SEARO, and Dr Bipin Verma,
WHO Focal Point for EHA Activities in India. The Government of Gujarat team
consisted of Dr Joy Cheenath, Health Commissioner, and Dr Paresh Dave, Assistant
Director, Health Education Bureau. About 1,500 district level officials participated
through the satellite.
At the conclusion of the meeting, the following observations and recommendations
were made :-
S.No. Observations and Expectations
1.
Recommendations
Dedicated work and
It is unanimously resolved that
appreciation.
appreciation should be expressed to
all those who worked to save lives
and minimize the losses to the
community affected in the disasteraffected areas. This is more crucial
for those who worked in the first 24
hours simply on their human
instincts and in the absence of
adequate resources.
Report of WHO Activities, 1 August 2001 - 31 January 2002
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Gujarat Earthquake Relief Mission
S.No. Observations and Expectations
2.
3.
Recommendations
Exemplary attempts to help
Various stories and tales of
their fellow brethren and
battles for survival and outstanding
courage seen in the local
courage should be recorded and
community.
published by the Government.
Coordination had
A permanent state level coordination
significant positive impact
committee, with various stakeholders
on the outcome.
as members, should be an integral
part of the Disaster Management
Authority. Similar units could be
formed at the district, taluka and
village levels. The approach should
be to build a transparent and
efficient system.
4.
A permanent organization for
The proposed plan by the
disaster management is
Government of India should
established by PMO. States
immediately be discussed and
are to prepare State plans.
adopted with appropriate
modifications.
5.
The disaster management
A disaster management plan should
plan is the immediate need
immediately be prepared and, if
and it should reflect ground
already prepared, should be
level realities and applicable
modified with current information
to local situations.
and technology.
Report of WHO Activities, 1 August 2001 - 31 January 2002
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Gujarat Earthquake Relief Mission
S.No. Observations and Expectations
6.
Recommendations
The first response was
The rescue teams should be
unplanned and rescue
identified, effectively trained and
operations in future require
equipped with self-sufficient
preparedness.
facilities for uninterrupted action.
The need for rapid transportation
of such teams with effective
communication systems should be
guaranteed. This is necessary for
quick transfer of critical cases to
nearest care centres and deploying
other mobile medical units.
7.
The nodal institutes have to
All nodal centres for health and
be safeguarded so that the
medical care and other emergency
key facilities do not get
and essential civil services should be
damaged, crippling the relief
assessed for their vulnerability to
operations.
disasters. The plans should be
implemented by allocating
appropriate funds to apply
technology for the new constructions
of such centres before clearance for
the work is given.
8.
Active participation of local
A detailed directory of various
doctors and social workers is
agencies that can assist in disaster
imperative.
management should be prepared
and made available to all concerned.
Report of WHO Activities, 1 August 2001 - 31 January 2002
34
Gujarat Earthquake Relief Mission
S.No. Observations and Expectations
Recommendations
All these agencies should have
coordination so that their
participation at any given point of
time and place is ensured.
9.
Periodic drills for the rescue
All activities aimed at immediate
activities will be necessary.
action in a disaster situation should
be subjected to periodic (once in six
months) drills or mock events. This
will require a manual detailing
the person, task, time-frame and
responsibility for the entire
operation. The manual can be part
of (or a separate identity) a manual
covering guidelines for relief and
rehabilitation issues.
10.
Training and awareness are
A state Disaster Management
important in disaster
Institute running multi-faculty
management.
courses and providing refresher
courses recognized by the University
is necessary. Such an institute in a
border state like Gujarat will help
in combating any situation related
to man-made disasters like war. The
institute should have the capacity to
take up operational research on
disaster management.
Report of WHO Activities, 1 August 2001 - 31 January 2002
35
Gujarat Earthquake Relief Mission
S.No. Observations and Expectations
Recommendations
Simple modules and health education
material for the general public
should be prepared in vernacular
and lessons on disaster management
should be incorporated in school
textbooks and college education.
Till the institute comes up,
appropriate regional centres should
be identified to carry out this
function.
11.
Disease surveillance and
Disease surveillance by trained
environment management
workers has to be a regular activity
have potential to prevent
of the health sector. Better softwares
epidemics after disasters.
and analytical methods and
WHO assistance in training
equipment must be made available
and monitoring is
for this crucial activity.
commendable.
The issues of safe water and sanitary
waste disposal should be tackled
even in normal times.
The surveillance in the rehabilitation
stage should include recording,
managing and follow-up of injured
and handicapped. WHO assistance
should extend to other districts for
betterment of surveillance and
reporting system.
Report of WHO Activities, 1 August 2001 - 31 January 2002
36
Gujarat Earthquake Relief Mission
S.No. Observations and Expectations
12.
Recommendations
The role of the media in a
A media cell within the health sector
disaster is very crucial and
is needed. Some senior academicians
should be utilized in best
and public health managers should
possible manner.
be trained for media interaction. A
close liaison with media should be
ensured by frequent regular
interaction.
13.
Psychosocial and nutritional
Necessary planning for long-term
rehabilitation to the affected
intervention should be made by the
population.
core groups and reviewed
periodically.
14.
Physical rehabilitation.
An organization should be set-up
for all such cases that may require
physical and social rehabilitation.
15.
16.
Training for material
It is recommended that the
management by using supply
personnel at CMSO be trained in
and management (SUMA).
supply and management (SUMA).
Planning for reconstruction
It is recommended that the
and redevelopment of the
experience be supported,
health facilities is subjected
strengthened and disseminated.
to new initiatives which have
This particularly applies to the
been quite successful.
empowerment of the health sector
for taking up the construction
projects.
Report of WHO Activities, 1 August 2001 - 31 January 2002
37
Gujarat Earthquake Relief Mission
S.No. Observations and Expectations
17.
Recommendations
Coordination experience in
This experience needs to be
the disaster management has
documeted. The team of experienced
been quite satisfactory.
officers should be used effectively
in future so that their skills are best
utilized.
Report of WHO Activities, 1 August 2001 - 31 January 2002
38
Gujarat Earthquake Relief Mission
Expansion of WHO Activities in other Earthquake-affected Districts
of Gujarat
The administrative and coordination unit of WHO has been shifted to Gandhinagar, the
state HQ, and it will continue to function as the State liaison office, while the disease
surveillance unit will remain in Bhuj with minimal staffing.
His Excellency the Governor of Gujarat inaugurated the first state level liaison office
of WHO India country office, in the presence of WHO Representative to India, Hon'ble
Health Minister of Gujarat, and senior government officials.
Three surveillance officers (National UNV doctors) now share offices and other
resources with NPSP officers in the field (Rajkot, Mahesana and Gandhinagar), to build
on the existing system and network of different surveillance activities. Currently, five
national UNV doctors and two national UNV engineers (water and sanitation) work in
the field for the integration of disease surveillance and coordinated water quality
surveillance in eight needy districts of north-west Gujarat.
In addition to the existing funds of Gujarat Earthquake Relief Mission, new funding
from the European Commission is assured for integrated disease surveillance activities
in these districts (June 2002 - August 2003), based on lessons learned in Kachchh.
The new WHO office at the state HQ has started functioning as the state liaison office
for WHO India country office. In addition to the integrated disease surveillance and
regular liaison with the state authorities, many more activities are being considered.
Report of WHO Activities, 1 August 2001 - 31 January 2002
39
Gujarat Earthquake Relief Mission
•
Integrated disease surveillance in eight districts of Gujarat;
•
Coordinated approach with water quality, sanitation and environmental
health;
•
Linkages with health sector disaster preparedness;
•
Developing guidelines for surveillance of noncommunicable diseases;
•
Developing a public health resource centre at the state HQ;
•
A disaster epidemiology training course for government officials;
•
Improvement of water and sanitation facilities in the health institutions;
•
NGO partnership for pilot, innovative projects in the fields of:
o
Indian systems of medicine;
o
Blood disorders; and
o
Prosthesis and rehabilitation.
Report of WHO Activities, 1 August 2001 - 31 January 2002
40