Day 1 Session: 1.6 Overview of DRR and Health 75min 15.45 – 17.00 hrsSession objectives:By the end of this session participants will be able to explain• The components of health services with respect to DRR.• The causes of morbidity (disease or injury) and mortality (deaths) pre-disaster, during and post disaster.• The transmission of infectious diseases• The various barriers that could be introduced to reduce public health risks in disasters.Key learning points of the session:• Definition of Health - Health is a state of complete physical, mental, social and spiritual well being- it is not the mere absence of disease• DRR related components of health services include health system, infrastructure, control of communicable diseases and non-communicable diseases.• Understanding of the structure of health services and systems in Madhya Pradesh is essential.• Feco-oral disease transmission route and the interventions that can act as barriers in the disease transmission route which eventually mitigate the public health risksHandout for the session:What is Health?WHO defines health as “a state of complete physical, mental, social and spiritual wellbeing - it is not the mere absence of disease”.DRR related components of Health Services
Fig 1. Components of health services (based on SPHERE Guidelines)Structure of Health Services in MPSub-centres provide for 5000 population in plains and for 3000 population in hills/ tribalareas. There is one ANM in every centre and a male health worker in many centres.Above this is a health supervisor (or LHV). The Medical Officer In Charge (MO IC/Prabhari) looks after this team. In many blocks there is also a Block Sanitary Inspector(BSI). Primary Health centres – (A) PHCs (usually non-bedded) exist at 30,000population level with a doctor and support staff. The Primary Health Centres - PHC/Referral Hospital has 16 to 30 beds. There are usually 2 to 3 doctors other than theBMOH. Deliveries should take place at all Referral Hospitals. First Referral Units (FRUs)are supposed to have specialists and be able to do Caesarean Sections and difficultdeliveries.The primary goals of disaster risk reduction are to:1) Prevent and reduce excess mortality and morbidity,2) Promote a capacity to return to normalcy in case a disaster strikes
Fig. 2. Health risks in disastersDifferent types of disasters are associated with differing scales and patterns of mortalityand morbidity (see table), and the public health and medical needs of an affectedcommunity will therefore vary according to the type and extent of disaster expected.Prioritization of health services requires a clear understanding of the affectedcommunity’s normal health status, needs, health risks, resources and capacities. Prior todisaster, information needs to be complete and all of the relevant data available andanalyzed so that important public health decisions can be made. A multi sectoralassessment that includes community representatives should therefore be conductedroutinely to determine the priority public health needs, the availability of local resourcesand the requirements for external assistance and the public health impact of anyexpected disasterAlmost 55.8% of the entire state is susceptible to floods.Aila affected more than 6.3 million people and nearly half a million homes.Health effects of Aila:Out of a total population of 13, 50, 000 affected in 24 Parganas: • 53,840 suffered from diarrhoea out of which 11 died. • 61 were victims of snake-bite and 2 people died. • 6,17,000 people were injured. • 22,400 people suffered from malaria, dengue and choleraSome Health Statistics in MP –
Table 1. Demographic Indicators in MPMinor ailments – cough, cold, fever, diarrhoea, worms, pain, cuts, injuries,red eye, allergies which are treated by ANM-s and field level health workers.Skin diseases commonly seen include– fungal infections, scabies, impetigoChronic DiseasesTable 2. Chronic Diseases in MP and India (NFHS 3 2005-06).Prevalence Madhya Pradesh CG India West BengalDiabetes (Males) 5.55/ 1000 9.32 10.51 23.23 (Females) 5.58 6.59 8.81 16.41Asthma (Males) 11.02/ 1000 8.58 16.27 43.65 (Females) 12.83 7.46 16.96 34.04Thyroid (Males) 4.24/ 1000 3.58 3.83 6.67 (Females) 5.99 5.63 9.41 16.26Table 3. Health Indicators in MP and India
NFHS 3 MP Bihar BengalDeaths IMR 70 62 48Child too thin for age 60 58 44
Table 4. Maternal Health Indicators in MP and India
Transmission of Infectious DiseasesDiseases are spread basically due to inadequate or poor quality of drinking water, poorsanitation and bad hygienic practices. Specifically, communicable diseases are causeddue to faeco-oral transmission routes as shown in (Fig.3) F-diagram or commonly calledas 5 F diagram. In this diagram the 5 F-s refer to Finger, Flies, Fields, Fluids and Food.Diarrhea and cholera are some of the commonly observed diseases post disaster.Faeco–oral disease transmission plays a vital role in the outbreak of diarrhea andcholera epidemics in emergencies. Even in normal situations also, such communicablediseases are spread from one person to another through the transmission routes asshown in the 5 F diagram.The transmission can be through making contact with any of these 5 F-s. Pathogens inthe faecal matter reach the host directly through unwashed fingers, flies, field (soil orland), fluids (water) and food. This is the primary transmission. Pathogens can also gettransmitted at the secondary level. For example, from fluids to food or finger to food.These are clearly mentioned in the F diagram. Fig.3 F- diagram
The diagram also shows vertical lines breaking the transmission routes. They are thebarriers which help prevent transmission. Specific WASH interventions can act asbarriers in the transmission route. They are classified as primary barriers and secondarybarriers. Primary barriers are the ones that prevent the pathogens in the faecal matterfrom reaching finger, flies, field, fluids and food. Secondary barriers are theinterventions that help in checking the secondary level of transmission. It can be notedthat primary barriers are basically water and sanitation interventions and the secondarybarriers are part of hygiene promotion.Five Barriers that reduce risk of disease1. Mother and Child Health.This is now called Reproductive and Child Health. It includes antenatal care ANC,Institutional Delivery and Immunization2. WASH or water, sanitation, hygiene.It includes Safe Water (which has undergone both filtration, and disinfection), SanitaryLatrines to dispose urine and faeces, Hand Washing (before eating and after going tothe toilet). Hand Washing should preferably be done using soap.3. Food.Early initiation of breastfeeding (within half an hour of birth) with exclusivebreastfeeding for initial 6 months of the infants life, Timely initiation of complementaryfeeding after 6 months and continuation of breastfeeding at least till completion of 2years of age of the baby – as per Infant and Young Child Feeding Practices (IYCF),ICDS for pre-school children (3-6 year) and Mid Day Meals for school going children (>6 years) are the various nutrition interventions for children4. The fourth barrier is for non-infectious causes. • Anti Snake Venom or ASV is to be made available in all PHCs and is the best way of saving lives in July and August • Good Life Jackets can be made at low cost and provide protection from drowning • Safe Housing can prevent deaths such as those in the tornado in U Dinajpur in April 2010 or lightning deaths5. The fifth barrier is against chronic diseases. Screening at Sub Centres helps detectdiabetes, high BP or other chronic diseasesSince 53% of the villages of West Bengal are flood-prone, so recovery includingrehabilitation and reconstruction is difficult in these areas. Both government and NGOsmust work together to face and manage these kinds of disasters. SAMBIT suggestedforming a group in every block comprising of one government official and a doctor andthat their contact numbers must be provided to everybody in the respective block. Pre-disaster and post disaster plans are required.
Session plan:Running Description of specific activities of the sessiontimeFirst 5 Facilitator starts the session with explaining objectives of the session and themins significance of the session for the entire training programme. This needs approximately 2 minutes followed by “Quick Brainstorming” The facilitator asks the question “What is Health?” to the participants and helps them come up with few answers that help determine the concept of health. The facilitator should list down the points from the brainstorming on the white board. At the end of the brainstorming please emphasize on following points: • Health is not the mere absence of disease • Explain elements with following specific examples o Physical: Able to do work and earn a living o Mental: Free from Tensions eg Joblessness/ Violence o Social well being: Freely able to Voice Opinion6-10 For understanding the various health services in DRR the visuals are used.mins Visual 1 Health Services: • Explain three components of Health services: Health Infrastructure- example sub-centre, • Control of Communicable Diseases- TB control or treatment of diarrhoea, Control of Non-Communicable Diseases- high BP/ injury/ RCH11-15 The facilitator emphasizes on the various structures of health services in Westmins Bengal. Here the focus should be on various systems of health mainly, ANMs, ASHA and AWWs. The structures details are given namely, about PHCs, sub- centres etc.
16-30 Explanation of visuals Visual 2 shows the fig 2. Printed on flex banners. It explains about the common diseases caused during disasters: Injuries, Drowning, Diarrhoea, Malaria, Measles, Pneumonia, Newborn Deaths, Pregnancy related The facilitator shows Fig 2 to the participants and gives an overview of the above diseases.31-45 Statistics of disease in Madhya Pradesh: Display the charts (Table 1 to 5) indicating various diseases prevalent in MP. Deaths/ Mortality – Compare state rates with local IMR U5MR Death Rates from Block MO or CMO Nutrition (Growth monitoring) – Compare state rates with local nutrition status from CDPO or DPO.46-60 Visual – 4: F diagram: The facilitator begins by asking “How diseases are caused?” Then shows the visual (printed on a flex banner) to participants and requests them to identify the name of the disease and the causes for the disease. Please list participants’ responses on flip chart. Explain F diagram to the participants. Please emphasize on how all the elements in diagram are interrelated. Show the transmission route from faecal matter to ultimately the host by referring to the flex banner. Explain how the transmission happens through fingers, food, field, fluids and flies.
61-75 Participatory discussion Explain the barriers in the transmission route. Ask the participants if the transmission route can be broken or can we introduce some barriers in the route. Welcome their ideas and ask them to explain how that can be barriers. Then introduce other barriers as shown in the F-diagram. The emphasis should be on the 5 Barriers that reduce risk of disease 1. Mother and Child Health 2. WASH 3. Food 4. Prevent non-infectious causes (-Anti Snake Venom -Life Jackets against drowning -Safe Housing) 5. Screening for chronic diseases. Conclude the session by assuring the participants that more and detailed information on public health risks will be dealt with in the subsequent sessions.Methods:Brain storming. Use of visual aids on SPHERE and F diagram.Participatory discussion on Minimum Standards for each of 5 Barriers and usingquestionsMaterial required:1 White board,4 white board markers differently coloured,8 flip charts,pre-designed visual aids – posters; pics of Mosquito, Dirty Water, Open Defaecation,Fly; flex banners, flip charts. Local Data on IMR, U5MR, Nutrition if available.