The first cross-sectoral Mental Health and Psychosocial Support working group meeting was held in Eastern Samar.

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1 Photo: WHO/Aphaluck Bhatiasevi PHILIPPINES HEALTH CLUSTER BULLETIN ISSUE #13 HIGHLIGHTS TYPHOON YOLANDA A dengue fever Plan of Action is being developed by Ormoc City Health office in collaboration with health partners to identify priority interventions and initiate a concerted effort to address the rise in dengue cases. The first cross-sectoral Mental Health and Psychosocial Support working group meeting was held in Eastern Samar. Two units providing diagnostic services for suspected TB and MDR-TB (Multi Drug Resistant Tuberculosis) through rapid, fully-automated molecular techniques (Xpert) have been installed at Eastern Visayas Regional Medical Centre in Tacloban city. A measles outbreak response immunization campaign was conducted between 24 th and 27 th January in Tacloban City covering all barangays with suspected or confirmed measles cases. BOHOL EARTHQUAKE 15 Barangay Health Stations are currently being newly established or rehabilitated in coordination with local partners. Inside this bulletin: Typhoon Yolanda page 2 Bohol Earthquake page 9 Health Cluster Partners page 11 1

2 TYPHOON YOLANDA SITUATION OVERVIEW AFFECTED DISPLACED INJURED DEATHS MISSING In Tacloban, the construction of bunk houses is expected be completed by the end of January. The first group will start moving in over the coming weeks. However some environmental sanitation and hygiene concerns remain. The city of Tacloban is preparing a permanent relocation site for people living in no rebuild zones. Humanitarian partners are engaged in consultations to provide support to the Government efforts. The formulation of a plan of action addressing immediate concerns for restoration and rehabilitation for the basic health services for RESPONSE Health care facilities On 21 January, the Department of Health and WHO convened a panel discussion in Manila on building back better hospitals and other health facilities. Experts from the Philippines, Japan and the WHO presented lessons learnt and good practices on safe hospitals. Tacloban sub-national health cluster has highlighted the need for support from health cluster partners to rehabilitate district health centers and Barangay health stations, as commitment is low so far. In Tacloban, WHO is providing mapping support to identify all health facilities located within 40 meters of the coast-line, as all critical infrastructure in this area will have to be relocated according to a recent bill passed by the Government of the Philippines. Source: National Disaster Risk Reduction Management Council (NDRRMC) of the Philippines each Local Government Unit (LGU) in western Leyte was initiated based on the results of the Post-Yolanda Health consultative meeting in Ormoc City on 17 January. The Department of Social Welfare and Development (DSWD) is leading an inter-agency group in supporting Typhoon Yolanda survivors to return to their homes in Eastern Visayas. The Government is offering the survivors a package that includes transport, financial assistance and health services. As of 24 January WHO has completed assessments on the Health Care Waste Management Systems of 15 hospitals in Tacloban, Ormoc and Balangiga in Region VIII and Northern Cebu and Bohol in Region VII to determine LGU capacity and practices. The next hospitals to be assessed are in Roxas and Iloilo in Region VI. WHO is in discussions with the Department of Environment and Natural Resources (DENR) regarding government policy on the use of incinerators for medical waste management. Training activities are planned to be conducted in February 2014 in selected Yolanda affected areas to improve the capacity of LGUs on health care waste management. A 4.8-magnitude earthquake struck Leyte Island on 26 January. Although no damage or casualties were reported, the earthquake highlighted the need for disaster risk reduction to strengthen preparedness levels for floods, landslides and other anticipated hazards at municipal, barangay and community levels. Another low pressure area is developing southeast of Guam in the Pacific. Its forecast path will most likely follow Tropical Depression Agaton, again expected to bring rains in Haiyan-affected areas. In the province of Eastern Samar, WHO was engaged in a quick-fix of three health facilities that were affected by recent heavy rains. Balangkayan Rural Health Unit was provided with a temporary roof cover and Quinapondan Community Hospital was supported in repair work of windows, doors and the ceiling of the main building. At Balangiga Albino Duran Memorial Hospital, existing temporary settings were adapted by constructing a roofed concrete pathway, a concrete dome tent floor, elevated bases for tents and an elevated ambulance parking lot as well as a permanent roof structure on the Lab building and semi-permanent sanitary facilities. 2

3 Map: A Map: B 3

4 Map: C Partners and Foreign Medical Eight teams provide mobile health Teams clinics and mental health and psychosocial support. As of 27 January, there are now 25 foreign medical teams operating in Regions VI, VII and VIII, Surveillance and communicable please refer to maps A, B and C disease control for further information on the exact Highlights from the EWARN report locations. below. For more in-depth information please refer to the weekly Thirteen teams provide basic out- EWARN report that is available online under: patient care (type I), Three teams provide more advanced health services including surgeries (type philippines/typhoon_haiyan/ II) and one team provides special- reports/en/index.html ty type services (type 3). This week, 75 health facilities reported 13,544 total consultations through SPEED The proportion of consultations due to acute respiratory infection increased in this reporting week (19 Jan 25 Jan) from 28% to 31%, and it remained the leading cause of consultation amongst the SPEED conditions. Fever and rash and AHF remained at less than 1%. Acute watery diarrhea fell from 3% in the previous three weeks to 2% this week. Table 1: Summary of SPEED Reporting in Typhoon Yolanda affected Areas Jan 2014 Region Provinces Municipalities VI (#) 2 (#) 10 VII VIII Health Facilities and Reporting Sites (#) 11 4

5 NCR, region 4a and 3 Measles situation update Expanded Catch-up Measles Immunization Campaign 23 Jan - 3 Feb 2014 An Expanded Catch-up Measles Immunization campaign, targeting over 2.2 million children within the age-range of 6 months to 3 years, residing in all cities in NCR, all provinces and cities in Region IV A, and the provinces of Bulacan and Pampanga in Region III is currently underway. The campaign is health center-based, complemented with mobile fixed posts. External monitors are deployed to monitor the campaign implementation and to perform rapid coverage surveys in selected high risk communities. Monitors are composed of WHO WPRO staff, US CDC staff and members of the STOP (Stop Transmission of Polio) Team. WHO will support consolidation of data from the survey and dedicated one data manager to consolidate reports. CDC will support analysis and documentation of the lessons learned from this campaign. Mop up for low coverage areas is planned based on Rapid Coverage Assessments. Vaccination and cold chain Following the reports of measles in Tacloban City, an outbreak response immunization (ORI) campaign was conducted from January covering all barangays with suspected or confirmed measles cases. An ORI campaign in all areas with suspected measles in the municipalities Palo, Tanauan, Santa Fe, Albuera, Baybay, and Kanangga will follow between 28 January and 7 February. For both ORIs, the target age group is all children between the ages of 6 months and 3 years. Central Office DOH is supplying 8,000 doses of measles vaccine to add to the regions current stock of 50,000 doses. It will be used for both routine and ORI activities. In Eastern Samar, the number of suspected measles cases has increased in several municipalities over the past 2 weeks. While currently only one case is laboratory confirmed positive another 23 cases have been identified and samples (dry blood samples due to cold chain issues for serum sample transport) have been collected and sent to the Research Institute for Tropical Medicine in Manila. In the meantime active case finding and catch up vaccination campaigns are taking place in all affected municipalities. A Provincial Health Office (PHO) / DOH team is on standby to roll out a province wide vaccination campaign, however stock levels of monovalent vaccines are low due to the high demands in the Philippines and a targeted catch up campaign in high risk areas is envisaged is being implemented for now. Dengue and vector control Various initiatives were launched to rapidly and effectively address the rise in dengue cases over the past weeks in Ormoc City. A dengue fever plan of action is currently being developed by Ormoc City Health office (OCHO) in collaboration with health cluster partners to identify priority interventions. Ormoc city health office has been strengthening its surveillance capacities. Weekly 4 o clock clean up campaigns take place at different barangays by Sanitation Inspectors in collaboration with Barangay captains. WHO has supported trainings on SPEED for all districts and several municipalities outside of Ormoc city and provided Rapid Diagnostic Tests (RDT) for Ormoc District Hospital (ODH) and OCHO. WHO has distributed mosquito nets for ODH and other private hospitals. Partners have pledged to participate in dengue related activities. Medicines du Monde (MDM) is conducting health education and hygiene promotion activities in different Barangays. WASH cluster members, particularly the sanitary inspectors, have been mobilizing the community. OCHO has been fogging and larvicidal spraying in different barangays, supported by MSF and Rotary club. In response to the increasing numbers of dengue cases in Eastern Samar the PHO/DOH team provided mosquito nets to all health facilities to distribute to all suspected and confirmed dengue cases with clear messages on when and why the patient has to sleep under the net to protect the transmission of the disease to further mosquitoes. This is just one of a number of preventive measures to mitigate the spread of the disease in Eastern Samar. Health messages are being aired on the radio and disseminated through health promoters, high 5

6 risk areas are being sprayed and most importantly a large number of cash for work teams from various partner agencies (UNDP, PIN, ICRC, MSF) are engaged in search and destroy activities that aim to reduce breeding sites in and around critical facilities like schools, health facilities and bunk houses. In Tacloban, of the total of 130 rapid diagnostic tests for dengue, that were utilized from mid- December last year until now, 34 (26%) were positive with the majority (21) coming from Tacloban city. As a result, fogging operations and environmental control interventions have been stepped up with the support from partners. Mental health and psychosocial support (MHPSS) The Tacloban sub-national Health Cluster reports, that the Mental Health and psychosocial support group is working on standardization of the delivery of services. Training for health workers was conducted by IMC in collaboration with WHO. Analysis of the work by the different partners showed that 9 organizations are currently working on dissemination of information to the community at large, 3 organizations are facilitating community mobilization, 22 organizations are working on strengthening community and family support, 5 organizations are providing safe spaces and 10 organizations are providing psychosocial support in education. On the 30th of January the Eastern Samar Provincial Health Office with support from WHO hosted the first cross-sectoral Mental Health and Psychosocial Support working group meeting with partners from the Department of Social Welfare, the Department of Education, with respective cluster coordinators in education and protection and various national and international NGO's working on MHPSS in Eastern Samar. Quality mental health services are difficult to access in Eastern Samar and needs at all levels of the "intervention period for mental health and psychological support" have drastically risen after Typhoon Yolanda. It is the desire of the PHO/DOH to seek the opportunity to introduce and implement sustainable mental health services in the province and this working group is a first step in this direction. Reproductive Health (RH) In the next 3 months, more than 70,000 births are expected, of which about 8,500 (12%) are from adolescent mothers under 19 years old. Since December 2013, a total of 56 RH missions have been conducted in Leyte, Eastern Samar, Capiz and Iloilo serving 8,948 beneficiaries, including 3,711 pregnant and 3,992 lactating women, through pre- and postnatal checkups, health information sessions, and hygiene kit distribution. Of these, 439 are adolescent girls years old. However, there has been a low uptake of family planning services among the affected population. Three ambulances were provided by UNFPA to provincial hospitals in Eastern Samar and Leyte as well as to the Tacloban City Health Office to enhance transport of emergency cases The Reproductive Health and Maternal and Child health working group (RH-MCH WG) reports that a total of 10 women friendly spaces, also serving as breast-feeding spaces, were established in different evacuation centers in the affected areas. New Maternal and Child Health Guidelines and Policies During Emergency and Disaster were published by the Female Health Office of the DOH and the RH- MCH WG to be distributed to all organizations working on Reproductive Health and Maternal and Child health in disaster affected areas, including Bohol and Zamboanga. Water, Sanitation and Hygiene (WASH) and Environmental Health Local capacities for water quality monitoring and management in Local Government Units (LGUs) in Eastern Samar and Leyte, including Tacloban and Ormoc, were assessed during a WHO field mission between 6 and 16 January. Findings show that not all LGUs currently have functional monitoring systems in place. While staffing is adequate, equipment and logistics are not sufficient in all LGUs. In addition, consultations with relevant partners including DOH, UNICEF, Oxfam, Metro Leyte Water District, City Health Offices of Ormoc and Tacloban and the Provincial Health Offices of Leyte and Eastern Samar on a proposed water quality monitoring framework are on-going. The consultations resulted in a project proposal to address the capacity issues in the affected areas on water quality management. Funding support is now being secured for the proposed project with a cost estimate of US $ 500,000. 6

7 Representatives from WHO and the DOH participated in a call-in Humanitarian Radio show for community questions related to health on Saturday Jan 25 in Tacloban. The 1 hour format was aired by Radyo Abante, funded by UNDP and housed at the UNFPA compound. Topics included WHOs and DOHs role in the Yolanda Response, dengue cases and monitoring in Tacloban City as well as the recent vaccination campaigns. TB Two units providing diagnostic services for suspected TB and MDR-TB (Multi Drug Resistant Tuberculosis) through rapid, fully-automated molecular techniques (Xpert) have been installed at Eastern Visayas Regional Medical Centre in Tacloban city. Representatives from WHO and the DOH participated in a call-in Humanitarian Radio show for community questions related to health on Saturday Jan 25 th in Tacloban. DONORS Major WHO donors: Australia, Canada, Norway, Japan, the United Kingdom and the UN Central Emergency Response Fund (CERF), Russian Federation, Sweden and the United States of America, and from the European Commission Humanitarian Aid and Civil Protection (ECHO). 7

8 FUNDING STATUS OF ACTION PLAN As of 29 January 2014, OCHA has updated the action plan, which is now at is 40% funded for the health sector (table 2). Merlin & Save the Children Essential Health Services for Preventing Excess Mortality and Morbidity in Typhoon Haiyan affected Population 29_January_2014_(03_01).pdf Table 2: FUNDING STATUS OF ACTION PLAN FOR HEALTH (US$) Project Appealing Agency Amount Required Funding % Covered Save the % Children Ensuring Access to Reproductive Health Services in the Aftermath of Typhoon Haiyan UNFPA % Provision of emergency health services to ty- WHO % Immediate assistance to injured and vulnerable HI % persons affected by Haiyan typhoon in Philippines Emergency Health care, public health and referral IOM % initiatives for displaced and affected persons on the move and their vulnerable host communities Provision of life-saving interventions for health UNICEF % to children 0-59 months affected by Typhoon Haiyan emergency Provision of quality medicines and developing IHP % resilience in the supply chain to avoid gaps by strengthening the department of health medicines stock management systems Prevent increase in maternal, neonatal and Plan % child mortality post disaster through ensuring continuity of services for these more vulnerable groups Promoting mental health and psychosocial wellbeing IMC % of populations affected by Typhoon Hai- yan Ensuring the health needs of older people in HelpAge International % Typhoon Haiyan Health care support for Typhoon Haiyan affect- IMC % Enhancing coordination within and outside the WHO % Surveillance, outbreak prevention and vaccination WHO % Local health system recovery for social and WHO % Delivery of essential health services to meet the WHO % immediate health needs of the affected population Typhoon Haiyan emergency health response WV Philippines % Health assistance for disaster affected communities RI % of inland Leyte and coastal Barangays of Tacloban municipalities of Tacloban City, Jaro, San Miguel and Carigara Provision of emergency medical assistance to MDM France % Saving Women s lives in Typhoon affected Saude em Protugues % provinces through reproduction health Restoration of basic health package within Concepcion Municipal Health Office area AAI % Sub total for health % 8

9 BOHOL EARTHQUAKE SITUATION OVERVIEW 1.25 Million AFFECTED DISPLACED 223 DEATHS IN EVACUATION CENTERS Most of the 367,760 people whose homes were damaged or destroyed are still living in their damaged houses, or in tents near their homes, with just 2,681 people remaining in evacuation centres. There is an increasing need for essential health services including mental health and psychosocial support delivery to be strengthened to support the need of the affected population. There is an estimated 7,894 pregnant and 5,262 lactating women, needing specialized services for prenatal, postnatal, child health, health promotion and family planning services, impeding the swift implementation of health cluster activities. Constrained resources (human, technical, financial), the limited number of cluster partners, as well as limited resources and competing priorities impede the swift implementation of health cluster activities. RESPONSE Map: D Health care facilities Currently, 15 identified Barangay Health Stations (BHSs) are being set up or rehabilitated in coordination with local partners. UNFPA in partnership with WHO has set up temporary birthing facilities and provision of reproductive health (RH) kits to serve 30,000 people and ensure access for pregnant and lactating women to skilled birth attendance and quality reproductive health services. Surveillance and communicable disease control From 19 to 25 January, 1,656 total consultations were reported on SPEED from 22 health facilities in 15 municipalities. The top five leading consultations were: Acute respiratory infection Open wounds Hypertension Bruises and skin diseases Fever There were 67 diarrhea, 29 fever and rash, 3 suspect dengue and 1 suspect leptospirosis cases reported. 9

10 Vaccination and cold chain Supplemental immunization activities for children 0-59 months old in 293 identified high risk barangays in 18 municipalities have been completed. 21,107 children were given oral polio vaccine and 20,139 children received measles vaccine. Mental health and psychosocial support (MHPSS) UNFPA has provided training to the health sector and social workers on psychosocial support to affected people. In addition, training on establishing women friendly spaces (WFS) were provided to two municipalities. There is a lack of capacity (knowledge and skills, medicines and supplies) on basic psychiatry in primary care settings (RHU level). The province has no facility for patients needing confinement. Reproductive Health Twenty-four local health staff coming from the 6 inter-local health zones (ILHZ) of Bohol province and the provincial health office (PHO) underwent a training-oftrainers on Essential Intrapartum and Newborn Care (EINC). They will form the local training pool tasked to build the capacity of rural health midwives towards reducing maternal and infant mortalities. UNFPA in partnership with WHO have set up temporary birthing facilities and provision of reproductive health (RH) kits to serve 30,000 people and ensure access for pregnant and lactating women to skilled birth attendance and quality reproductive health services. Water, Sanitation and Hygiene (WASH) and Environmental Health A representative from WHO met with the WASH cluster coordinator and the water quality monitoring laboratory in charge to investigate the contamination of water sources and plan for further activities. On October 15, 2013, a powerful earthquake struck central Philippines. Measuring 7.2 on the Richter scale with a depth of 33km, PHILVOLCS reported the quake s epicentre in the municipality of Sagbayan in Bohol province. The tremor was felt in Cebu, Bohol, Negros Occidental, Negros Oriental, Iloilo, Siquijor, Leyte, where houses, public buildings, roads, bridges, churches, seaports, schools, health facilities, were damaged and thousands of people dis- placed. The earthquake killed 222 people (209 in Bohol) and injured 976 (877 in Bohol). As of 3 November, 2013, PHILVOLCS recorded a total of 3,198 aftershocks, with 94 strong enough to cause alarm to the population. Aftershocks continue to be felt beyond this period. On November 8, 2013, super typhoon Yolanda (international name Haiyan) made landfall in Guiuan, Eastern Samar. Electric power cables supplying electricity to Bohol were damaged, causing power outage in the whole island and affecting the delivery of disaster relief including cold chain integrity and immunization services 10

11 Health Cluster Partners National Manila: AECID, Americares, Australian Aid, CDN- DART, CFSI, ChildFund, DFID, DOH, FPOP, Handicap International, HuMa, IFRC, IHP-UK, ILO, IMC, IOM, IRC, ISAR-Germany, JICA, MERLIN, MDM, MSF, National Bureau of Investigation, PHE, Philippines Red Cross Society, Relief International, Plan International, Project Hope, PU-AMI, SCI, UNFPA, UNICEF, USAid, US Forces, WHO, World Vision. Sub-national Tacloban: AECID, ACF, ACTED, Action Pompiers Uzgence Inlana Vionus, ARC, ASEAN, ASYA SAR/KYM, B-FAST, AUs, Bomberos Unidos SP, Care, Christian Aid, DFID, DOH, ECHO, Emergency.LU, Ericsson Response, EUCPT, First Relief Fund, First Response Radio, Fuel Relief Fund, German Embassy, German Red Cross, Globalmedic, GOAL, Good Neighbours Intl., Good People Intl., HUMEDICA,IFRC, International Disaster Relief, Internews, IOM, IsraAid, JICA, KIHI, KOICA, Leger Foundation, Miral Welfare Foundation, MSF/ F, OCHA, Oxfam, Philippines Red Cross Society, Pompiers Humanitaires France, PUI France, Samaritan 119 Korea, SC, SCDN, Solidarities International, Spanish Red Cross Society, TGCFI, RTR hospital, UNDAC, UNDP, UNFPA, UNICEF, USAID, US OFDA, Vodafone foundation, WFP, WHO, WISAR, World Vision. Sub-national Cebu: AmeriCares, ASB Austria, Canadian Emergency Response Unit, Canadian Medical Assistance Teams, CFSI, ChildFund, DOH, Embassy of Israel, Eversly Child Sanitarium, GOAL, Glory Reborn, ICRC, IFRC, IEAD relief, Health Organization of Mindanao w/ Helping Hand relief and Development, International Medical Corps, JICA, Japan Red Cross, LandsAid, Magna Children at risk, Med Japan, The Mentor Initiative, Merlin, MSF, NYC Medics, PNA, Project hope, React Philippines, Samaritan Purse, Samu Sevilla International, SC, SCI, Spanish Red Cross Society, Saint Anthony Mother and Child Hospital, Talisay District Hospital, UNICEF, Vicente Sotto Memorial Medical Centre, WHO, World Vision. Health Cluster Contacts Sub-national Roxas: ACF, Action Aid International, Canada DFAT, Child Fund, CRWRC, DoH, GOAL, IOM, Japan Heart Foundation, Philippine Rural Reconstruction Movement, MSF-Swiss, NETHOPE, Save the Children, UNDAC, UNICEF, Welthungerhilfe, WFP, WHO, World Vision International. Sub-national Guiuan / Borangan: IOM, Medical Team International, DOH, Plan, PHTO, Norwegian Church aid, Radio Bakdaw. Sub-national Ormoc: AusAID, Australian Army, CMAT, ChildFund, Clarion Global Response IMAT, COSE, CFSI, COPAP, DOH, HelpAge International, HuMA, IFRC, IsraAID, IRC, Johanniter International Assistance, KMA, Magna Children at Risk, MDM France, MDM Spain, Mercy Malaysia, MSF, OCA, Ormoc City Health Office, Ormoc District Hospital, Philippine Army, PAC, Pureworks Foundation, Merlin-Save the Children International, SADC- Swiss Humanitarian Aid, Singapore Red Cross, Vestergaard, WHO, World Vision. Sub-national Bohol: UNFPA, Philippines Red Cross Society, UNICEF, MERLIN, IOM, DOH National- Manila: haiyanhccmanila@wpro.who.int Sub-national- Tacloban: haiyanhcctacloban@wpro.who.int; hcctacloban@gmail.com Sub-national- Cebu: haiyanhcccebu@wpro.who.int Health Cluster Website: 11