AUICK Newsletter. No.58. Asian Cities and People. Inside. Aug FEATURE: Maternal and Child Health Care and Natural Disasters

Transcription

1 ISSN AUICK Newsletter Asian Cities and People No.58 Aug 2013 A maternal and child health care clinic in Olongapo, the Philippines Inside FEATURE: Maternal and Child Health Care and Natural Disasters AUICK / WHO Kobe Centre Urban HEART Workshop 4 AUICK Action Plan System 5 Kobe City Reports 7 WHO Kobe Centre Urban HEART Training 9 AUICK Associate City Reports and Action Plans SUPPLEMENTS 22 AUICK Associate City News 23 International News 24 AUICK/JICA Technical Support Project Kobe Commerce, Industry and Trade Center Building 2F, Hamabe-dori, Chuo-ku, Kobe , Japan Tel: Fax: auick@auick.org AUICK is supported by Kobe City Government

2 UICK / WHO Kobe Centre A Urban HEART Workshop AUICK and the World Health Organization Centre for Health Development (WHO Kobe Centre) jointly held the 2013 Urban HEART Workshop on Maternal and Child Health Care and Natural Disasters in Kobe, Japan, from 11 to 15 March. Participants were officials of seven AUICK Associate Cities (AACs). Background According to the World Health Organization (WHO), poor maternal, newborn and child health remains a significant problem in developing countries. Worldwide, 358,000 women die during pregnancy and childbirth every year and an estimated 7.6 million children die under the age of five. The majority of maternal deaths occur during or immediately after childbirth.* In times of disaster, it is necessary to ensure safe childbirth and reestablish maternal health services where they have been devastated. Through its experience of the Great Hanshin- Awaji Earthquake which devastated Kobe and its surrounding areas on 17 January 1995, Kobe City Government has learned the importance of securing nutrition, water and hygienic conditions, continuing regular check-up services and supporting the physical and mental conditions of pregnant women, infants and babies in the aftermath of a natural disaster. Kobe has also established a Department for General Crisis Management, which has given the city greater capacities to manage natural disasters, and maintain its secure and peaceful environment. Since 2004, the Asian Urban Information Centre of Kobe (AUICK) has been supported by Kobe City Government and UNFPA to conduct training workshops for senior government officials of nine AUICK Associate Cities (AACs), to increase their capacities to address issues related to population and development. AUICK incorporated an Action Plan system into its Workshop project in 2005, for the AACs to utilize lessons learned from training programs in Kobe. Since 2005 under this system, 79 Action Plans have been made, of which over half are now implemented as government policies. The World Health Organization (WHO) Centre for Health Development (WHO Kobe Centre) has also recently developed the Urban Health Equity Assessment and Response Tool (HEART) as a guide for decision makers to plan action on inequities in health. * Aim The 2013 Urban HEART Workshop from 10 to 16 March was arranged for senior officials of the health departments of AAC governments to exchange information on inequities and challenges in the provision of maternal and child health care services, as well as preparedness for the provision of those services in disaster situations. Participants were also trained to make Action Plans based on the WHO Urban Health Equity Assessment and Response Tool (Urban HEART), to assist their formulation of policy and programme solutions to overcome inequities in health and health care services, especially for vulnerable populations. AUICK Newsletter No.58 2 August 2013

3 Participants Participants of the 2013 AUICK / WHO Kobe Centre Urban HEART Workshop were health officials of the AUICK Associate Cities (AACs), including Chittagong (Bangladesh), Weihai AUICK Associate City (AAC) Government Participants Dr. Irin Akter Consultant, Gynaecology and Obstetrics Mostafa Hakim Maternity Hospital, Chittagong City Corporation, Bangladesh Mr. Tian Qing Deputy Director, Obstetrics and Gynaecology, Weihai Women and Children s Hospital, China Mr. Mahesvaran Chinnapalli Namadev Deputy Commissioner (Health), Health, Corporation of Chennai, India Dr. Vitri Saktiwi Paediatrician, Child Health Department, Bhakti Dharma Husada Hospital, Surabaya City Government, Indonesia Dr. Nasir Muhammad Untung Obstatrician and Gynaecologist, OBGYN Department, Government General Hospital Dr. M. Soewandhie, Indonesia Dr. Amirullah Mohd. Arshad District Health Officer of Kuantan District, Department of Health, Pahang State Health Department, Malaysia Mr. Lloyd Brian Joson Tubban City Health Officer I, City Health Department, Local Government of Olongapo City, Philippines Dr. Tan Ba Huynh Director, Center for Reproductive Health Care, Danang, Vietnam Opening Remarks On behalf of the AUICK Secretariat, Dr. Hirofumi Ando, President, welcomed participants to the 2013 AUICK / WHO Kobe Centre Urban HEART Workshop on Maternal and Child Health Care and Natural Disasters. With WHO Kobe Centre, the Workshop would introduce the Urban Health Equity Assessment and Response Tool (HEART), for participants to apply to maternal and child health programs in the AUICK Associate Cities (AACs). AUICK has been working with AACs for a number of years through Workshops to improve health services and to address two major health issues, infant and maternal mortality, as recognized and reflected in Millennium Development Goals (MDGs) 4 and 5. Participants are the key components of (China), Chennai (India), Surabaya (Indonesia), Kuantan (Malaysia), Olongapo (Philippines) and Danang (Vietnam). Mr. Dung Quang Ho (Interpreter) Officer, Protocol Division, Department of Foreign Affairs, Danang People s Committee, Vietnam AUICK Secretariat Dr. Hirofumi Ando President Mr. Toshihiko Ono Executive Director Mr. Masashi Hashikura Deputy Executive Director Ms. Yasuyo Inoue Manager Mr. Benjamin Tams Staff Ms. Akane Yoshida Staff World Health Organization Centre for Health Development (Kobe) Secretariat Mr. Alex Ross Director Dr. Amit Prasad Technical Health Officer, Urban Health Management Dr. Megumi Kano Technical Officer, Urban Health Metrics Ms. Atsuko Ito (Attendee) Intern AUICK Workshops, as they share experiences and knowledge towards the formulation of Action Plans in their cities. Mr. Alex Ross, Director of the World Health Organization Centre for Health Development (Kobe), thanked AUICK for arranging the meeting, the first in a collaborative partnership between the two centers. WHO Kobe Centre is a global research centre, and there are also WHO offices in each of the countries of the AACs. Urbanization and health is a key area of focus for the centre, as well as increasing equity by focusing on services to vulnerable populations. In the context of the 2013 Urban HEART Workshop, participants can take new insights, skills and tools back to their cities. The following pages contain articles on the presentations given at the 2013 AUICK / WHO Kobe Centre Urban HEART Workshop. August AUICK Newsletter No.58

4 Mr. Benjamin Tams, Staff, Asian Urban Information Center of Kobe (AUICK) The AUICK Action Plan System Mr. Benjamin Tams explained how participants of AUICK workshops since 2005 had made plans to improve service provision in their cities. AUICK has incorporated the Action Plan system into its Workshop project since 2005, as a way for the nine AUICK Associate Cities (AACs) to utilize the lessons learned from training programs in Kobe. The Action Plans, formulated by all participants and addressing issues covered by the workshops, improve service provision according to the specific problems faced by each city. Assessment of the plans implementation progress provides AUICK with a means to measure the effectiveness of its programme as a whole. During each Workshop, participants (typically the heads of city government departments relevant to the issues covered) are given guidelines on effective Action Plan formulation. They decide the problem(s) to be addressed, and the resources and support necessary for effective implementation. This might include administrative, academic, community, NGO or media support. A timeline for each Action Plan shows when every step is to be taken, usually ammounting to about 18 months implementation, but the plans usually set up projects that are sustainable or expandable beyond that period. They need to get the approval of AAC mayors, and be realistically achievable with each city s available resources. In many cases, small pilot projects are started, with a view to their future expansion from the momentum achieved by an initial implementation period. A total of 87 Action Plans have been made at AUICK Workshops since 2005, and many of these have been successfully implemented as government policies. Action Plans of past Workshops have established programs to address adolescent reproductive health care and HIV/ AIDS, ageing populations, urban environment management, water and sanitation and primary education. Successful plans have also addressed maternal and child health care and natural disasters, the theme of the 2013 AUICK / WHO Kobe Centre Urban HEART Workshop. In Chittagong, Bangladesh, an AUICK workshop participant formed a Disaster Management Core Committee headed by the Mayor, for crisis management and maternal and child health care provision. An Action Plan for Weihai, China, developed a Disaster Prevention Welfare Community, with over 30 members from medical, emergency and government departments, and a large volunteer network. This works to improve emergency response capacity and establish community partnerships for knowledge and information sharing on disaster preparedness. In Chennai, India, an Action Plan incorporated MCH into Chennai s Disaster Coordination Committee, focusing on care provision in the first 48 hours after flooding occurs. In Surabaya, Indonesia, an Action Plan established a Task Force for Disaster and Casualty Management and published guidelines on disaster prevention and control to educate the relevant sectors. 120 of Surabaya s 163 villages have since been declared ready for disaster control. In Kuantan, Malaysia, an existing diasater preparedness and management plan was amended to incorporate monitoring and relocation of pregnant women to hospitals and other safe environments, and provision of specific maternal and child health care items in times of pandemics or natural disasters such as the flooding which regularly affects the city. In Olongapo, Philippines, a Disaster Volunteer Brigade for community-based preparedness, integrated into and trained by the city s Disaster Management Office to augment its disaster prevention activities. Disaster contingency planning in Danang, Vietnam, lacked maternal and child health components, so an Action Plan informed local authorities on their urgent need, and a special City Committee for MCH in Natural Disasters was created within the government s disaster management organization. For the participants of the 2013 AUICK /WHO Kobe Centre Workshop, these plans informed on strategies and implementation procedures, before ideas from other programs of AUICK Associate Cities (AACs) and Kobe City, as well as Urban HEART guidelines on data collection and utilization, assisted their formulation of new Action Plans. (See following pages for details.) AUICK Newsletter No.58 4 August 2013

5 Dr. Akifumi Mita, Manager (MD,MPH), Public Health Center, Kobe City Government Maternal and Child Health Care in Kobe City Dr. Akifumi Mita explained the history of health conditions and services for mothers and infants in Kobe. Kobe City s population of 1.54 million makes up 1.2% of the population of Japan. The city has nine local wards, each having its own public health care sector, for an annual 13,000 births. Two hundred years ago Kobe was just a small village, but with the opening of Japan to outside trade in 1868, a major port city arose. The introduction of an infectious disease clinic and clean water provision at the turn of the century helped to eliminate diseases like cholera, but with rapid population growth, poorer citizens suffered poorer health. By 1924, about 60% of the population could not afford to go to hospital, so the city opened a new facility offering cheap medical fees and nighttime care. Then the introduction of a nurse training school in 1926 increased access to health professionals. Infant health examinations and guidance began in 1939, and guidance for prenatal/postnatal women started in the start of the universal national health insurance system, and in 1965 and thereafter, the number of tuberculosis patients fell sharply thanks to BCG vaccination and other measures. Now Kobe attributes a massive drop in the number of neonatal deaths to three main factors; hygienic water supply, services offered at health care centers such as vaccinations, health examinations and education for residents, and nationwide improvement of insurance systems, facilities and medical professionals. Without universal access, improvements in services are meaningless, so it is vital for providers to consider economically and socially disadvantaged citizens, and how to make medical infrastructure and systems available to them. In early pregnancy, expectant mothers receive a maternal and child health handbook, and a book to record their heath condition. They meet with ward office staff and attend regular health checks, as well as seminars with other pregnant mothers. Expectant fathers also attend seminars to learn about baby care, and even practice wearing weighted stomach packs to empathize with their partners. Their participation is especially August 2013 Casually dressed nurses create a friendly environment for young mothers in Kobe. important with the increased advancement of women in the work place. Each family of a newborn baby receives a visit from a health care official who provides counseling and health checks. Once the baby reaches four months, mother and child go to the health care center for height and weight checks, examinations, dental care, BCG vaccinations and guidance on nutrition. Vaccinations are given free to mothers, but at a cost to each tax payer of 24 US dollars. Most recently, in this phase 70% of babies are reported to have no abnormalities, 15% are diagnosed as needing special attention and around 14% require medical treatment, and are sent to medical institutions. Treatment is free for babies under one year-old. In the city, many mothers are isolated from their parents, so government provided seminars give them opportunities to learn on baby care and feel reassured by meeting other mothers. With improved accessibility to health care facilities with professional birth attendants, there is a nearly one-hundred percent rate of institutional delivery, and caesarian sections have increased from 8 percent in 1985 to over 20%. Universal insurance means that anyone can access health care at any time, and only pay one-third of the actual cost, while the poorest pay nothing. Now, with women giving birth later meaning a higher risk of pregnancy related complications, and with lower infant mortality giving a higher rate of survival with congenital abnormalities, universal access to health care is as important as ever. 5 AUICK Newsletter No.58

6 Dr. Chika Shirai, Director (MD, MPH), Medical Affairs, Public Health and Welfare Bureau, Kobe City Government Natural Disasters and Maternal and Child Health Care in Kobe City Dr. Chika Shirai described Kobe City s experience of post disaster shelter and health care. The timing and location of natural disasters cannot be known, so they are difficult to prepare for. The Great Hanshin-Awaji Earthquake struck Kobe City at 5:16 in the morning of 17th January, 1995, killing 6,434 people and completely destroying over 60,000 homes. Ninety percent of the city s hospitals closed, elevated highways collapsed, and vital supply lines were cut. At peak, over 230,000 citizens were in temporary shelters set up in schools and public halls. Health officials needed to ascertain the circumstances of each family to provide healthcare, especially to vulnerable citizens, such as the injured, sufferers of chronic diseases, the elderly, disabled, people in residential care facilities, pregnant women and mothers with newborns. Many mothers and children in good health left Kobe, but those who stayed at home had to be accounted for. It was winter, so pneumonia, influenza and gastro enteritis were prevalent in the shelters, and health checks also screened for tuberculosis. Pregant mothers and babies cannot stay in shelters long, and need to be relocated to other institutions. Children too can find the environment of a shelter frustrating, as they need to be active. The stress of a disaster and subsequent unrest can also cause them to have head and stomach aches, vomiting, infantile regression or restlessness. As this in turn affects the elderly, some shelters have separate rooms for children to play in. Where women are expected to have a traditional role, disaster conditions bring added burdens. Washing, cooking, bathing and cleaning are all adversely affected when water, electric and gas supplies are cut. In Kobe, women needed three times the toilet facilities as men, and had basic daily medical needs unmet. Shelters provided little light, and there were incidents of sexual attacks on women. Governments must take women s perspectives into consideration when planning for disaster management, in order to provide the necessary health care, hygiene and safety items, such as personal alarms. Shelters need Shelter conditions after the earthquake in Kobe special female-only designated areas, and mothers of infants need powdered milk and baby food. To ensure these needs are met, it is best for women to be involved in the management of shelters. For the improvement of living conditions, water is a lifeline. After the Hanshin- Awaji Earthquake it took three months for water supplies to be re-connected. In the meantime, water was provided by wells and by the national Self Defense Force. Flush toilets did not work, so people resorted to using unclean water from broken pipes or swimming pools, and where there were no toilets at all, people used the grounds of schools or manholes. Girls and women did not want to use the toilets so often, as there was little privacy except for cardboard partitions, and danger of urinary infection. Hygienic measures like hand washing and gargling were promoted, and simplified showers and laundry machines were sent from surrounding districts. Addressing issues that arise at the time of a disaster is not enough. Steps must be taken in normal time to keep records of vulnerable people, pregnant and newborns in each area, and to establish communication networks for a disaster situation. So, Kobe City provides disaster information to mothers in motherand-baby handbooks. Mothers should keep good records of their babies health, and consult professionals on both physical and mental concerns, and families are informed to prepare their own emergency procedures, such as where to go in the event of a disaster. Local governments can do much more than save lives by implementing these measures. AUICK Newsletter No.58 6 August 2013

7 Dr. Amit Prasad, Technical Health Officer, Urban Health Management Dr. Megumi Kano, Technical Officer, Urban Health Metrics Training on Urban HEART World Health Organization Centre for Health Development (WHO Kobe Centre) On 13 March, participants of the 2013 AUICK / WHO Kobe Centre Urban HEART Workshop were trained on the Urban HEART strategy to promote health equity. The Urban Health Equity Assessment and Response Tool (i.e. Urban HEART) was developed by the World Health Organization Centre for Health Development (WHO Kobe Centre) to aid decision makers in planning action on inequities in health in urban areas. Using the tool, planners and policy makers assess health indicators to find inequities, and take appropriate action to address situations where there may be better access to health services and care for some population groups than for others, because of geographical, financial or social issues. Urban HEART is a political, as well as a technical tool, so its advocacy to political leaders, such as city mayors, is most important for its success to be achieved. The key steps in implementing Urban HEART are to build an inclusive team to engage different departments and sectors, define the indicators to gather relevant data, and then analyze the data to decide on actions to take. As issues of health inequity are often politically sensitive, supporting data must be very accurate. Step One: Build an Inclusive Team Firstly, a project leader needs to build a team of persons from relevant departments and sectors. This will give vital political support to a project. The endorsement of the mayor is a great advantage here. Depending on the focus issue, different departments will be able to provide data or other resources, but must be included from the start, so that they share ownership of the project. If invited to join later, such as at the problem solving stage, people will be less willing to participate, so everyone needs to be engaged and clearly informed of their roles as early as possible. August 2013 Workshop participants learn Urban HEART Getting the cooperation of a city mayor, different sectors, community leaders or academic experts means they have to be informed on Urban HEART. It is important for them to know what health equity is, why it is necessary and why they should be part of the project. Sectors to get involved in improving an area of health may include educational, transport and infrastructure or environmental departments. Each department has to be encouraged, and a city mayor has to be informed of the political benefit of promoting and achieving health equity, rather than inequities themselves being highlighted by a project. In Parañaque, Philippines, for example, urban health equity has been used as a mandate for elections, and in China projects have been endorsed since challenging inequities was pronounced as a national political aim. Success greatly depends on the creativity and intelligence of project leaders in reaching out to authorities to get their support. When assembling a team, factors which contribute to health inequities and the actors who can help change these factors through interventions need to be considered. For example, departments related to education, finance and planning can provide data, academics can provide technical support to help process the data, and the project team itself can work with local communities to implement interventions and sustain projects. This all depends on the political and social environment of each city, though. In Tehran, Iran, for example, the university was a key 7 AUICK Newsletter No.58

8 player, as it had strong links with the local government. Assembling a team is time consuming, but is one of the most important steps. If motivated people are involved, subsequent steps will be easier to implement, as they will look for solutions rather than problems. In Ulaanbaatar, Mongolia, the local government has strong links with the national Ministry of Health, and inter-departmental cooperation was better coordinated than in sites where such links did not exist. In Ho Chi Minh City, Vietnam, the Institute of Public Health and Hygiene worked well with national counterparts and other local government departments, but did not engage senior authorities such as the mayor, which resulted in poor follow up at the intervention stage. In Jakarta, Indonesia, the National Institute of Health Research and Development (NIHRD) became the focal point for supporting Urban HEART. In Indore, India, a project to address health in the slum areas was completely community-based, with the Federation of Slum Women deciding on priorities and interventions, with support from local NGOs. In Dalian, China, the local government has been working with the National Patriotic Health Campaign Committee, part of the central government. Sometimes a government department will work alone, sometimes with the national government or local communities; sometimes an academic institution will lead a project. The different ways depend on the specific political and administrative environment of each city. If the team is formed according to the political and social environment of the city, it can get the maximum benefit from its work. Step Two: Define Your Local Indicator Set and Benchmarks. The second step of Urban HEART is for the team to decide which data indicators will enable them to collect the information needed to address health inequities. Disaggregation variables, such as geographic subunits and socioeconomic status, need to be considered, to allow the identification of health inequalities associated with these variables. The Urban HEART manual provides a list of 12 core indicators and additional strongly recommended or optional indicators as guidance, but these are flexible, and it is very important to focus on local indicators relevant in each context. Step Three: Assemble Relevant and Valid Data Data should then be gathered according to the chosen indicator set. It is not always necessary to acquire new data through surveys, as there are often already available data that can be utilized. The more people are working together, the more data can be Figure 1. Data matrix as a snapshot table Figure 2. Data monitor for tracking performance of an indicator over time accessed. In some cases national surveys can also provide useful data at the local level. Gathered data should then be analyzed in consultation with data experts and local communities, who should decide on its validity related to the problem faced. Data quality is always a big question. Many cities do not have quality data, and it can be worse still at the district level. It is important to promote the value of quality data, so that people see its importance and become accountable for its improvement. Validity can be put in question if data do not correspond to the actual situation on the ground. An example of this is where increased crime data are actually due to increased reporting and management of crime. If valid, data then guides city planners on how to formulate a response. In the Philippines, administrative data were presented to the public in six villages, three richer and three poorer. Although it showed there to be 100% access to safe water, poorer villagers negated this, and accurate figures were subsequently produced. Step Four: Generate Evidence The Urban HEART data matrix assesses city data by comparing it to certain benchmarks, such as urban averages and national targets. As a simple exercise, it presents data colorcoded according to three categories; red means worse than the lower benchmark, AUICK Newsletter No.58 8 August 2013

9 green means having reached the set target, or upper benchmark, and yellow means between the two. The color-coding helps understand what the priorities are, and data can be charted in a snapshot table (see figure 1) or be plotted over time to monitor trends of an indicator (see figure 2), especially in relation to inequalities. Once the data are charted, the team should consult stakeholders and other relevant persons, such as the general public, to decide on priorities for interventions. Step Five: Assess and Prioritize Health Equity Gaps and Gradients According to the color-coding of the data matrix, red areas are performing worse than the lower benchmark and need to be improved, green areas are those that have achieved desired targets, and yellow are in between those two states. Benchmarks can be set using national averages, or targets of the Millennium Development Goals (MDGs). For example, MDG number five is to reduce maternal mortality by 75% of the 1990 rate by They might be political, city or national targets, or comparisons with better developed cities. They should not be too high (unachievable) or too low (not aspirational). As the matrix is simple, it can be made with anything from color pencils, up to any level of technology available, such as Geographic Information System (GIS) for example. Technology should never be a constraining factor, and the general public can be involved in making a matrix, as well as in its analysis, which can also be as complicated as necessary. Questions need to be asked as to how far below the benchmark a red indicator is, or whether a yellow indicator is rising or falling. Step Six: Identify the Best Response Based on analysis of the Urban HEART data matrix and monitor, the purpose of step six is to produce clear and strong recommendations about what governments and communities need to do to address the health inequities found. This involves showing authorities the evidence that action is needed, and proposing a response with the backing of all the relevant sectors, communities and champions of the project. A government can then support appropriate actions or reallocate budget to a poorly performing area. The Urban HEART team should make a response proposal and present it to decision makers, so that the right actions are taken. To be sustainable, Urban HEART itself should be integrated into the planning cycle of local governments or authorities. Interventions should be operationally feasible and sustainable, aiming to restore equity towards the ultimate aim of universal access to health. Information and manuals on Urban HEART can be found at publications/urban_heart/en/index.html C ity Reports and Action Plans Chittagong, Bangladesh Chittagong is regularly hit by natural disasters such as cyclones, so it is vital to improve both preparation and provision of maternal and child health services. August 2013 Dr. Irin Akter Consultant, Gynaecology and Obstetrics Mostafa Hakim Maternity Hospital, Chittagong City Corporation, Bangladesh The City Chittagong is the second largest city of Bangladesh, in the south-east of the country. It contributes much to the national economy as a commercial hub with the nation's busiest sea-port. Chittagong s population has increased from 3.2 to 4.8 million over the past decade, due to declining agricultural livelihood and growing employment opportunities in the urban area, due to foreign investment. Bangladesh is on track to meet Millennium Development Goal five (to reduce maternal mortality by 75% of the 1990 rate by 2015) having achieved tremendous improvement in reducing maternal mortality over the last nine years - a 40% drop from 322 to 194 per 100,000 live births. This has been brought about with increased facility-based delivery by skilled attendants, a reduction in child marriages, and increased female education. Maternal and Child Health (MCH) services are provided by both public and private facilities. The public facilities include Chittagong Medical College and Hospital (1,010 beds), Chittagong General Hospital (250 beds) and a Mother and Child Hospital (75 beds). There are two private medical colleges (250 beds) and private 9 AUICK Newsletter No.58

10 clinics each with obstetrics / gynecology and pediatric departments, and twenty charitable dispensaries and six maternity hospitals of Chittagong City Corporation (CCC) located in different parts of the city, which have 278 beds. Two categories of MCH services are Safe Motherhood, incorporatting ante natal care, skilled attendance at birth, caesarean sections and emergency obstetric care (EOC), perinatal, neonatal, postnatal care, etc; and Primary Healthcare, providing growth monitoring, oral re-dehydration therapy (ORT), breastfeeding, immunization, food, family planning, diarrhea control and female education. Due to its geographic location, Bangladesh frequently suffers from devastating cyclones. The funnel-shaped northern portion of the Bay of Bengal causes tidal bores, when cyclones make landfalls. Since 1998, there have been casualties from landslides over multiple years, with the number of deaths ranging from 16 to as high as 127 people. Landslide vulnerability is increasing day-by-day, due to hill cutting for construction, sand and clay mining, increasing settlements in foothills and deforestation. The increasing dangers from cyclones and earthquakes have also heightened awareness of the need for emergency preparedness within the Maternal and Child Health (MCH) community. The Health Department of CCC, supported by the national Ministry of Health, has increased capacities to engage in disaster preparedness. Under an Action Plan formulated at the AUICK Second 2007 workshop, 41 ward level Disaster Management Committees, established under the guidance of the Central Disaster Management Committee, conduct disaster management activities with the participation of a wide range of stakeholders to support early warning systems, evacuation of pregnant women and at-risk children to multi-purpose shelters in the coastal and flood prone areas, provision of emergency medical care and relief items (food, water, clothes), and psychological counseling. Chittagong has a number of factors constraining the provision of maternal and child health care during natural disaster situations, though. There is a need for increased human resources and appropriate medications and supplies, so that skilled professionals can assist pregnant women and newborns in times of disaster. Medical records, basic provisions and facilities must be available to perform emergency surgery like Cesarean Sections and intervention for postpartum hemorrhage. Mental health resources are imperative for women and children, as the figure of one in eight women experiencing perinatal depression in normal time is exacerbated tremendously by a disaster. Also in normal time, the availability A cyclone shelter in Chittagong of condoms is essential for birth control and protection from sexually transmitted infections. Early preparedness and warning systems for cyclones are imperative to avoid human causalities, and an effective inter-government departmental coordination cell is necessary to maximize disaster response. Rapid restoration of access to affected areas and essential facilities is vital, as is community awareness, ownership and empowerment during the disaster and recovery period. The Proposed Action Plan The aims of the Action Plan for Chittagong made at the 2013 Urban HEART Workshop are to reduce maternal mortality and infant mortality, and to increase disaster preparedness, maternal and child health care during natural disasters, and the number of skilled birth attendants. Specifically, the Plan will ensure the early registration of pregnant women, and increase awareness among citizens through effective linkages with grass roots socio-cultural organizations and the support of NGOs. This will be achieved through media campaigns on ante-natal care, neonatal and maternal danger signs and the importance of skilled birth attendants, as well as timely immunization and female education. Home based prenatal care and emergency lifesaving skills training will be launched for Chittagong City Corporation health workers at the field level. A neonatal resuscitation program will be developed for facility based skilled birth attendants (physicians, midwifes and nurses), in conjunction with an initiative called Helping Babies Breathe", already undertaken by the national Ministry of Health. It is essential to ensure effective training, refresher training and implementation of these activities in Chittagong. Disaster preparedness will be improved by increasing awareness and warning systems, early evacuation planning, repair and construction of cyclone shelters and AUICK Newsletter No August 2013

11 hillside slum area housing, and preparing medical, relief and rescue teams for immediate operation. The city's data collection system can be modified both qualitatively and quantitatively, and the number of Skilled Birth Attendants increased. Financial support for the Action Plan will be solicited from Chittagong City Corporation, the national government and local donors, and the plan will be implemented by City Corporation staff, health service providers and female welfare organizations. Monitoring can be done by site visits and monthly meetings among the implementers and stakeholders of the Plan. Chittagong Action Plan Time Frame: March August 2014 Steps / Actions M A M J J A S O N D J F M A M J J A 1. Present project to Mayor 2. Discussion with colleagues and concerned officials 3. Build an inclusive team 4. Define local indicator set Infant Mortality Maternal Mortality Skilled Birth Attendants 5. Assemble and validate data Consulting with data experts Gathering quality data 6. Generate evidence Simple charting / graphing software after data assembling Presenting the evidence to stakeholders Budget allocation 7. Identify priority health gaps and gradients 8. Motivation and advocacy 9. Training and workshops 10. briefing to media and the community 11. Implementation and observation Weihai, China Weihai suffers from extreme weather-related natural disasters, but has taken extensive measures to prepare emergency services and citizen participation. Mr. Tian Qing Deputy Director, Obstetrics and Gynaecology, Weihai Women and Children s Hospital, China The City Weihai is located at the eastern end of Shandong Peninsula of China, and has a resident population of 2.8 million. In late 2012, the city had 760 health institutions, including 28 hospitals, 65 health centers, and 575 clinics and infirmaries. There are over 17,000 beds in the various health Weihai training for disaster management institutions (including 11,000 hospital beds), and health workers number 17,500. In recent years the government and Health Agency August AUICK Newsletter No.58

12 have improved the protection of women and children's health, as part of overall health service improvement. As a result, skilled birth attendance was almost 100% in 2010, the rate of infant deaths (before one year of age) per 1,000 live births fell from 5.76 in 2000 to 4.8 in 2012, and the rate of maternal deaths per 100,000 live births also fell from in 2005 to 5.99 in Natural disasters in Weihai occur mainly from the heavy snowfall in winter and heavy rainfall in summer. The city is susceptible to typhoons, hail, mountain collapse, landslides, mudslides, storm surges, tsunamis and other ocean-related hazards and rare occurrences. Specific emergency measures under the guidance of the government include: - to organize the rescue and treatment of persons affected, evacuation and proper placement of personnel threatened, with other relief measures; - to control as soon as possible the sources of danger, indicating the danger zone, blocking dangerous places, delineation of the warning area, implementation of traffic control and other control measures; - to immediately repair damaged public facilities for transportation, communication, drainage, and supply of water, electricity, gas and heating, and to provide victims with shelter and other necessities like food, drinking water, medical care and health and epidemic prevention, with other safeguard measures; - to prohibit or restrict the use of equipment, facilities, close or restrict the use of the premises, suspend the activities of the densely populated areas to avoid harm caused by expanding production and business activities, and other protective measures; - to enable emergency relief supplies, set up a financial reserve fund and provide other urgently needed supplies, equipment, facilities and tools; and - to organize citizens to participate in emergency rescue and disposal work, and staff with specific expertise to provide services. In 2012, Weihai Municipal Health Bureau organized a series of training activities for more than 360 emergency leaders and emergency teams, and the City implemented emergency plan drills in the Land and Resources Bureau and set up the Weihai Sudden Geological Disaster Contingency Plans. These increase awareness in normal time through drills and practices, and build the capacities of emergency support and relief agencies to maintain order and to safeguard the lives and health of women and children in the occurrence of a natural disaster. Weihai Action Plan Time Frame: March August 2014 Steps / Actions M A M J J A S O N D J F M A M J J A 1. Present project Formulate plan with Health Bureau Discuss and revise the plan Report to Health Bureau and Weihai Municipal Government 2. Build an inclusive team Discussion with the concerned officials Organize the team 3. Local indicators / Assemble and validate data Training of health care workers and attendants Instructions for the community Supplementary materials Education of young people Collecting the data and identifying the problems Summarize progress 4. Identify priority health gaps and gradients Health Bureau, Weihai 5. Identify best response Health Bureau, Weihai Weihai Municipal Government AUICK Newsletter No August 2013

13 The Proposed Action Plan The Action Plan of the 2013 Urban HEART Workshop aims to reduce unwanted pregnancies and unsafe abortions, through education and publicity by medical staff, communities and schools, and the distribution of free contraceptive drugs and condoms. The eventual target is to completely eliminate deaths from unsafe abortions. The Plan will be led by the Municipal Government, and implemented by the Health Bureau, hospitals, clinics, the Women s Federation, the education sector and volunteers of local welfare communities. Overall, the Plan will improve the capacities of the Government and citizens to reduce unwanted pregnancies, as well as draw attention to the needs of mothers and adolescents. Funding will come from the government and social funds and the local media, and additional support will come from schools and universities. Chennai, India Chennai learned much on disaster management in the aftermath of the Great-Sumatra Earthquake Tsunami, which struck on 26 December, A new Action Plan for the city aims to improve overall health conditions. August 2013 Mr. Mahesvaran Chinnapalli Namadev Deputy Commissioner (Health), Health, Corporation of Chennai, India The City Chennai, the capital city of Tamil Nadu State in Southeast India, covers an area of 426 square kilometers. Its population of 6,128,481 consists of 986 females per 1,000 males. Maternal and Child Health Care is provided by the Family Welfare Department, which also manages schemes to financially support the poor and the needy at various levels, through marriage benefit, pregnancy and maternal plans. Better health care for women and mothers is facilitated by the provision of good referral services, qualified well trained staff, skilled lab technicians, sonologists and counselors, and health care professionals to provide intra natal care. These have helped the city achieve positive health indicators of Maternal and Child health, with decreased Infant, Maternal, Neonatal and Under-five Mortality rates. The city has also achieved an increased literacy rate, and 100% coverage of children against vaccine preventable diseases through immunization. Chennai faces frequent natural disasters in the form of cyclones and floods, but the most devastating of these was the Sumatra Earthquake Tsunami, which created havoc in the coastal area of the city on December 26th An earthquake of the magnitude of 9.3 on the Richter scale, with its epicenter off the coast of Sumatra, triggered a tsunami in the Indian Ocean at 6:29 am, whose devastating waves caused massive loss of life, property and the livelihood of coastal communities at large. Initial response to the disaster was from the general public in the area, who rescued large numbers of people. Their contribution in providing immediate relief until other persons could arrive was extraordinary. In the aftermath of the disaster, the city learned a number of important lessons on short and long-term recovery. Shelters have to be prepared for displaced persons with not only living space, but also privacy, bathrooms and sanitation maintenance, hygienic food and protected water supply. Special attention should be given to infection control, the continuation of ongoing medical programmes, mental stress management, health education and then relocation of people according to their needs. There is an immediate need to set up points for service for grievance counseling and psychosocial support, police, missing persons, NGOs, health care, media information and other relief issues. Special attention should also be given to care for orphans, semi orphans, destitute women, pregnant women, old age and physically and mentally handicapped persons during a disaster situation. Health officials need to prepare in advance epidemic prevention measures, adequate immunizations, medical emergency kits and disposable delivery kits for women who are giving birth. Also as preparation in normal time, buildings should be disaster resistant, and vulnerability mapping should be done to locate safe areas in the event of a disaster. Moreover, Chennai's experience deems that the following concrete steps can ensure disaster preparedness: - Focused leadership at political and administrative levels and constant monitoring; - Participation of the community at every level of decision making; - Complete decentralization of powers to local district officials; - Need-based relief activities taken up in advance, examples being sustenance packages, packages for fishermen, farmers and for orphaned children / adolescent girls; 13 AUICK Newsletter No.58

14 - Effective leverage of the flow of resources from all sources (government, NGOs, CSOs, the corporate sector); - Risk mitigation and insurance as part of rehabilitation and reconstruction; - Strict building standards and supervisory mechanisms to ensure compliance; - Comprehensive coverage of all sectors reaching every affected family; - Extensive use of web technology to enable transparency, efficiency and seamless communication; and - Focus on the conservation of coastal ecology. United Nations disaster relief guidelines promote vulnerability assessment; health workers identifying pregnant women and children; planning on the basis of vulnerability and past experience; planning with local community, vulnerable communities, other government bodies, NGOs and communities. The inclusion of women in disaster relief efforts not only helps A community maternal health care clinic in Chennai women in times of crisis but helps to break down gender inequalities and imbalances in general. Chennai Action Plan Time Frame: March August 2014 Steps / Actions M A M J J A S O N D J F M A M J J A 1. Present project to Mayor / Build an inclusive team Collect the latest related data Formation of special committee to draw up Action Plan and implementing procedure Get formal approval of Mayor Preparation of detailed guidelines and empowering the concerned to commence the work after training 2. Define local indicator set Active implementation of the scheme Encouraging outreach activities Meeting with beneficiaries Monitoring work 3. Generate evidence Conducting inter-department coordinating meetings Assessing the data of other departments Realising the substantial evidence Reorientation of the programme 4. Identify priority health gaps and gradients Conducting meetings to identify priorities Assess gap between the scheme and knowledge of the people Constant monitoring Reassessment of the programme 5. Identify best response Identify the scheme's most successful areas Find out the reasons Changes among the people 6. Implement the same techniques in similar places AUICK Newsletter No August 2013

15 Chennai also learned lessons toward long term reconstruction strategies. Government officals, NGOs and citizens should partake in joint disaster management training, solar lighting should be prepared for the event of a power cut, and housing, water supply, sanitation, schools, hospitals, veterinary care institutions, as well as coastal protection should be maintained. Disaster Management should be linked with overall development, institutional mechanisms strengthened, search and rescue capacities improved, policy and legal support established, latest technologies utilized and Public Private Partnerships and Information Education and Communication (IEC) activities increased. For the future, more Health Posts are to be created in Chennai City and to increase the number of 24-hour Emergency Obstetric Care (EOC) hospitals. Creation of a Disaster Management Team with focused training involving various departments, and Multi Disaster resistant hospitals are to be constructed in appropriate places, with messages on disaster management to be disseminated to women and children. A shift from post- to pre-disaster response according to the National Disaster Management Policy will include health services adopting the Incident Command System response, a GISbased data base as a resource inventory, a holistic approach involving all stakeholders and government agencies for a better delivery mechanism, developing capacities of the community as first responders, preparing community health plans linking and forming networks among government agencies, hospitals and volunteers commemorating a Disaster Awareness Day to hold mock drills, and developing an uninterrupted information and communication network. The Proposed Action Plan The Action Plan made at the 2013 AUICK / WHO Kobe Centre Urban HEART Workshop aims utilize the lessons of the workshop to improve overall health conditions, increase intersectoral coordination to eliminate vector borne diseases, train husbands on handling infants, improve the immunization procedure and foster a holistic approach towards complete health. The Public Health and Family Welfare Department, Education Department and Water Board will coordinate to improve health services to private hospitals, new habitations and slum areas, as well as Information Education and Communication (IEC) services to schools in Chennai. The project will be supported financially by the Municipal Corporation, government grants, and public, private, NGO and international funding. Data collection, field inspections and monitoring will guide the development and continuation of the Plan. Surabaya, Indonesia Community participation is a characteristic of health care provision in Surabaya, and a Workshop Action Plan seeks to improve the city's birth attendant skills. Dr. Vitri Saktiwi Paediatrician, Child Health Department, Bhakti Dharma Husada Hospital, Surabaya City Government, Indonesia Dr. Nasir Muhammad Untung Obstatrician and Gynaecologist, OBGYN Department, Government General Hospital Dr. M. Soewandhie, Indonesia The City Surabaya is the second largest city in Indonesia, the main core of development of East Java Province, and referred to as its Capital. It is also known as center of business commerce, industry, health, and education in eastern Indonesia. Nutrition advice is given to pregant women at the Integrated Health Service Posts ('Posyandu') in Surabaya. Surabaya s total population in 2012 was 2.9 million. Since 2005, all citizens have access to safe water and more than 97% have access to hygienically good sanitation. In the provision of health care, government focus has been on the enhancement of medical support and facilities for the poor, pregnant women, infants and children. Health facilities such as hospitals and clinics have grown in quality, quantity, and accessibility. Surabaya August AUICK Newsletter No.58

16 also has Public Health Centers as the first referral system of health services, which increased in number from 53 in 2005 to 62 in Exclusively for maternal and child health, there are also 2,808 Integrated Health Service Posts ( Posyandu ) which focus on five programs including improved nutritional status, maternal and child health care, family planning, immunization, and diarrhea prevention and treatment. Health data show the effective strategies by the City Government, administered by the Health Office, to improve maternal and child health.the Infant Mortality Rate (IMR) has been decreasing every year, falling from 25 in 2005 to 7 by The Maternal Mortality Rate (MMR) decreased from 193 in 2005 to 144 by Births with skilled birth attendants increased from 78% in 2005 to more than 97% in Making Pregnancy Safer (MPS) is one of the strategies to decrease MMR significantly by improving recognition, and in 2004, the Health Office of Surabaya initiated the Comprehensive Obstetric and Neonatal Emergency Service to improve the capability of Public Health Centers, and develop a better referral system. Since 2011, a national policy has also provided health insurance for pregnant women and infants. Several factors cause flooding in Surabaya, such as high rainfall, rising sea level, river sedimentation, change in regional spatial structure and garbage blockage in drains. Learning from past disasters, efforts are being made to increase public awareness on the drainage system, and promote better cooperation between the community and city officers. Although the occurrence of flooding in Surabaya was quite frequent, the volume of water is low, so evacuation of affected citizens is not always needed. Emergency response for natural disasters in Surabaya Surabaya Action Plan Time Frame: March August 2014 Steps / Actions M A M J J A S O N D J F M A M J J A 1. Consultation with Head of City Health Office 2. Consultation with colleagues and other sectors for preparation of detailed proposal 3. Report to the Mayor 4. Build an inclusive team 5. Data collecting 6. Data processing (make matrix) 8 7. Discussion to identify priorities 8. Workshop with Public Health Centers, professional organizations 9. Scheduled training / workshops for skilled birth attendants 10. Monitoring and evaluation is conducted by the Disaster Mitigation Unit, assisted by volunteers from the community, and collaboration with the Fire Department, Social Department and Health Department, among others. Government efforts to manage disaster mitigation include providing logistics, safe water, medication, evacuation crews and social assistance, as well as 24-hour emergency posts. The government needs to plan better to face disasters in the future though, such as by formulating a comprehensive disaster mitigation system to establish a proactive, fully integrated, city-scale monitoring system. This will better ensure that disaster threats are properly monitored, prevented, and well managed. It is also important to pay more attention to assisting vulnerable populations, including women and children, who are often neglected in disaster planning and management. The Proposed Action Plan The 2013 AUICK / WHO Kobe Centre Workshop Action Plan for Surabaya aims to reduce the Maternal Mortality Rate by improving the skills and knowledge of birth attendants (midwives), and promoting the Family Planning Program. Following relevant data collection and analysis, the Health, Education and Program Development Departments of Surabaya City Government will coordinate to arrange workshops with Public Health Centers and professional organizations, and training for skilled birth attendants. The health service referral system will also be strengthened. Personnel to implement the project will include Health Department officials, staff of Community Health Centers and trainers (gynaecologists, senior midwives), and financial support will come from the City Government and National / Provincial Health Departments. AUICK Newsletter No August 2013

17 Kuantan, Malaysia An AUICK Action Plan in 2007 incorporated Maternal and Child Health care into disaster management planning for Kuantan. The Action Plan of the 2013 Workshop seeks to tackle obesity, a national problem in Malaysia. Dr. Amirullah Mohd. Arshad District Health Officer of Kuantan District, Department of Health, Pahang State Health Department, Malaysia The City Kuantan in Pahang State, Malaysia, has a population of 423,383, of which 84% live in the urban area. The city covers an area of 2960 sq. km and is divided into six subdistricts. The number of health centers and community clinics provide access to maternal care is gradually increasing, and there are two types of health care facility; Health Centres for every 15,000-20,000 people and community clinics for every 3,000-4,000 people. These are each run by a minimum of two community nurses and especially trained midwives who can provide out-patient care. Public health facilities include 11 Health Centers, 27 Community Clinics, one Maternal and Child Health Clinic and one government hospital, while private facilities number 88 medical clinics and six hospitals. There was a significant decline in maternal mortality in Malaysia after 1950, from 540 deaths per 100,000 live births to 28 in The rate in Kuantan also greatly decreased, but it is now settled (53.4 in 2012), so there is a challenge to meet the Millennium Development Goal by As a low lying city surrounded by several rivers, Kuantan is hit by floods every year during the monsoon season between September and February. Most recently, during the floods of winter, 2012, 366 families were evacuated to 16 evacuation centers. An AUICK Action Plan in 2007 created an additional policy for Pahang State disaster prevention planning, so that during floods all pregnant women, bed ridden evacuees and infants should be Kuantan is regularly affected by flooding admitted to hospital, and if more than 500 persons are evacuated, a special static clinic is set up. Various government departments have worked with the community to put this into effect. The Proposed Action Plan The Action Plan made at the AUICK 2013 Urban HEART Workshop will set up a Worksite and Community Intervention Programme for Non-Communicable Diseases, to tackle obesity among women. Overweight/obesity is a national issue, and prevention is the third commitment of the National Strategic Plan for Non Communicable Disease ( ). As Pahang State has a high prevalence of adult overweight, the Plan aims to promote healthy diets and increase physical activity to reduce the cardiovascular risk factor among women. Concretely, the Plan will train district healthteams, other relevant department officials and community volunteers to conduct community health screening on BMI, RBS and cholesterol, as well as arranging lectures, group discussions, and information dissemination to improve awareness and the physical condition of citizens. Financial support will come from Pahang State Health Department, the Malaysian Health Promotion Board and Kuantan Municipal Council, while personnel to implement the project will include officials of the District Health Office / Health Centre, NGOs and fitness instructors. August AUICK Newsletter No.58

18 Kuantan Action Plan Time Frame: April August 2014 Steps / Actions A M J J A S O N D J F M A M J J A 1. Build an inclusive team Meeting with the State Health Director Formation of a Health Distict Technical Committee Team Meeting with City Mayor Meeting with District Officer Meeting with relavent agency and department 2. Preparation of the project Situation analysis using current available data Gathering information in context of national health issue, state health issue and local council issue Identification of site Preparation of material 3. Capacity building Training of district health team anad relevant agency and department 4. Implementation of the programme Community health screening (selected community and agency) - BMI, RBS, cholesterol Organizing community training - volunteers Implementaiton of the intervention - Behaviour change - Diet - Physical activity - weekly - Physical activity (lectures, small group discussions, log books, info blast 5. Monitoring Site visit Meeting with community Technical Committee Meeting (public health specialist, dietician, family physician, fitness instructor) 6. Evaluation of the project Process evaluation Health screening - BMI, RBS cholesterol Pre-test (OAP) Post-test (OAP) 7. Final Report Preparation of report Olongapo, Philippines Olongapo is exposed to annual typhoons and flooding, but its Disaster Preparedness Program is among the best in the Philippines. Mr. Lloyd Brian Joson Tubban City Health Officer I, City Health Department, Local Government of Olongapo City, Philippines The City Olongapo City is a medium-sized highly urbanized city in the southernmost portion of the Province of Zambales, Philippines, with apopulation of 227,270. It is administratively subdivided into 17 villages. For maternal and child health, preventive health care services are managed under the City Health Department through 21 Barangay (Village) Health Centers, and include AUICK Newsletter No August 2013

19 immunization, family planning and nutrition programs, disease control (STIs, HIV/AIDS, tuberculosis, malaria and leprosy), dental and reproductive health services. Twelve of the Health Centers have been upgraded to incoporate BEmONC (Basic Emergency Obstetric and Newborn Care) facilities. Curative health care is administered through one government and seven private hospitals. Faced with rapid urbanization and in-migration, urban-poor subpopulations and a high risk social environment for STIs, Olongapo City entered into a partnership agreement with the United Nations Population Fund (UNFPA) in 2005 to address the functional needs of its multi-tiered population. One of the first Philippine cities to pass a Reproductive Health Code, this became the main policy framework by which programs for RH was implemented in the city. The Gender Code promoted the rights of every woman, girl child and person in need of special protection, and victims of gender-based violence. Adolescent Reproductive Health (ARH) was also incorporated into the school curricula to provide young adults essential life skills, and population development strategies were implemented to upgrade the socio-economic information system, develop programs for migrant populations, and address the effects of climate change on health. With the latest maternal and infant mortality rate figures at 0.36 per 1,000 live births and 8.52 per 1,000 live births respectively (2010), the city s health care status is comparatively at optimal level against the national average. Issues still abound though, with regards to traditional health practices, universal access to social health insurance, and the continued high risk social environment for sexually transmitted diseases. Olongapo City is geographically vulnerable to natural disasters. In June 1990, a 5.6 magnitude quake reverberated through the city causing damage to structures but no loss of life. In June 1991, the climactic eruption of Mount Pinatubo caused major disruption of the city s socio-economic infrastructure and sent destructive volcanic debris across international borders. Typhoons in 2006, 2009 and 2011 have also led to loss of life and displaced families. Since creating the Disaster Management Office (DMO), the city has been able to responsively manage emergency situations and categorically prepare for natural calamities. As an AUICK Workshop Action Plan, a Disaster Volunteer Brigade (DVB) is also set up to complement the DMO s structure, especially with the recent effects of climate change causing unconventional super-typhoons and flash floods. The Olongapo City Emergency Response Plan provides comprehensive guidelines on Olongapo maternal and child health conditions are above the national average responding to disasters, and the city s Disaster Preparedness Program has in recent years been recognized as one of the best local disaster response teams in the country. Capacity building on the Minimum Initial Service Package (MISP) for Reproductive Health in Crisis Situations has been initiated, and with the reproductive health service initiatives undertaken by the city government through its Coordinative Mechanism for Quality Reproductive Health Services, Olongapo City was cited as a 'Healthy City' by the national government. With effective local leadership, able manpower, and utmost commitment from key stakeholders, the city is now embarking on further mobilizing resources to fully implement a comprehensive Disaster Management Program, so that disasters can be fully mitigated and that unnecessary loss of lives will no longer ensue. The Proposed Action Plan An Urban HEART Project already implemented in Olongapo found there to be a particularly high death rate from the disease Diabetes Mellitus (DM). In one district, Old Cabalan, the mortality rate was found to be 32.62/100,000, higher than the national average of 21.6/100,000 population and the National Target of 10/100,000 population. The project aims to reduce this rate by 10% or from 32.62/100,000 population to 29.36/100,000 population. Activities to improve public awareness and prevention of the disease have so far included increased supply of medicines, and counseling and lectures on fitness, healthy cooking and diet, and taking body mass index. The Action Plan of the 2013 Workshop aims to continue this project, with support from the Mayor, the Department of Health, the City Planning Office, Budget, Treasury, Government Service Office, Department Of Interior and Local Government, Department Of Education, as well as women s civic groups, police and NGOs. Financial support will be requested from the national government, local government and the private sector. August AUICK Newsletter No.58

20 Olongapo Action Plan Time Frame: March August 2014 Steps / Actions M A M J J A S O N D J F M 1. Presenting project to Mayor Report to supervisor Meet with Mayor Identify stakeolders 2. Build an inclusive team Hold seminar with stakeholders and get commitment Identify possible sources of data 3. Assemble and validate data Gather data from key stakeholders Present data with stakeholders 4. Generate evidence Consolidation of verified data by Urban HEART implementers 5. Identify priority health gaps and gradients Present the identified inequities with the key stakeholders (matrix and monitors) 6. Identify best response Meetings with stakeholders to draft action plans based on the packages and intervention of Urban HEART Budgetary plan for the intervention (month to be specified) Danang, Vietnam Danang has put in place effective mechanisms for looking after pregnant women and infants during the typhoons which regularly hit the city. Dr. Tan Ba Huynh Director, Center for Reproductive Health Care, Danang, Vietnam Mr. Dung Quang Ho (Interpreter) Officer, Protocol Division, Department of Foreign Affairs, Danang People s Committee, Vietnam The City Danang City, on the coast of central Vietnam, has a total population of 951,684, and is made up of eight districts comprising 56 communities. Typhoon damage in Danang City After 37 years of development, the city s Maternal and Child Health (MCH) system covers the whole city from the grass-root level thorugh the community, district and municipal levels. At the municipal level, the Center for Reproductive Health Care (CRHC) is the main organization responsible for planning and managing Maternal and Child Health (MCH) activities for the whole AUICK Newsletter No August 2013

21 city, operating under the management and supervision of the Central Department of MCH of the Vietnam Ministry of Health and the Health Department of Danang City. The CRHC currently has 91 staff, including 21 physicians and 35 nurses/ midwives working with modern equipment such as 4D-Ultrasound machine, mammography, Elisa-system, etc. The two main functions of the center are to provide clinical MCH services and to plan, conduct and manage MCH programs in the city. The MCH network includes four municipal hospitals; seven district health centers with Reproductive Health (RH) teams of four to ten staff, and obstetric/gynecological departments; 56 RH staff working at 56 community health stations; and 842 community health volunteers working at the village/ hamlet level to cooperate in public health programs. Key MCH projects currently conducted under the management of Danang CRHC include improving quality of family planning services, enhancing the capability of program management in MCH, child malnutrition prevention program, and specific projects in improving RH in terms of cervical and breast cancer screening, adolescent health, and mother-to-child HIV transmission. A number of challenges in the field of MCH remain: - Gender imbalance in newborns, as the rate of male to female newborns is increasing. - Although the malnutrition rate of weight-forage among under-five year-old children has been reducing rapidly, the height-for-age malnutrition rate is still high (18% in 2012) and overweight-obesity tends to increase in urban areas. - The demand of MCH services is increasing rapidly in recent years, while the resources have not kept up with this pace, especially the number of physicians. - Abortion has been reduced but is still at a high rate: 8,443/20,581 (41.02%) live births in Current and future orientations are to encourage and create a favourable environment for socialization in the health sector, especially to develop private clinics/ hospitals in MCH, to enhance health education activities in MCH at the community level through mass media and through the health volunteer network, and to increase training activities in the field of MCH to improve both quantity and quality of human resources. Being a coastal city in the central region of Vietnam, natural disasters in Danang are mostly storms, typhoons and floods caused by heavy rains that often happen from July to November. Thanks to the geographic characteristics and the well-planned preparedness in dealing with natural disasters, human loss has been minimized. Damages were mostly on infrastructure and the economy. Danang CRHC and other agencies are responsible for providing MCH services during disasters. In district and provincial hospitals, the provision of services is rarely disrupted by floods and storms, as they are built in high areas and have electrical generators to maintain power for emergency operation. To cope with natural disasters and to ensure the provision of these services, officials of the MCH network collaborate with local authorities, and organizations follow the guidelines of the Committee for Natural Disaster Prevention and the Department of Health of Danang City. These are based on the strategy of Four Site-preparedness, whose aim is to utilize site resources at the grass-root level to cope with problems occurring during natural disasters, when the connection with higher levels is interrupted. The four pillars of preparedness are site direction, site human resources, site means and equipment, and site supply. Health officials participate in disaster drills arranged by local authorities, and Community Health Stations (CHS) manage the list of names and addresses of pregnant women and children in case of evacuation needed during disasters. Community health staff collaborate with local government to provide knowledge to local people on natural disaster preparedness, and health facilities at all levels have packages of medical supplies ready for natural disasters. CHSs cooperate with the local government to keep lists of households and organizations that have suitable equipment such as boats, trucks and other vehicles to mobilize during disasters, and local authorities also educate citizens on reserving food and medicine supplies. Each CHS has a package of medical equipment and supplies reserved for natural disasters, and the head of each CHS is the site director of medical activities in the affected area, including MCH services and house visits. CHS staff are supported by district health centers or emergency service mobile teams, and participate in recovery activities in the local area by securing clean water, sanitary services and epidemic control, etc. Local health staff check the health status of women and children at evacuation sites and provide services as needed. If all sectors at the local site are wellprepared, they can actively deal with disasters. In Danang, full coverage of residential areas and mass evacuation before storms or floods have greatly reduced the number of deaths and injuries. The city government has also moved residents from high risk areas to new safer areas permanently. August AUICK Newsletter No.58

22 The Proposed Action Plan Vietnam is one of the countries with the highest abortion ratio in the world, and the ratio in Danang is also high compared to the national ratio (41% in 2012), which makes this a major problem to solve. The AUICK Action Plan aims to reduce the ratio of abortion to live births in Danang to 35% in It will provide education to women and students on contraception methods and safe sex, and improve and enhance the quality of RH services and the accessibility to services for the community. The Plan will be implemented by health officials, heads of women s associations and community health volunteers. It will solicit the support of the mass media and the Health Education Center of Danang, as well as funding from the City budget, Central Government, public support and an independent budget of Danang Reproductive Health Center. Danang Action Plan Time Frame: March August 2014 Steps / Actions M A M J J A S O N D J F M A M J J A 1. Group meeting to introduce Action Plan 2. Build planning, executing and supervising teams 3. Rapid survey about the knowledge of abortion amongst students and women in piloted area 4. Assemble available data at related agencies 5. Make detailed plan and budget estimation 6. Call for budget from related sources 7. Design and print communication materials 8. Organize communcation campaigns 9. Supply free condoms at the places chosen by the RHC, within the communication campaigns 10. Maintain direct communication through community health volunteers 11. Training and retraining for RH staff of CHS, RH teams and other MCH clinics 12. Enhance the role of pharmacies in selling contraceptive drugs 13. Monitor, supervise and assess the project SUPPLEMENTS AUICK News AUICK Associate City (AAC) News Chittagong - The World Bank announced in February 2013 that a new 149 million USD project will help provide clean water and safe sanitation to residents of Chittagong. ( Weihai - An AUICK Action Plan for Weihai formulated at the 2013 AUICK / WHO Kobe Centre Urban HEART Workshop to reduce unwanted pregnancies and unsafe abortions (see pages 12-13) has been approved by Weihai municipal government. The Plan will train health care workers and attendants, increase community awareness and provide AUICK Newsletter No August 2013

23 material to students, volunteers, teachers and parents to educate on reproductive health. (Mr. Tian Qing, Deputy Director, Obstetrics and Gynaecology, Weihai Women and Children s Hospital) Chennai - Tamil Nadu Energy Development Agency (TEDA) are promoting the use of solar power by homes in Chennai. So far around 550 households have applied to use a 1kw ( Surabaya - The World Education Expo in Surabaya Indonesia is scheduled to take place on Tuesday 8 October in Surabaya. ( AUICK is due to send a Technical Support team to Surabaya from September 2013 to follow up on extensive training in 2009 of the city s emergency services to cooperate in a large-scale disaster. The course will be conducted by members of Japan Paramedical Rescue (JPR). Kuantan - Kuantan Port, the most prominent maritime terminal in the east coast of Peninsular Malaysia, is set to double its capacity. The construction should take two to three years to complete, and will confirm Kuantan as the integrated industrial and logistics hub for the region. ( Olongapo - Olongapo City government recently acquired an automated weather station to upgrade the city s disaster risk reduction and management capability. Installed at the City Disaster Risk Reduction and Management Office (CDRRMO), the AWS can record the basic weather parameters of the locality, which is regularly hit by typhoons and flooding. On February 10, 2013 around 10,000 runners from all walks of life participated in the second Million Volunteer Run organized nationwide by the Philippine Red Cross. The run promoted Red Cross 143, a program designed to engage Filipinos into volunteerism, as the country is one of the most disaster-prone nations in the world. ( Khon Kaen - AUICK is arranging an agreement with the Faculty of Engineering and College of Local Administration of Khon Kaen University, with Khon Kaen Municipality, to send officials and academic experts to its future training workshops. This will help Khon Kaen to manage population, health, and developmental issues, so as to better meet the needs of its citizens. Danang - Meeting with officials of Danang People s Committee, Japan International Cooperation Agency (JICA) in Vietnam has proposed to continue cooperation to support the implementation of projects utilizing Public - Private Partnerships (PPP), including a part of the 86 million USD Hoa Lien water supply plant, and providing financial assistance for port facilities. The Vietnam Red Cross Society is cooperating with the Red Cross of Danang to organize the launch workshop for the Health Care 2013 project by the end of This will enhance awareness on the prevention of dengue fever and malaria, build the capacity of staff members and volunteers, and prioritize prevention of and response to epidemics in emergency situations and newly discovered diseases. It will also promote health education communicative activities involving water and environmental hygiene, and the support of healthcare humanitarian activities. ( AUICK welcomes contributions from its Associate Cities to auick@auick.org AUICK International News World Toilet Day - The United Nations General Assembly has designated 19 November as World Toilet Day, urging changes in both behaviour and policy on issues ranging from enhancing water management to ending open-air defecation. Of the world s seven billion people, six billion have mobile phones, but only 4.5 billion have access to toilets or latrines meaning that 2.5 billion people, mostly in rural areas, do not have proper sanitation. In addition, 1.1 billion people still defecate in the open. The countries where open defecation is most widely practiced are the same countries with the highest numbers of under-five child deaths, high levels of under-nutrition and poverty, and large wealth disparities. Almost 2,000 children die every day from preventable diarrhoeal diseases, and poor sanitation and water supply result in economic losses estimated at $260 billion annually in developing countries. Every country is urged to accelerate progress towards a world in which everyone enjoys this most basic of rights. ( World Hepatitis Day - On World Hepatitis Day (28 July 2013), WHO has urged governments to act against the five hepatitis viruses that can cause severe liver infections and lead to 1.4 million deaths every year. The priority areas are raising awareness, August AUICK Newsletter No.58

24 evidence-based data for action, prevention of transmission, and screening, care and treatment. The fact that many hepatitis B and C infections are silent, causing no symptoms until there is severe damage to the liver, points to the urgent need for universal access to immunization, screening, diagnosis and antiviral therapy. Many of the measures needed to prevent the spread of viral hepatitis disease can be put in place right now, and doing so will offset the heavy economic costs of treating and hospitalizing patients in future. ( MDG 5 Target - The target of the United Nations Millennium Development Goal 5 is to reduce the maternal mortality rate (number of maternal deaths per 100,000 live births) by three quarters between 1990 and There have been some improvements in health care offered to mothers or mothers-to-be, meaning maternal mortality has nearly halved since 1990, but the target is far from being met. An estimated 287,000 maternal deaths occurred around the world in 2010, a decline of 47% from 1990, but the rate is still 15 times higher in developing countries. A doctor, nurse or midwife can intervene to prevent life-threatening complications such as heavy bleeding, or refer the patient to a higher level of care when needed. In developing regions overall, the proportion of deliveries attended by doctors, nurses or midwives rose from 55% in 1990 to 65% in Increased access to safe affordable and effective methods of contraception provides individuals with greater choice and opportunities for responsible decision making, and contributes to improvements in maternal and infant health by preventing unintended or closely spaced pregnancies. ( ( Plant-for-the-Planet Campaign - After the Billion Tree Campaign oversaw the planting of more than 12 billion trees worldwide, it has now been formally handed over by the United Nations Environment Programme (UNEP) to the Plant-for-the-Planet Foundation. This was founded in January 2007 following a school project on climate change by Felix Finkbeiner, then nine years old, outlining a vision of children planting one million trees in each country worldwide to help offset global carbon emissions. Plant-for-the-Planet has since grown into a global movement with around 100,000 children in over 100 countries involved. ( AUICK / JICA Technical Support Project Under its Technical Support Project, AUICK is training nurses and midwives of a 600- bed Mother and Child Hospital in Danang, Vietnam. A three-year program supported by the Japan International Cooperation Agency (JICA) since April 2012 has sent trainers from Kobe and revceived trainees from Danang, for courses on Infection Control, Communication Skills and Physical Assessment of pregnant mothers and infants. Most recently, a third training course in Kobe was conducted from July. A special course for senior doctors and nurses in charge of training programs will be conducted in September, Nurses from Danang, Vietnam, are trained in Kobe AUICK welcomes your contribution Sharing information is a crucial part of AUICK's activities. This newsletter is intended to be for the exchange of information on urban and population problems in Asian cities. Your contribution to the newsletter is very important. Based on our regulations, payment will be made for published works. Please send your opinions, articles, information, papers and pictures to: Editor of AUICK Newsletter Asian Urban Information Center of Kobe (AUICK) Kobe Commerce, Industry and Trade Center Building 2F, Hamabe-dori, Chuo-ku, Kobe , Japan AUICK Newsletter No August 2013