How to write a CERF proposal HAC/RRO, April 2010 How to write a CERF proposal Points to remember: 1. CERF life-saving criteria CERF grants are for life-saving activities. For the health sector, the CERF defines life-saving activities as: Activities that have an immediate impact on the health of populations affected by an emergency Based on the revised life-saving criteria 1 recently issued by the CERF, HAC/HQ has prepared a comprehensive table (see Annex 1) of the typical health interventions, products, activities and inputs that meet the CERF's criteria. All WHO staff involved in CERF projects are asked to refer to this table when preparing CERF proposals. Note the CERF is unlikely to approve proposals that do not contain any of the basic elements contained in the table. The standard CERF grant application template is attached as Annex 2. 2. Types of CERF proposals Remember there are two types of CERF proposal: 1. Proposals that cover WHO activities only. 2. Proposals that cover Health Cluster activities and involve different implementing partners. A sample Health Cluster CERF proposal is attached as Annex 3. CERF proposals that involve different implementing partners always have priority over those that involve WHO activities only. 3. Project summary In this section, you should briefly describe how CERF funding will be used to support life-saving/core humanitarian activities. Remember to include the results of recent joint assessments. 4. Project objective The project objective must be life-saving, clearly defined, and SMART (specific, measurable, achievable, relevant and time-bound). When drafting your objective, ask yourself the following: o o o o What do you want to achieve in the timeframe available? (Remember that CERF rapid response grants have a timeframe of only three months. CERF grants for under-funded emergencies have a timeframe of between six months and one year.) Is the project objective reasonable, achievable and measurable? Can you reach the objective within the timeframe of the project? How can you measure the result? 1 WHO and the CERF secretariat have worked closely together to revise the CERF's life-saving criteria for the health sector. The updated criteria were issued in January 2010: see the CERF web site for more details (http://ochaonline.un.org/cerf/cerfhome/tabid/1705/language/en-us/default.aspx).
How to write a CERF proposal HAC/RRO, April 2010 2 See sample objectives below (taken from successful proposals): To reduce excess mortality and morbidity in Darfur by ensuring the availability of life-saving health services for the most vulnerable population. To save lives and prevent further deterioration of public health conditions in the affected areas of Haiti. To reinforce health facilities' capacity to provide medical care for children suffering from severe acute malnutrition. 5. Proposed activities There must be a clear link between the objective, the proposed activities and the expected outcome. When drafting the proposed activities, ask yourself the following: o o o Are you able to implement the activities within the timeframe and taking account of any logistical, political or access constraints? (Remember that CERF no-cost extensions are difficult to obtain.) Will implementation of the activities lead to the expected outcome? Are the activities clearly linked to the budget? 6. Expected outcome Remember that objectives are intended results. Outcomes are achieved results. When drafting the expected outcome, ask yourself the following: o o o o Is there a clear link between the objective and the expected outcome? Is the expected outcome measurable? Can the expected outcome be achieved in the timeframe available? What indicators will you use to measure the outcome? WHO must list a maximum of five indicators it will use to measure the outcome of the project. Remember to select these from the Global Health Cluster's set of core indicators and benchmarks (attached as Annex 4). All Global Health Cluster partners have agreed to use these indicators as the basis for monitoring and measuring humanitarian health outcomes in all WHO and Health Cluster funding proposals and work plans. The GHC's Health Services Checklist setting out the minimum levels of essential health care services in an emergency setting is also attached (see Annex 5). This document should be used to complement to the core indicators, and will help you select the indicators that are most appropriate for the project. 7. Implementation plan The implementation plan should briefly describe how, in practical terms, WHO is going to implement the project (how, when, in what order, and with whom). 8. Budget There must be a clear link between the activities and the budget. See the separate document "How to Construct a CERF budget".
How to write a CERF proposal HAC/RRO, April 2010 Annex 1 CERF Life-Saving Criteria for the Health Sector: Sample products, activities and inputs Life-saving intervention Rationale Sample products/ outputs Sample activities Key inputs Coordination of health aspects in the context of natural disasters and complex emergencies. Key references: Health Cluster Guide SPHERE Handbook 2004 (under revision) Proper coordination of the health sector is critical for effective life saving action. This coordination serves as a mechanism for common identification of: evidence-based priorities, strategies, and gaps to be filled in basic health services delivery, and to assure efficient use of available resources. Identifying jointly critical issues that require multi-sectoral responses, and planning the relevant synergistic interventions with the other clusters concerned. Health cluster coordination minutes highlighting priority action points to be addressed. Regular Health Cluster Bulletins elaborated in full collaboration with health partners, stakeholders, and beneficiaries. Joint Health action plan developed and implemented Mapping of Who is doing What, Where and When (4W) Convene regular Health Cluster Meetings. Identify agencies as focal points for specific subsectors. Develop the 4W table (Who is doing What, Where and When) Monitor, map and update financial and human resources availability for Health Cluster partners. Staff (Health Cluster Coordinator and secretarial support). Avoiding duplication of interventions in a multi-actor response scenario.
How to write a CERF proposal HAC/RRO, April 2010 4 CERF Life-Saving Criteria for the Health Sector: Sample products, activities and inputs Life-saving intervention Rationale Sample products/outputs Sample activities Key inputs Collection and dissemination of critical health information Key references: Health Cluster Guide SPHERE Handbook 2004 (under revision) During crises, monitoring of the health situation and risks as well as the performance of the response is essential to ongoing identification of public health priorities for the provision of rapid and effective lifesaving interventions. Monitoring includes: the severity of an emergency; trends in incidence of major diseases and malnutrition; the impact of specific health interventions and; providing information to all stakeholders including the MoH to enable health programme planning, implementation and adaptation, and resource mobilization. Regular Health Cluster Bulletins. Updated emergency profiles. Assessment reports. Quick surveys reports. Minimum sets of indicators. Conduct joint initial rapid assessment Collect, process, analyse & disseminate health data. Promote the adoption of standardized data collection tool Staff including information manager, data collectors and reporters.. Computers, stationery, means of transmitting health data. Transport and communication means. Ensuring equitable and timely access to essential Primary Health Care including basic repair of the providing structure Key references: Health Cluster Guide SPHERE Handbook 2004 (under revision) During an emergency, priority humanitarian interventions must focus on ensuring essential medical care based on relevant primary health care principles. While the delivery of this essential care may in some settings require the establishment of temporary or mobile clinics, in many settings provision of support to overstretched and disrupted existing local services and systems is required to save lives. This may include functional minor structural rehabilitation of health facilities. Support may also be directed at eliminating barriers such as user fees that may block access to this critical element of care, including support for emergency referral systems. Health facilities & support systems including mobile clinics available & accessible. Basic medical equipment & essential medicines in kits or in bulk delivered. Basic repair of the structure to provide essential primary care International medical staff deployed. National experts mobilized. Emergency referral to secondary care ensured. Financial resources for waiving health user-fee made available. Support local health system in delivering essential PHC to address health problems such as acute respiratory infections, malaria, and diarrhoeal disease, by deploying health team This includes supporting the deployment of mobile clinics (where needed) and emergency referral services and carrying out basic health infrastructure repairs to allow restart of activities Staff. Medical equipment. Essential medicines. Ambulance and cars. Cash.
How to write a CERF proposal HAC/RRO, April 2010 5 CERF Life-Saving Criteria for the Health Sector: Sample products, activities and inputs Life-saving intervention Rationale Sample products/outputs Sample activities Key inputs Ensuring adequate management of cases of acute severe complicated malnutrition in health facilities Management of severe malnutrition: a manual for physicians and other senior health workers. Geneva, World Health Organization, 1999. Malnutrition contributes to an estimated 60% of deaths in children under five years old. Mortality rates can be reduced substantially by modifying treatment to take account of the physiological and metabolic changes that occur in cases of severe acute complicated malnutrition and by treating the complication they suffer from, at health facility level. Health workers in health facilities settings trained on the management of complications of severe acute malnutrition in children under five. Appropriate medical supplies for severe malnutrition management available. Nutritional surveillance system integrated into disease surveillance system Train health workers on severe malnutrition management in health facilities settings. Procure medical supplies for the management of severe malnutrition (hypoglycemia, hypothermia, dehydration, electrolyte imbalance, infection, micronutrient deficiencies). Staff. Supplies. Equipment. Provision, distribution of quick turnover emergency stockpiles. Key reference: Guidelines for drug donations, WHO 1999 revised Immediate response to emergencies may require quick mobilization of essential medical equipment and medicines from emergency stockpiles so that life-saving care is available as soon as possible. Existing stockpiles need to be quickly replenished to respond to contingencies and new emergencies. Emergency stockpiles promptly replenished. Management of incoming pharmaceutical donations. Procure essential medicines and medical equipment to deal with lifethreatening diseases and health conditions (epidemic-prone diseases, diabetes, hypertension, ARV ). Essential medical equipment and medicines Logistics staff Transport cost Storage capacity
How to write a CERF proposal HAC/RRO, April 2010 6 CERF Life-Saving Criteria for the Health Sector: Sample products, activities and inputs Life-saving intervention Rationale Sample products/outputs Sample activities Key inputs Mass casualty management Key reference: Mass Casualties Management Systems, WHO 2007 In emergencies with a large number of injured patients, a standardized system for the management of multiple casualties including protocols for triage, referral and treatment of injured people contributes dramatically to saving lives. Access to appropriate services for the management of injuries ensured. Support first aid centres. Conduct rapid inservice capacity building Procure and deliver essential medicines and medical equipment. Staff. Essential medical equipment and medicines. Logistic means for medical rescue and evacuation activities. Support medical evacuation services. Support health staff deployments. Secondary level health care (repair of existing health facilities) The provision of life-saving hospital care during both natural and man-made emergencies may be severely disrupted because of structural damages and/or looting of health facilities and equipment. Life-saving care at secondary health care level is ensured. Undertake basic, rapid repairs to ensure hospital functionality. Provide essential emergency medical equipment and medicines to emergency wards. Staff. Structural rehabilitation to ensure utilities (water, sanitation, medical waste management, power, communication) and material. Essential medical equipment and medicines.
How to write a CERF proposal HAC/RRO, April 2010 7 CERF Life-Saving Criteria for the Health Sector: Sample products, activities and inputs Life-saving intervention Rationale Sample products/outputs Sample activities Key inputs Addressing lifethreatening conditions related to chronic diseases Key references: Chronic Diseases in Emergencies, WHO (to be published) Older People in Emergencies: Considerations for Action and Policy Development, WHO 2008 Mental Health and Psycho-social support for survivors of emergencies Key reference: Guidelines on Mental Health and Psychosocial Support in Emergency Settings, IASC 2007 The interruption of therapy for chronic conditions such as dialysis-dependant, renal failure, insulindependant diabetes, etc may result in death. One of the priorities in emergencies is to protect and improve people s mental health and psychosocial well-being. Achieving this priority requires coordinated action among all humanitarian actors. A multi-sectoral, interagency framework enables effective coordination, identifies useful practices, flags potentially harmful practices, and clarifies how different approaches to mental health and psychosocial support complement one another. Life-saving drugs and medical equipment for treatment of lifethreatening chronic diseases available and accessible. A multi-sectoral, interagency coordinated mental health and psycho-social framework with functional referral system. Psychological first-aid and protective care for people with severe mental disorder supported. Procure and deliver drugs to deal with lifethreatening diseases and health conditions. Ensure inter-sector and/or inter-cluster coordination for nonspecialized and specialized support (Guidelines). Essential drugs and medical equipment and medicines. Staff. Staff. Specific drugs
How to write a CERF proposal HAC/RRO, April 2010 8 CERF Life-Saving Criteria for the Health Sector: Sample products, activities and inputs Life-saving intervention Rationale Sample products/outputs Sample activities Key inputs Addressing lifethreatening conditions related to communicable diseases Key reference: Communicable Diseases Control in Emergencies: Field Manual, WHO 2005 Poor living conditions in crowded setting and lack of water and hygiene are favourable to the spread of epidemic-prone and vector borne diseases (mosquitoes, rats, etc ) and mortality due to communicable disease may be much higher than usual due to deteriorating health conditions, malnutrition, unusual climatic conditions and lack of access to proper care. Since epidemics may spread very fast in these conditions, the early detection and confirmation of and readiness for response to outbreaks of communicable diseases is a must to prevent excess mortality. Social mobilization is key in limiting morbidity Simplified protocols for treatment of communicable diseases. Standardized agreed case definition. Focused vaccination programme to protect the population and to respond to outbreak of vaccinepreventable disease where adequate. Readiness for response to life-threatening communicable diseases (measles, meningitis, cholera, shigellosis, hepatitis, etc.). Weekly epidemiological bulletin including both epidemiological and laboratory data. Surveillance system for detecting and monitoring life-threatening epidemicprone diseases. Conduct refresher training for health staff to improve case management and other control measures. Provide drugs and materials and establish specific adhoc treatment units (e.g. cholera treatment centre). Implement interventions to interrupt disease transmission: Social mobilization and targeted health education; Reactive mass vaccination campaigns (measles, meningococcal, yellow fever outbreak) Implement a specific EWARN system and take other measures needed for active case finding during collection, shipment and testing of specimen from suspected cases. Drugs, vaccines, cold chain materials and other medical supplies. Staff. Transport for collecting/delivering specimens.
How to write a CERF proposal HAC/RRO, April 2010 9 CERF Life-Saving Criteria for the Health Sector: Sample products, activities and inputs Life-saving intervention Rationale Sample products/outputs Sample activities Key inputs Medical (including psychological) support to survivors of sexual violence. Key reference: Clinical management of rape survivors : developing protocols for use with refugees and internally displaced persons, WHO, UNHCR 2004, MISP guideline Priority reproductive health (RH) emergency interventions Key reference: Reproductive health in refugee situations: an interagency field manual, 1999; MISP guideline In crises, people (especially women and children) may be at increased risk of sexual violence. The timely provision of health care to those who experience sexual violence can prevent severe health outcomes including death. RH services must be immediately implemented at the onset of emergencies in order to reduce deaths from RH-related risks. Basic and Comprehensive Emergency obstetric Care (EmOC) including post-abortion care are essential components of an early RH care system. Protocol for clinical management of sexual violence. Coordinated service provision and referral to other sectoral interventions. Access to priority life saving RH services including MISP (response to sexual violence; prevention of excess newborn and mother illness and death; and reduction of HIV transmission). Update health staff on protocols for the clinical management of sexual violence. Supply drugs and materials (including inter-agency reproductive health kits). Supply drugs and materials (including inter-agency RH kits such as clean delivery kits, midwifery kits). Staff. Essential medical equipment and medicines. Staff. Essential medical equipment and medicines. Logistical means of evacuation/referral.
How to write a CERF proposal HAC/RRO, April 2010 10 CERF Life-Saving Criteria for the Health Sector: Sample products, activities and inputs Life-saving intervention Rationale Sample products/outputs Sample activities Key inputs Priority responses to HIV/AIDS Key reference: Guidelines for HIV/AIDS, IASC 2004 Priority HIV/AIDS activities must be undertaken in all emergencies to prevent deaths, avoidable illness and avert transmission of HIV. HIVrelated risks may be exacerbated by conditions arising in the emergency. HIV/AIDS awareness information dissemination, provision of condoms, prevention of mother-tochild transmission, postexposure prophylaxis, standard precautions in health care settings. Emergency awareness and response interventions for high risk groups. Care and treatment for people with HIV. Supply drugs and materials (including inter-agency RH kits). Adapt and disseminate information on HIV. Distribute condoms. Provide treatment for people with HIV. Provide equipment and supplies for safe blood transfusion. Staff. Essential medical equipment and medicines. Condoms. Information materials.
Annex 2 CERF No. Date Type of submission New Revised Sector To be completed by the CERF Secretariat. III. AGENCY PROJECT PROPOSALS (2 pages each) 1. Requesting agency: 2. Project title: 3. CAP/Flash Appeal project code: (Mandatory to provide where an appeal exists) 4. Cluster/sector/cross-cutting issue: 5. Geographic areas of implementation targeted with CERF funding: (Please be specific) 6. Total number of individuals targeted with CERF funding (provide a breakdown by sex and age). a. Female b. Male c. Children under 5 d. Total individuals: Funding (USD) 7a. Total project budget: 7b. Total project funding received so far: 8. Total amount of CERF funding requested: Please provide the total amount and include an estimation of the planned breakdown of funds by type of partner: Note: The total requested from the CERF should not be 100% of the total budget for this project, as CERF funding should be complemented by other funding sources. US$ US$ a. UN agencies/iom: US$ b. NGOs (please list US$ individually): c. Government: US$ e. Total: US$ CERF Application Template January 2010 http://ochaonline.un.org/cerf
9. Briefly describe the overall project, including information on how CERF funding will be used to support lifesaving/core humanitarian activities. 2 Describe the profile of beneficiaries and how gender equality is mainstreamed in project design and implementation (ensuring that the needs of women, girls, boys, and men are met equally). Include relevant assessment data. 10. Description of the CERF component of the project (2 pages). (a) Objective(s) (b) Activities (c) Expected Outcomes and Indicators (please use SMART 3 indicators) 11. Implementation Plan: Please include information on the mechanisms for implementation, grants to cooperating partners, the duration for implementing CERF-funded activities, monitoring and reporting provisions. 2 The CERF Life-Saving Criteria, which specify sectoral activities that the CERF can fund, are available at http://cerf.un.org. 3 SMART indicators are: specific, to avoid differing interpretations; measurable, to allow monitoring and evaluation; appropriate to the problem statement; realistic and able to achieve; time-bound indicating a specific period of time during which the results will be achieved. Indicators must be designed to enable you to identify the different impacts (intended and unintended) your project has on women, girls, boys, and men. Application Template January 2010 http://ochaonline.un.org/cerf
12. CERF Project Budget Please use the template below without modifying the section headings. Provide a detailed breakdown of items (quantity, unity costs) and costs for each budget line for the CERF component of the project only. Add additional rows, as needed. Cost breakdown A. Staff costs (salaries and other entitlements of UN staff) Amount (USD) B. Travel C. Contractual Services (please list and provide general cost breakdown for implementing partners) D. Operations (please itemize expendable operational inputs, e.g. quantity of food, medical supplies etc.) E. Acquisitions (please itemize asset purchases, e.g. computers) F. Other Subtotal project requirements Indirect program support costs (not to exceed 7% of subtotal project costs) PSC amount Total CERF project cost Application Template January 2010 http://ochaonline.un.org/cerf
Requesting Agency: Project Title: CAP/Flash Appeal Project Code Sector: CERF No. Date Annex 3 To be filled in by the CERF Secretariat World Health Organization (WHO) Emergency Primary Health Care for IDPs and host communities focusing on filling the gaps/unmet life-saving needs in the health response WHO: PKA-10/H/29473/122 IMC: PKA-10/H/29344/5160 SCF: PKA-10/H/29351/6079 ARC: PKA-10/H/29342/5586 CORDAID: PKA-10/H/29390/5375 NIDA: PKA-10/H/26615/8766 Johanniter: PKA-10/H/29555/1024 HHRD: PKA-10/H/27305/12839 Malteser: PKA-10/H/29314/7560 HEALTH WHO and 8 Health Cluster Partners: Geographical area: Kohat, Hangu, Swat, Buner, IDP Camp (Nowshera), Conflict affected Districts: Approximately 4.5 million people living in conflict affected districts and IDP camps Interventions targets: 1.06 million population approximately (including IDPs, host communities, returnees and populations in crisis zones) 8 Health Cluster Partners: S.No. Agency Target Area Beneficiaries Targeted Beneficiaries: 1 2 3 4 5 6 7 8 9 IMC Swat 110,000 SCF Swat 100,000 ARC Swat 84,400 CORDAID Kohat/Shangla 81,000 NIDA Swat 150,000 Johanniter Kohat 33,000 HHRD Swat 90,000 Malteser Swat 72,000 WHO Kohat, Hangu, Swat, Buner, DIK, Tank 270,000 TOTAL: 990,400 Implementing Partners: Total Project Budget: IMC, SCF, ARC, CORDAID, NIDA, Johanniter, Malteser Int., HHRD, WHO 915,000 8 HC Partners 1,085,000 TOTAL US$ 2,000,000 Note: a separate funding proposal will be submitted by UNICEF with budget of 400,000 US$ for mother and child health care
Amount Requested from the CERF: Pakistan Humanitarian Response Plan Funding 2,000,000 USD WHO: 31,243,746 IMC: 500,000 SCF: 1,871,590 ARC: 1,324,339 CORDAID: 968,491 NIDA: 800,000 Johanniter: 599,498 HHRD: 300,953 Malteser: 1,156,000 Total US$: 38,764,617 (a) Project Summary The overall goal of the project is to contribute to the health response in IDP-hosting areas by targeting health assistance to both the IDPs and the population affected by the IDP influx. The Health Cluster will supply essential drugs, help repair health facilities, restore basic health care services and reinforce disease surveillance aimed at outbreak prevention and containment. WHO Pakistan, in collaboration with the federal and provincial Ministry of Health, other UN agencies and health cluster partners, intends to provide emergency health assistance to control and prevent outbreaks in the affected areas. There are over 580,000 registered IDPs in 11 districts in North-West Frontier Province (NWFP). Most IDPs are from Bajaur agency in the Federally Administered Tribal Areas (FATA), where the heaviest fighting took place in 2009 and from SWAT district in NWFP itself. Almost half the IDPs both inside and outside the camps are women. Children under-five account for almost 20% (over 100,000) of the total number of IDPs (both inside and outside the camps). Despite various initiatives, critical gaps remain in the delivery of health services due to lack of funding, scattered IDP populations and poor health facilities in the IDP-hosting districts. WHO s core functions in the affected areas are to: 1) coordinate all health-related activities and promote transparent data collection and information-sharing with all sector partners, 2) ensure that there is no duplication of activities, and 3) be the provider of last resort for health services. The immediate needs are in Primary Health Care (PHC) services (including mother & child care and reproductive health) and emergency health services. Special attention and assistance needs to be given to vulnerable groups including the disabled and elderly in Kohat, Hangu, Nowshera and Swat. The poor living conditions, inadequate health care services and harsh weather conditions are conducive to the rapid spread of communicable diseases such as acute respiratory infections and diarrhoeal diseases that are already endemic in the affected areas. The lack of a disease surveillance and outbreak response system must be urgently addressed. Description of the CERF Component of the Project The Pakistan Humanitarian Response Plan (PHRP) represents the Humanitarian Country Team s common overall response plan and strategy. However, three months into 2010, there are new and acute relief needs that require additional donor support in order to sustain activities until the end of June. These gaps, and the Health Cluster prioritization process, form the basis of this application. The process of determining the projects to be included in this proposal involved extensive consultations at both inter-agency and cluster levels, involving UN agencies, implementing partners including the provincial and federal governments, and other humanitarian organizations including the International Committee of the Red Cross/Red Crescent.
Health Coordination Health and nutrition activities are coordinated through regular meetings of all Health Cluster partners (bi-weekly meetings at both central (Islamabad) and provincial levels and weekly/monthly meetings at district level (security permitting). At the peak of the IDP movements, The Health Cluster convened special coordination meetings to coordinate activities and collate data for the response. The office of the EDO-Health in each district will appoint a health sector focal point to avoid overlap between the health partners. Health partners will share and analyse data and use the results to shape priority public health interventions. Health coordination meetings will focus on reaching agreement with all health partners on priorities for action by: 1) sharing regular health updates and analyses, 2) ensuring equitable distribution of assistance to the affected population (including disease surveillance). Access to Primary and Secondary Health Care Services Currently with the reduction in the military offensive, the true scale of the destruction of basic health services has become clear. Moreover, there is an increased risk of outbreaks of communicable diseases including measles and scabies, and the number of acute respiratory infections is on the rise. WHO and health partners will scale up and provide more focused support to local health staff for the treatment and management of communicable diseases. WHO and partners will also provide life-saving drugs, emergency health kits and other essential health supplies to PHC facilities in the affected areas. This strategic focus ensures that essential health care services, delivered by trained health staff, are readily available and accessible to the target populations. Health care service delivery will focus on enabling access to essential emergency health care at health facilities; these will be the first point of entry for patients. The quality of health care in health facilities will be improved by 1) providing the required medical supplies and equipment and technical assistance to health staff and 2) monitoring and reporting communicable disease alerts and outbreaks to facilitate and enable a speedy response to developing challenges. To respond swiftly to any outbreaks or emergencies, WHO and partners will maintain buffer stocks of drugs and medical supplies at federal and provincial levels. Essential drugs and medical supplies for districts will be pre-positioned in provincial or district warehouses. Early Warning, Alert and Response System Strengthening and improving the existing Disease Early Warning Alert and Response System (DEWS) will ensure that outbreaks are rapidly detected and controlled through adequate preparedness and focused use of technical staff (stockpiles, deployment of trained medical staff, standard case definitions and treatment protocols) and rapid response (confirmation, investigation and implementation of control measures). With this system, monitoring and analysing disease trends and facilitating the timely detection and response to outbreaks will be possible. Planned Interventions: Health Cluster interventions are planned for two distinct groups: (a) IDPs (in camps, with host communities and in transit) and host communities (b) IDPs trapped in inaccessible areas
The proposed priority health response interventions are: 1) IDPs (in camps, with host communities and in transit) and host communities Ensure equitable access to comprehensive PHC services for IDPs and host communities in Kohat, Hangu, DI Khan, Tank, Swat, Buner, Shangla and Jalozai Camp (Nowshera). Ensure provision of PHC service package (including maternal, neonatal and child health (MNCH)/reproductive health, mental health and psycho-social support through strengthening service delivery points (basic health units, rural health centres, civil hospitals, temporary health clinics in IDP camps, mobile health units). Ensure the access of IDPs to essential referral services through strengthening emergency surgical and comprehensive obstetric and neonatal care at district level (secondary health care). Provide essential medicines as per the health cluster approved list to all health posts in camps and health facilities, both primary and secondary. Expand and strengthen the DEWS and improve outbreak response capacities through stockpiling and readiness measures to mitigate the seasonal public health risks. Increase community awareness on health and hygiene issues with emphasis on reproductive health. Coordinate health cluster partner interventions; Strengthen the coordination, planning and operational response capacity of local health authorities and partners for epidemic preparedness and emergency response. Ensure access to health care services in affected areas through assisting and supporting functioning health facilities, and establishing mobile clinics for inaccessible areas. Provide supplies for response to outbreaks in all affected areas (e.g. PHC kits, long-lasting insecticide-treated bed nets, oral rehydration salts, drugs and essential medical supplies). 2) IDP population trapped in inaccessible areas The Government has been shouldering co-responsibility for the provision of emergency services and medical evacuation in inaccessible areas. Some support, consisting of life saving medicines and basic medical equipment, will be provided by the Health Cluster (WHO) due to increased caseloads in existing facilities (4 DHQs). Support the resumption and restoration of basic service delivery at all levels including in damaged/nonfunctional health facilities. Ensure access to life saving interventions through campaign approaches (e.g. Mother and Child Days, measles and tetanus toxoid vaccination campaigns). (b) Objectives: Reduce mortality and morbidity among the crisis-affected population by restoring/maintaining/strengthening essential health service interventions. Specific objectives: Ensure equitable access to integrated essential PHC services (including MNCH, reproductive health, mental health and psycho-social support) at community level and in facilities for all crisis-affected populations, particularly women and children, the elderly, and people with disabilities. Address emerging public health threats in a timely and appropriate manner by expanding DEWS to all affected areas and developing health contingency plans Ensure the delivery of the health response in a coordinated manner and according to SPHERE and national standards through increased stakeholder commitment and awareness of the affected population, especially women, on key life-saving health issues/interventions.
(c) Proposed Activities Ensure equitable access to comprehensive PHC for IDPs and host communities in Kohat, Hangu, and Swat. Provide, distribute and replenish emergency stocks of drugs and other medical supplies. Undertake basic and essential rapid repair of existing health facilities to make them functional and provide essential emergency medical equipment and drugs. Address life-threatening conditions related to communicable diseases, immunization and outbreak control activities through the establishment of DEWS to detect communicable diseases; train health staff, supply drugs and materials; conduct social mobilization and targeted health education campaigns; reactivate mass vaccination campaigns and establish ad-hoc treatment units. Implement priority reproductive health emergency interventions including supply of drugs and materials (e.g. inter agency RH kits such as clean delivery kits, midwifery kits). Provide medical and psychological support to survivors of sexual violence, including training health staff on sexual violence protocols for the clinical management of rape; supply drugs and materials (including interagency RH kits). Address life-threatening conditions related to chronic diseases where treatment has been interrupted due to the recent breaks in supplies and care after the snowfall. Support the provision of psychological first aid; protect and care for people with severe mental disorders (suicidal behaviour, psychosis, sickness, severe depression) in communities in the camps and institutions. (d) Expected Outcomes a) Provision of standard package of PHC to the IDP population including MNCH/RH/FP, psychosocial support, rehabilitative services for persons with disabilities, provision of essential drugs and supplies; strengthening of DEWS in affected areas. b) Availability of an essential package of emergency health services including treatment of common illnesses, emergency obstetric services, ante-natal care and post-natal care and expanded programme on immunization (EPI), to the people living in the area of return and IDP- hosting districts. c) Timely emergency warning and response system operational for all outbreak alerts; disease outbreaks avoided. d) Identification of epidemiological alarms through EPI vaccination campaigns, nutrition, DEWS system, health education and inter-sectoral collaboration (WASH, Nutrition, Health, NFIs distribution etc.) e) Attack//incidence rate of priority communicable diseases (cholera, measles, malaria) within acceptable levels for emergency situations. f) Contribution to a reduced morbidity and mortality among affected population. g) District health departments' ability to plan and implement timely interventions to address lifethreatening conditions strengthened. h) Children in IDP camps and in host communities vaccinated. (e) Indicators: Average population per functioning health facility (HF), by type of HF and by admin unit. Percentage of births assisted by a skilled attendant. Percentage of primary health facilities offering mental health care: support of acute distress and anxiety and front-line management of severe and common mental health disorders. Number of health facilities with comprehensive emergency obstetric care/500 000 population, by administrative unit. 90% of alert outbreaks responded to within 48 hours of reporting. Coverage of measles vaccination (6 months-15 years).
(f) Implementation Plan: The CERF project is planned as part of the Health Cluster's overall response. The health cluster has some funds available through other donors and the activities funded by the CERF will complement the overall response. WHO in collaboration with Department of Health and Health Cluster Partners is planning to implement the CERF projects activities as follows: WHO will contract NGO partners to provide PHC services to the IDPs and those in upper Swat areas through mobile units as well as existing health facilities. Referral mechanisms will be strengthened by providing 24/7 ambulances at health facilities, and referral hospitals will be supported through the provision of medicines and trained staff (female medical staff wherever possible). WHO public health and surveillance officers will be present in the IDP-hosting districts and the snow-affected areas to support disease surveillance and alert investigation and response. WHO environmental health engineers will assist in investigating and responding to disease alerts/outbreaks. To ensure the rapid availability of essential medicines and supplies, WHO will send available medicines from its existing stocks in Islamabad and procure new medicines to replenish emergency stocks. Medicines not available in the emergency stock will be procured immediately. Medicines will be provided to implementing partners for fixed and mobile clinics and to district health authorities. The supply of medicine will be matched with the number of patients treated to monitor the use of these medicines and ensure the rational use of drugs. Vaccination campaigns in the camps and the in IDP hosting districts will be supported in collaboration with health partners and the provincial department of health. UNICEF will ensure the delivery of basic preventive, promotive and curative maternal, newborn and child health services to IDPs living in camps and host communities, in collaboration with Health Cluster partners and the department of health. Coordination will be done through the Health Cluster at national, provincial and district levels, jointly chaired by WHO and the Ministry/Department of Health. All implementing partners and UN agencies (UNICEF and UNFPA) regularly attend the cluster meetings and share information on their activities. Disease data monitored through the surveillance system will be shared by the partners with WHO on a daily/weekly basis.
Budget Cost breakdown Amount (USD) A. Staff costs (salaries and other entitlements) 226,750 National/provincial staff for implementation, monitoring/supervision of activities at field level for three months. 8 Field Surveillance Officers for three months @ USD 2,000 p.m X 8X3 mths = 48,000 Health Cluster Coordinator: $ 13,583 per month X 3 = $40750 4 Pharmacists to ensure rational use/distribution of medical supplies @ USD 1,100 X 4 X 3 mths = 13,200 4 Medical Officers for three months @ USD 2,000 p.m X 4 X3 mths = 24,000 1 logistics assistant @ USD 600 p.m X 1 X 3 mths = 1800 1 Admin/Finance Assistant @ USD 600 p.m X 1 X 3 months = 1800 1 Emergency Health Officer @ USD 13000 p.m X 3 months = 39000 Office staff costs = 60,000 B. Travel Travel cost of staff 10,500 C. Contractual Services (please itemize below; add rows if necessary) Support to the partner NGOs and health department for delivery of an essential emergency health package in order to fill the gaps in existing emergency healthcare services (supplies will be supported by WHO/UNICEF): 1,085,000 S.No. Agency Proposed Allocation (US$) 1 2 3 4 5 6 7 8 IMC 200,000 SCF 250,000 ARC 180,000 CORDAID 150,000 NIDA 80,000 Johanniter 45,000 HHRD 80,000 Malteser 100,000 TOTAL: US$ 1,085,000 D. Operations (please itemize below; add rows if necessary) Field operations and monitoring of interventions (rented vehicles, fuel etc) 109,923 Disease early warning and response system (DEWS) = 48,024 48,024 Health education and hygiene promotion activities Printing cost of awareness raising material E. Acquisitions (please itemize below; add rows if necessary) 5 Generators (25 Kva), 5 District Head Quarter Hospitals (5 X USD 8,930) 44,650 Procurement of Emergency medicines and supplies 1. Mini Emergency Health Kits: 100 units X 1,330 US$ = 133,000 2. Secondary Health Care package kits 2 units X $ 28,675 = 57,350 3. Trauma Kit A and B = 15,601 4. Female hygiene kits: 4,000 units X 14 US$ = 56,000 5. Neonatal Resuscitation equipment 3 units X $ 1,500 = 4,500 6. ICU Ventilator 2 units X $ 11,303 = 22,606 7. Anesthesia equipment 2units X $ 14,167 = 28,334 Transportation cost =24,921 2,000 342,312 F. Other Subtotal project requirements 1,869,159 G. Indirect programme support costs (not to exceed 7% of subtotal project costs) PSC amount 130,841 Total cost US$ for WHO (including Partners) 2,000,000 Total request for CERF US$ 2,000,000 -
IASC Inter-Agency Standing Committee Global Health Cluster GLOBAL HEALTH CLUSTER SUGGESTED SET OF CORE INDICATORS AND BENCHMARKS BY CATEGORY Category # Name of indicator Type Health resources availability A.1 Average population per functioning health facility (HF), by type of HF and by admin unit A.2 Number of HF with Basic Emergency Obstetric Care/500 000 population, by administrative unit A.3 Number of HF with Comprehensive Emergency Obstetric Care/500 000 population, by administrative unit A.4 Percentage of HF without stock out of a selected essential drug in 4 groups of drugs, by administrative unit A.5 Number of hospital beds per 10 000 population (inpatients & maternity), by administrative unit A.6 Percentage of HF with clinical management of rape survivors + emergency contraception + PEP available A.7 Number of health workers (medical doctor + nurse + midwife) per 10,000 population, by administrative unit (% m/f) Input, proxy Input, proxy Input, proxy Data collection method HeRAMS Benchmarks SPHERE standards: 10 000 for1 Health Unit, 50 000 for 1 Health Centre, 250 000 for 1 Rural/District Hospital Comments Proxy indicator of geographical accessibility, and of equity in availability of health facilities across different administrative units within the crisis areas. HeRAMS >=4 BOEC/500 000 Proxy indicators for the physical availability and geographical accessibility of emergency obstetric services and their distribution across districts in the HeRAMS >=1 CEOC/500 000 affected areas. An unbalance between the availability of BEmOC and CEmOC (with too few BEmOC) is often observed. Input IRA 100% Indicator for the effectiveness of the procurement and distribution of essential drugs, and proxy indicator of the quality of care. Its comparison across the crisis areas and its monitoring over time is very important. Input HeRAMS >10 Indicator for the availability of hospital beds across crisis areas and proxy indicator of equity in the allocation of resources. Input HeRAMS 100% Key indicator to measure the allocation of resources and the availability of services to address consequences of sexual violence. Input HeRAMS >22 Key indicator to monitor the availability of health workers. It can serve as a proxy to monitor equity in the allocation of resources by humanitarian actors across different groups within the humanitarian case load and/or crisis affected population versus local populations. No consensus about optimal level of health workers for a population. It can be broken down according to the type of health worker to present the workforce mix. Health services coverage A.8 Number of CHWs per 10 000 population, by administrative unit C.1 Number of outpatient consultations per person, per year, by administrative unit C.2 Number of consultations per clinician, per day, by administrative unit C.3 Coverage of measles vaccination (6 months 15 years) C.4 Coverage of DPT3 in <1 year, by administrative unit Input HeRAMS >=10 Indicator monitoring the availability of human resources key to delivering community-based intervention. Output HIS / EWARS >= 1 new visit/person per year Output HIS Less than 50/day per clinician Output HIS, survey > 95% in camps or urban areas >90% in rural areas Output HIS, survey >95% Proxy indicator for accessibility and utilization that may reflect the quality of services. It does not measure the coverage of this service, but the average number of visits in a defined population. Measure for the workload and proxy indicator of the quality of care. These indicators are used for estimating the vaccine coverage of the total EPI strategy. To avoid overestimation, measles vaccination coverage is often used as a proxy since it is usually lower than DPT3 coverage. Both indicators should be calculated on a yearly basis. Good indicators of health system performance. October 2009
Category # Name of indicator Type Health services coverage C.5 Percentage of births assisted by a skilled attendant C.6 Percentage of deliveries by Caesarean section, by administrative unit Data collection method Benchmarks Comments Output HIS, survey > 90% Measure for the utilization rate of obstetrics services in health facilities and in communities where Village-Trained Midwives are operating. It can serve as a proxy for monitoring progress. Output Prospective HF based surveillance >= 5% and <= 15% Number of deliveries by C section for a given period over the expected number of births during the same period. Denominator should be calculated by using the fertility rate by age class and region (e.g. obtained via demographic and health surveys). In Sub-Saharan Africa, for instance, the expected proportion of births is between 4 and 5 % of the total population. It can serve as a proxy for monitoring progress. Risks factors Health outcomes R.1 Number of cases or incidence rates for selected diseases relevant to the local context (cholera, measles, acute meningitis, others) R.2 Number of cases or incidence of sexual violence Outcome Outcome R.3 CFR for most common diseases Outcome, proxy R.4 Proportional mortality Outcome, proxy R.5 Number of admissions to SFT and TFC R.6 Proportion/number of U5 GAM and SAM cases detected at OPD/IPD R.7 Proportion of people with <15L of water/day Outcome, proxy Outcome, proxy EWARS, IRA, prospective HF based surveillance, surveys Prospective HF based surveillance, surveys Prospective HF based surveillance Prospective HF based surveillance Prospective HF based surveillance Prospective HF, SFC and TFC based surveillance Measure trends Measure trends Measure trends Measure trends Measure trends Measure trends Measure trends O.1 CMR Outcome HH survey >=2 x base rate OR >1/10 000 per day* O.2 U5MR Outcome HH survey >=2 x base rate OR >2/10 000 per day* O.3 Prevalence of GAM Outcome HH survey <10%, measure trends Useful measure of the burden of diseases. The list of diseases is contextspecific. Health facility surveillance may have low sensitivity for conditions that do not commonly go to clinic. Access to health services is another factor. Health facility surveillance may have low sensitivity for conditions that do not commonly go to clinic, also depends on access to health services. Can be very sensitive and difficult to measure, requires highly trained staff to collect data. Mixture of disease severity and of quality of health care. Most likely will be biased upwards because only more severe cases normally go to clinic. Non-violent versus violent causes of death. Proxy for measuring trends. Prerequirements such as stability of quality of care and access are needed (validity not demonstrated). Proxy for measuring trends, preferably through MUAC. I must be seen in light of the context (national policy, existence of nutrition programmes) (validity not demonstrated). L/person per day is more informative because it is continuous. Since the L/p/ day must be measured, presenting the actual figure, rather than a yes/no variable, is more informative. Difficult to measure in surveys with sufficient precision. A very large sample size is needed. O.4 Prevalence of SAM Outcome HH survey Measure trends Difficult to measure in surveys with sufficient precision. A very large sample size is needed. O.5 Percentage of the population in worst quintile of functioning, including those with severe or extreme difficulties in functioning Outcome WHODAS 2.0*, population survey Thresholds have to be defined according to the local context and the nature of the crisis. Measure trends WHODAS 2.0* is a tool that can be used to assess and monitor the overall health status of crisis-affected populations, measuring the level of functioning/disability. The instrument is applicable across cultures, it captures the level of functioning in six domains of life (i.e. cognition, mobility, selfcare, getting along, life activities, participation), and allows to compute domain-specific and a summary score of disability. * Measuring Health and Disability, Manual for WHO Disability Assessment Schedule WHODAS 2.0, WHO 2009 (in press).
Who is Where and When?... Health Resources Availability Mapping System (HeRAMS) Level of care Sub sectors Initial essential services/packages * C. Community Care Supervision Self-referral 1. General clinical services 2. Child health 3. Nutrition 4. Communicable diseases... Doing What? Outpatient department (OPD) Vaccinations Inpatient beds Therapeutic feeding for severe acute malnutrition Early warning and response system (EWARS) P. Primary Care Referral Sexual and reproductive health (SRH) 5. STI & HIV/AIDS 6. Maternal and newborn health 7. Sexual violence SRH minimum initial service package (MISP) S. Secondary and Tertiary Care 8. Non-communicable diseases and mental health 9. Enviromental health Injury care & mass casualty management Water quality control What is initial-herams What is HeRAMS The standard Health Cluster tool to be used during the first days/weeks of an acute crisis for the collection, collation and analysis of health sector information in affected areas, aggregated by administrative level (e.g. district or sub-district) on the number of active health partners, functioning health facilities (by type) and key health staff (physicians, nurses, midwifes) as well as on the availability of initial essential health services. Ṫhe standard Health Cluster tool that should be used as soon as possible and throughout the duration of a crisis for the collection, collation and analysis of health sector information for each facility, mobile clinic or site with community-based interventions in order to monitor the availability of resources. These are: key characteristics of the points of delivery (urban/rural area, IDP/refugee camp) and of the facilities (functioning/non functioning, temporary/permanent, active health partner(s), management, other), number of staff (by type) and availability of services as per the list of 62 services (see reverse). * The indicated initial essential services or packages are intended as the minimum response that has to be present at the beginning of any crisis. The services proposed for child health, nutrition, communicable and non-communicable diseases and environmental health sub sectors may be changed with other priority service(s) as required by the nature of the crisis and/or the local context, for the other sub sectors the recommended services or packages should be in place in full before further expansion of the other services of the respective sub sectors.