Health Cluster - Myanmar JOINT PLAN OF ACTION in Response to Cyclone Nargis Background Cyclone Nargis struck Myanmar on 2 and 3 May 2008, sweeping through the Ayeyarwady delta region and the country s main city and former capital, Yangon, with winds of up to 200kph. Altogether, about 2.5 million people were affected. The extent of the damage and the number of casualties remain difficult to assess. As of 17 May, the official figures stood at 77 738 dead and 55 917 missing. Unofficial estimates are considerably higher. Several hundred thousand people are estimated to be without shelter and safe drinking water. Given the size of the area hit by the storm, the number of people in need of assistance is expected to rise considerably as assessments continue and access slowly improves. The damage to health facilities and the loss of health personnel in the affected areas are major risk factors for death and illness. Population displacement, overcrowding in temporary shelters and lack of safe drinking water are other factors that greatly increase the risk of disease outbreaks. Humanitarian needs are overwhelming and urgent, and can be expected to continue at least into the medium term, complemented by recovery efforts. National and international health partners in Myanmar have developed a joint plan of action that addresses humanitarian needs in the Ayeyarwady and Yangon divisions, focusing on those in temporary shelters and relocation sites. The plan serves as a working document, to be updated as the situation demands, that will help coordinate work to save lives, reduce suffering and reactivate local systems during the coming six months. Objectives The overall objective is to reduce morbidity, disability and preventable mortality of the affected population following Cyclone Nargis in Myanmar, and to restore delivery of and access to preventive and curative health care. The specific objectives are to: Engage national and international partners in coordinating the health sector response with agreed strategies and joint action; Assess and monitor health needs and strengthen disease surveillance;
Respond to outbreaks and other health threats, strengthen disease control and fill gaps that are critical to the delivery of health care; Strengthen and repair systems and build capacity. Strategy The strategy adopted by the Health Cluster hinges on four principles: Agreeing on one implementation plan for health response; Aligning activities with national efforts to restore health in the affected areas and with the recovery strategy of the Ministry of Health (MoH); Adopting an inclusive Cluster approach that will harmonize and coordinate the activities of the different Health Cluster partners; Maximizing resources and comparative advantages of Health Cluster partners. As lead agency and thus provider of last resort for the Health Cluster, WHO, at all three levels (country, regional office, headquarters) will put in place standby mechanisms and resources to respond to any major outbreaks that exceed the capacities of the Health Cluster in Myanmar. Activities Support to coordination of health activities Overall, central level Health Cluster coordination will be complemented by the establishment of coordination hubs in the affected areas in the townships of Labutta, Bogale and Pathien. The Cluster will post health liaison officers in each hub to support the coordination and management of health activities and liaise with local health authorities. Information on the activities of Health Cluster partners will be compiled and shared on a regular basis. This will facilitate joint planning and identification of gaps, and will avoid overlap. Special attention will be paid to in-kind donations. The Cluster will disseminate the national essential drug list as well as WHO's guidelines for the donation of drugs and medical supplies and equipment. A clearing mechanism for drugs and medical supplies that are not in line with the essential drug list will be established in collaboration with the MoH. Assessing and monitoring health needs, threats and capacities The Health Cluster will conduct rapid assessments of health needs, the status of health infrastructures and the performance of health services. The information yielded will be used to help plan and implement the immediate delivery of emergency and essential services to the affected population. (NB: several partner agencies have undertaken assessments in the immediate aftermath of the cyclone, which have yielded substantial information.) In areas
where assessments are still needed, standardized tools will be used. Information from these assessments will be shared within the Cluster, consolidated, analysed and distributed to Health Cluster partners and other clusters for information and action as necessary. As soon as possible, these initial evaluations will be followed by more in-depth assessments to plan for restoration of health services in the medium and long term. WHO and its partners will strengthen disease surveillance by establishing early warning systems to detect and control potential disease outbreaks. In close consultation with the MoH, mechanisms will be established to verify rumours and consolidate official information collected by the MoH and informal data collected by health partners. Responding to threats to health and filling gaps in the delivery of care Support will be provided to local health authorities and non-governmental organizations to ensure adequate and immediate provision of and access to essential health services at health facilities, temporary health service delivery points in relief camps, temporary shelters and relocation sites. This will be done through mobile clinics and outreach services. Mechanisms to improve access to referral centres will also be put in place. For the immediate future, the focus will be on the following activities: 1. Restoring routine immunization programmes and implementing campaigns for special immunizations (polio, measles) and vitamin A administration for children in temporary shelters and amongst displaced persons; 2. Providing essential emergency care, medicines, supplies and preventive kits (e.g. Inter-Agency Emergency Health Kits, bed nets); 3. Ensuring prevention, early detection, control and case management of communicable diseases, by water quality monitoring (in collaboration with WASH cluster), vector control, prompt and proper case management of diarrhoea, pneumonia, tetanus, measles, dengue, malaria; 4. Ensuring the continuity of TB, malaria and HIV care and treatment; 5. Supporting access to and delivery of primary health care services, with particular focus on the most vulnerable groups, including women and children; 6. Strengthening reproductive health and HIV services and incorporating this focus into other relevant clusters (such as shelter and protection); 7. Including mental health and psychosocial support as essential services for displaced populations and those who have lost members of their families; 8. Supporting access for patients needing referral to appropriate levels of health care;
9. Ensuring correct medical waste disposal by developing user-friendly guidelines for medical waste disposal. Contrary to common wisdom, experience has shown that natural disasters such as Cyclone Nargis are not always followed by disease outbreaks. However, a number of diseases including malaria, dengue, and acute diarrhoea are already endemic in Myanmar. Distress, displacement and concentration of people in camps, the increased breeding of mosquitoes, and disruption to water and sanitation systems undoubtedly increase the risk of disease outbreaks, at a time when local health systems are already weakened. As provider of last resort for the Health Cluster, WHO will set in place contingency plans, mechanisms and dedicated standby surge capacity to support national and international health partners in the event of a disease outbreak that exceeds their capacities Repairing and strengthening systems and building capacities By their own efforts, and in coordination with other clusters on the ground, Health Cluster partners will support the immediate repair and provision of water and power supply to critical facilities including hospitals and central medical store depots. Health Cluster partners will also operate temporary health service delivery points. Damaged health and medical equipment will be replaced, including cold chain and waste-disposal infrastructures. The national and local primary health care networks and systems will be reactivated by mobilizing and supporting community health workers and voluntary workers. Particular attention will be paid to the orientation of new doctors and other health staff to be deployed to the affected areas. These staff will be briefed on various aspects of the emergency health activities, including psychosocial response. Aligning the above efforts with national plans and policies will be key to successful emergency health response. Building back better will be the guiding principle in the emergency efforts. This includes strengthening capacities of national health partners and integrating them in the delivery of humanitarian assistance. Expected outcomes 1. Joint planning and coordinated management of health activities at central level and at township level through the Health Cluster approach; 2. Harmonized and timely reporting and sharing of information; 3. Information on health needs, health system delivery capacity and operational constraints collected and analysed and consolidated; 4. Information arranged and displayed in a way that facilitates consensus and decision-making;
5. Disease surveillance and outbreak response strengthened; 6. Basic health services restored and revitalized; 7. Emergency care provided and life-threatening conditions prevented; 8. Rehabilitation of health infrastructure initiated; 9. Outbreak of communicable diseases prevented; 10. Case management of common communicable diseases among displaced / affected populations in place; 11. Minimum Essential Services Package for Reproductive Health provided; 12. Morbidity and mortality reduced. The financial requirements for the Health Cluster for the next six months are estimated at US$ 28 million. This includes an estimated US$ 10 million for WHO.