Ministry of Health

Post Earthquake Response and Revitalization Need of the Health Sector

Muhammad Nasir Khan Minister for Health November 19, 2005

Special Features of Earthquake • • • • • • • • • •

Worst Earthquake in Pakistan’s History Deaths beyond 73,000 More than 5.5 million population affected Approximately 30,000 sq-KM area affected. More than 130,000 patients injured More than 1,100 amputees More than 500 Spinal Injuries Hilly affected area - an extreme challenge for relief Rough, extremely cold and unpredictable weather Inaccessible and scattered hilly population

More Challenging than Tsunami

Outline •

•

• • •

Health Sector Damage Infrastructure System Operations Human Resource Health Sector Response Coordination Mechanism Patients Statistics Human Resources Mobilization Public Health Campaigns International Support Success Challenges Strategy for Relief & Re-vitalization Revitalization Funds Assessment

Health Sector Damage – Infrastructure TOTAL Health Facilities Destroyed - 574

60% damage in NWFP 90% damage in AJK

Approx. 85% damage overall 100% 80% Partially Funtional

60%

Partially damaged 40%

Fully Damaged

20% 0% NWFP

AJK

Grand Total

Health Sector Damage – System Operations • • •

Loss of human life, devastating disabilities (amputations and paraplegics) Higher mortality and trauma in AJK Damage and collapse of all the major programme services in AJK & NWFP – Collapse of the Primary, Secondary & Tertiary Health Services – Collapse of referral systems, disease surveillance, HMIS – Complete Halt of the services package being provided under different national programmes

Health Sector Damage – Human Resources

• • • •

Death toll more than 73,000 More than 1,33,050 patients injured 1,150 patients amputated 541 patients with spinal injuries latest by 17-11-2005

Health Sector Response - Mechanism PHC

Field Hospitals Surveillance

MOH - WHO Disaster Health Cluster Management & International partners, Coordination UN, NGOs, WHO-MOH Coordination Cell (Control Room)

NWFP Teams

Health Services

Man Days input = 2453

CONVALESCENCE CENTERS

Data Collection & Coordination

AJK Aims

EPI - Vaccination NIH - Lab-based surveillance HIV-AIDS – Blood transfusion MCP – Fogging PHC – District teams, LHWs TB – PHC Assessment HMIS – HR/ HF Assessment

Better Systems for Bigger Challenges

Health Sector Response – Patients Statistics Province / territory

Total patients received

Still admitted

NWFP

51,781

922

AJK

40,266

1,222

Islamabad & Rawalpindi Hospitals

19,950

2,657

Armed Forces Hospitals

11,106

1,599

Punjab

9,710

842

Sindh

237

83

Total

133,050

7,325

Total Operations

31,618

Health Sector Response – Mobilization of Health Professionals Total number of Health Professionals Mobilized

27,401

Teams Mobilized Spray Teams EPI Teams

181 Team days 4,062 Team days

Mental Health Teams

14

Medical/Surgical Teams

29

Public Health Teams

28

Health Education Officers Team

05

Health Sector Response – Public Health Campaign Measles

Immunizations/Supplementation (3056 team days) 423911

Tetanus

116621

Typhoid

27088

Sustained Polio Eradication

35837

DPT

11015

Vitamin A

138,959

NEW VACCINE INITIATIVE Hep A Vaccine

350,000*

Hem. Inf. B Vaccine

One Million*

Meningitis Vaccine

One Million*

• Water Purification Arrangements for Water Purification Aqua Tablets 5.6 million Sachets 6.3 Million Calcium Hypochloride 8,500 kg, Chlorine Gas Cylinders

• Blood Provision of safe and screened blood. Establishment of Blood Bank at Muzaffarabad & Bagh. Strengthening of Mansehra Blood Bank Services

• Environmental Construction of 1000 pit latrines /day to cover all camps. 40,000 Hygiene kits 100,000 kits provided by UNFPA 100,000 Kits provided by UNICEF

Health Sector Response – International Support Earth Quake Area

Field Hospitals

Primary Health Care Facilities

Muzaffarab ad

8

6

5

Turkey, Saudi Arabia, UAE, Iran, Italy, Ukraine, UNFPA, Malaysia

Bagh

3

1

4

MSF, Russia, USA, Cuba, Spain, Qatar, Malaysia

Rawalakot

1

1

1

Singapore, Afghanistan, Canada

Batagram

2

3

-

Estonia, Sweden, Jordan, South Africa, SCUS

Balakot

3

2

1

UAE, China, Merlin, Pakistan Islamic Service, MSF, AKHS, Italy

Mansehra

6

1

4

Saudi Arabia, Doctors of the world, Germen RC, Korean Med. Association, Norwegian RC, UNFPA, Belgium, Czech Republic, French, ICRC, Mercy Corps

Abbottabad

1

-

2

Child Advocacy, IFRC, Austrian Aid Intl.,

Total

24

14

17

Medical Teams

Country/Agency

1500 health care workers mobilized

Health Sector Response – Success

EPIDEMICS HAVE BEEN SUCCESSFULLY AVERTED

Need sustainability of efforts and resources to contain any epidemic

Health Sector Response – Success EXPECTED AND ACTUAL TREND OF MORTALITY AFTER EARTHQUAKE (Ref. WHO) “An Early Success Story”

Immediate deaths due to the disaster (1st Wave in 1000s)

Mortality from infections from wounds/nontreatment (2nd wave in 1000s)

Mortality from disease outbreaks/ epidemics (3rd wave in 1000s)

Expected Trend

Observed Trend (< 500 deaths) (< 50 deaths)

EQ

Immediate TIME

0- 10 days

0- 45 days

CHALLENGES • Rehabilitation of affectees – Physically handicapped – Psychologically traumatized

• Rebuilding of new and seismic/earth quake sensitive health care structures • Sustainable prevention of epidemics • Capacity building at all levels of healthcare services – Technical capacity building – Human resource

• Long term care of chronically ill • Social integration of disabled and other affectees in the mainstream • Establishing effective Health Management Systems

Strategy for Relief and Re-vitalization Short Term • Rehabilitation of patients and psychologically traumatized health workers. • Re-vitalization of Primary Health Care System and all Public Health National Programmes. • Sustaining sound epidemic prevention programmes. • Improvement in the sentinel surveillance in the affected districts for prevention of communicable diseases. • Capacity building, health planning & human resource development • Enhance partnership with national and international NGOs and the private sector • Commence special health care packages for vulnerable

Strategy for Relief and Re-vitalization Long Term • Reconstruction of damaged infrastructure with rationalization and construction of seismic/earthquake sensitive structures • Long Term rehabilitation of disabled and traumatized focusing on women and children • Re-vitalization of health care services MONITORING MECHANISM

Through third party validation

The Biggest Challenge

Resource Mobilization

*Revitalization Funds Assessment – Healthcare Facilities 1

Reconstruction of Field, Civil and District Headquarter Hospitals with equipment including Ventilators & other Accessories

2

Setting up of spinal injury units

3

Setting Up of BHUs , RHC, MCH & Civil Disp.

4

Setting Up of Public Health Laboratory Systems

100.00

5

Setting Up of Blood Bank & Complete Lab. System

300.00

6

Setting Up of School of Nursing

400.00

7

Setting Up of workshop for provision of Artificial limbs

300.00

8

Setting Up of Drug Testing laboratory

9

Reconstruction of Ayub Medical Complex

10

*Access to Primary & Secondary Health Care Services (Immediate measures)

16680.00

750.00 8700.00

20.00 500.00 11165.60

Total in Rs.

38,915.60

US $ (equivalent)

648.59M

* Includes one year recurrent cost Estimates are need based as compared to World Bank’s report of early November 2005

Revitalization Funds Assessment – Healthcare Facility Packages Serial No.

Health Care package

Unit Cost

Estimated Total Amount in US $

01

Field hospitals with equipment (26)

1.69 Million

44 Million

02

Reconstruction of Civil dispensaries, MCH Centers with equipment (240)

0.2 Million

48 Million

03

Reconstruction of BHUs with Equipment (289)

0.2 Million

58 Million

04

Reconstruction of Rural Health Centers with equipment (44)

0.90 Million

40 Million

05

Reconstruction and Provision of equipment of district/civil hospitals (23)

10 Million

230 Million

Thank You For Your Generosity