For a comprehensive and practical approach, it is advisable to assess the health disaster preparedness program in terms of the following technical components:

3.1 Coordination activities
3.2 Planning and technical programs
3.3 Training activities and research
3.4 Resources and logistical support

3.1 Coordination Activities

Assessment of this component measures the health disaster preparedness program's working relationship and coordination with key authorities and institutions. The assessment should be carried out to define the:

· Level of coordination with technical departments or units within the Ministry of Health;
· Level of coordination with other health sector entities;
· Level of coordination with other sectors.

Key indicators/questions:

· Is there effective participation of other technical units in disaster preparedness activities?

· Which institutions are currently participating in disaster preparedness activities together with the health sector?

· Is there a mutual understanding or agreement with other health institutions?

· What is the relationship and level of commitment with Civil Defense, Ministry of Communications, Ministry of Housing, and other key institutions that play an important role in emergency situations?

· Are there provisions, current agreements, or joint activities with the UN agencies, bilateral agencies, or NGOs?

Sources of information:

The assessment team should visit the offices of the Civil Defense, UNDP, WHO, UNICEF, FAO, and other selected UN or bilateral agencies as well as selected NGOs.

Summary of findings:

The summary of coordination activities should define the degree of involvement and commitment of the agencies participating in the interview.

3.2 Planning and technical programs

The overall assessment of this component will measure the degree of technical development in the following areas:

3.2.1 Disaster plans - operational plans for natural, technological, and manmade disasters
3.2.2 Mass casualty management - prehospital and hospital disaster plans
3.2.3 Epidemiology - surveillance mechanisms for disease control
3.2.4 Sanitation and sanitary engineering
3.2.5 Temporary settlements - organization and function

3.2.1 Disaster plans (operational)

The assessment of disaster plans should verify the existence of contingency plans according to the country's vulnerability and the extent of their application during emergency situations.

Key issues:

· Availability of disaster plans, and degree of familiarity with these plans on the part of the health sector's human resources

· Availability of a directory of key disaster personnel at national, regional, and local levels

· Availability of critical supplies; inventory at national, regional or local levels

· Degree of complexity of existing plans

· Degree of community familiarization with existing plans

· Mechanism for activation of disaster plans

· Levels of authority and chain of command in the activation process

· Public information strategy

· Mass media information procedures

· Existing mechanisms to respond to health needs

A devastating result of the 1985 Mexico City earthquake was the collapse of two major hospitals and serious damage sustained by others. More than 500 ambulances were mobilized to evacuate and relocate patients to unaffected institutions. (Photo: Vizcarra, PAHO/WHO)

Sources of information:

Interviews should be carried out with disaster preparedness offices of the Ministry of Health, Civil Defense and selected health institutions. Existing plans should undergo extensive review. Some of the issues mentioned above must be separated in accordance with the complexity of the national disaster preparedness program.

Summary of findings:

The analysis of operational disaster plans should indicate their practical applicability.

3.2.2 Mass casualty management

Assessment should focus on the mechanisms, strategies, or procedures for providing emergency medical care during disaster situations. Mass casualty management can be divided into two components:

3.2.2.1 Prehospital activities
3.2.2.2 Hospital activities

Key issues/Check list

3.2.2.1 Prehospital activities

· Availability of an established Medical System (EMS), and regulations for its operation

· Is the EMS controlled by state or private institutions?

· Existence of search and rescue teams. Do they also provide medical care? At what level of complexity?

· Does the Ministry of Health control EMS activities during emergency situations?

· Is there any understanding or identified role in coordinating activities between the EMS and the Ministry of Health during disaster situations?

· Basic profile of EMS personnel, academic qualifications, training

· Degree of training for the general population

3.2.2.2 Hospital activities

· Hospital network: are hospitals organized in a network for disaster situations?

· Hospital disaster plans: Do hospitals have disaster preparedness plans? How current are they? What are their contingency provisions?

· Hospital organization: How do these plans address the organization of main services? Are they operational?

· Hospital staff: Has the staff received adequate training to face disaster situations? What is the level of motivation and staff participation? Are staff familiar with the hospital disaster plan?

· Do the hospitals perform drills? How often?

· Hospital facilities: Have methods of construction and maintenance been applied to reduce structural and nonstructural vulnerability in hospitals and other health facilities?

· Do the hospitals have basic backup equipment for key services? Are they operational?

· Emergency team: How are personnel organized for emergency response?

· Emergency directory: Is it accessible and updated?

· Emergency communication: Inspect/inventory means of emergency communications.

· Emergency transport: Inspect/inventory means of emergency transport.

· Emergency medical supplies: Inspect/inventory existing supplies.

· Safety measures: Inspect main items (i.e., fire alarms, elevators, emergency exits, evacuation routes).

Sources of information:

Select two or three hospitals, meet with hospital authorities, emergency services, and personnel. Visual inspection is highly advisable. Quick review of the hospital plan is also recommended.

Summary of findings:

Analysis of mass casualty management should be oriented to qualify the prehospital and hospital response capacity in case of a disaster.

3.2.3 Epidemiology

This component should outline the existing surveillance system for disease control in emergency situations and the existing resources to face potential health risks.

Key issues/Checklist

· Indicators of morbidity and mortality on important communicable diseases

· Surveillance system: Existing information and reporting system adapted to emergency situations. Who is in charge?

· Existence of special programs for vector control. What are the main resources?

· Existence of laboratory support: Is there a network? How does it work at the national, regional, and local levels?

· Technological disasters: Is there a surveillance system for health effects caused by chemical or radiological accidents? Who is in charge?

Sources of information:

Ministry of Health, laboratories, departments of epidemiology.

Summary of findings:

The analysis of surveillance mechanisms for disesase control should indicate the response capacity for early detection and prompt intervention of the existing system in emergency situations.

3.2.4 Sanitation and sanitary engineering

This component should identify the state of preparedness of the basic sanitation services and their ability to operate under emergency situations.

Checklist:

· Inventory of water supply and environmental sanitation institutions participating in the national program on disaster preparedness.

· Existence of contingency plans for disasters, staff training and their active participation. Who is in charge? What is the level of their authority?

· Vulnerability analysis: List of institutions carrying out vulnerability analyses of the main water supply services.

· Resources and equipment: Existence of emergency teams and backup equipment to be used in emergency situations. How are they activated?

The isolation caused by flooding interrupts basic public health services and can lead to the long-term decline in a population's well-being. (Photo: Vizcarra, PAHO/WHO)

Sources of information:

Water supply companies, Ministry of Health, on-site inspection of water supply plants.

Summary of findings

These should identify the existing potential risks and response capacity in case of disasters.

3.2.5 Temporary settlements

The assessment of this component determines the organization and operation of facilities serving as temporary shelters and settlements, their location, housing capacity, and the availability of basic health services.

Checklist:

· How are facilities designated to serve as temporary shelters. How are they organized? Under whose authority? When are they activated? Are they known to be structurally safe?

· Are existing basic services, water supply adequate?

· Are excrete control, waste disposal services operational?

· What is estimated number of persons to be housed?

· What areas are identified for temporary settlements? What is the policy for establishing them? What type of shelters? What kind of materials are being used? Are they temporary shelters or settlements?

· What are existing health problems in temporary settlements?

· What is management system of the temporary settlements?

· Are health care programs available?

Sources of information:

Civil Defense, Red Cross, Ministry of Internal Affairs, on-site inspection.

3.3 Training and research

The assessment of this area determines the national program's capacity to develop training activities, produce and disseminate technical material, participate in research, and promote disaster preparedness teaching in schools of medicine, public health, and other institutions.

Key points/Check list:

· Training in the health sector. Number of training activities per year, category of participants, type of training activities, and resources for their implementation.

· Training in graduate and post-graduate levels. Is the national program actively participating and collaborating with these institutions? Is an increasing demand for cooperation? Define the number of institutions carrying out teaching activities in the field of disaster preparedness.

· Participation of UN agencies, Civil Defense, and NGOs in training activities. Are they actually participating?

· Production of technical material. Does the national program develop technical materials? Who is in charge? What type of materials? What is the distribution?

· Field studies: Is the office of disaster preparedness involved in field studies or operational research?

Sources of information

Information should be gathered from technical offices, office of disaster preparedness of the Ministry of Health, Ministry of Education, review of locally available material.

3.4 Resources and logistical support

The assessment should determine the program's ability regarding:

· Staff
· Budget
· Communications
· Transport
· Essential supplies

Key points:

· Staff: How is the staff of the program distributed at the national, regional and local level? Are they full-time or part-time employees or volunteers? To what health disciplines do they belong (e.g.: physician, sanitation engineer, health educator, etc.)?

· Budget: Is the program being supported by a regular budget? Does this cover salaries and operational activities? What financial provisions exist for emergency situations? Is there flexibility in budget management?

· Communications: List of available means of communication accessible to the disaster preparedness program (phone, fax, telex, electronic mail, ham radio operators network, satellite telecommunications).

· Reliability of existing communications systems: Does the Ministry of Health have an organized and operational communications center? What is the geographical coverage? What type of restrictions affect the use of the communications tools?

· Mobilization: Is the program equipped to mobilize its staff and emergency team on short notice? Who is in charge of providing transportation in case of an emergency?

· Supplies: Identify the existence of essential medical supplies and medicines and availability of inventory system for existing supplies and donations.

Sources of information:

Ministry of Health, NGOs, Civil Defense, health authorities and administrative departments, communication companies, ham radio associations.

3.5 Final report on assessment

Based on the findings outlined in different areas, the final report should contain an overall analysis of the state of preparedness in the health sector and its potential for emergency response. Based on the strengths and weaknesses identified, recommendations should be made to strengthen the disaster preparedness and emergency response capability of the health sector.