( By A Working Guide (WHO - OMS, 1989) )

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Chapter 4.Monitoring the community’s health status

The system for monitoring the community’s health status is based on a few essential elements:

· the basic network made up of voluntary workers and those in charge of the family groupings,

· the instructions issued at national or intermediate level on the diseases that must be kept under special scrutiny,

· the possibility for the local health personnel to send specimens to an intermediate-level laboratory for examination to confirm diagnoses,

· the drafting of regular reports.1

1 See Periodic reports by the local health personnel.

Disease monitoring must be particularly meticulous when one or more of the following conditions exist:

· presence of endemic foci,
· people living in shelters,2 concentrations of displaced persons in camps or on sites without services,
· precarious or unsatisfactory nutritional status,
· difficulties in drinking-water supply,
· difficulties in disposal of refuse and waste water,
· unfavourable climatic conditions.

2 See Annex 1.

Monitoring should not be based merely on the data concerning patients who attend the local health establishment. It should also take into account the activities carried out by the local health personnel in people’s homes or in the community. An important means of monitoring is to use the network of persons in charge of the family groupings. All such persons, possibly with assistance from voluntary workers trained by the local health personnel, should do the rounds (daily to begin with) of the shelters in their charge, noting information on a card.3 This also provides an opportunity for them to discuss health problems. They can act as health education workers if the local health personnel give them clear and simple information on the essential subjects and teach them how to conduct meetings and organize educational activities. Cases of disease detected or suspected will be indicated in the local health personnel’s report. Information received from the local personnel will enable the intermediate-level authorities to summarize the data obtained, pinpoint disease foci and trends and take the necessary steps.

3 See Annex 2.

The epidemiological study of recent disasters shows that epidemics resulting from disasters are the exception. However, the possibility must be borne in mind that the precarious hygienic situation after a disaster may encourage the spread of diseases that already existed in the area beforehand. The worse the situation before, the more real will the danger be. Often, alarming rumours on the appearance of foci of infectious diseases are spread and sometimes the press, the other media and even medical circles end up by confirming and amplifying the rumours. If faced with such a situation, characterized by the existence of a potential risk and irrational reactions, the local health personnel must intensify their monitoring of communicable diseases in order to obtain objective information on the situation so as to be able to reassure the authorities and the public.

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