Posted: August 4th, 2022

public health

Public Health situation analysis on sri lanka economic crisis

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8/29/2018
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Public Health Information Services

Public Health Situation Analysis Standard Operating Procedures

Anonymous

WORLD HEALTH ORGANIZATION

Table

of Contents

Public Health Situation Analysis Standard Operating Procedures 2

Background 2

Timing of initial and repeat PHSAs 2

Geographic scope of PHSA 3

Relationship of PHSA to other

risk assessment

s 3

Use of PHSA in WHO grading and re-grading 4

Distribution of PHSA 4

Presenting imprecise or conflicting data 5

Finding source data 5

Guidance on filling the templates 6
Short-form PHSA 6
Long-form PHSA 14
Annex 1: References and Citations 26
Annex 2: Crisis typology icons legend 26

Annex 3: Additional guidance for the analysis of disease threats

27

Annex 4: Scoring the magnitude of health threats/needs 29
Annex 5: Expected evolution of crisis-emergent health threats over time 31
Annex 6: Scoring the magnitude of disruption to key health system components 35
Annex 7: Expected evolution of disruptions to key health system components over time 35

Annex 8: Appropriate methods for the collection of primary data

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Background

Public Health Situation Analysis (PHSA) Standard Operating Procedures

Humanitarian needs assessments are carried out to determine the immediate needs of a population following an emergency or humanitarian crisis, serving as a basis for operational response. The purpose of the Public Health Situation Analysis (PHSA) specifically is to identify the current health status and potential health threats that the population may face, the functioning of the health system, and the humanitarian health response. It is a review of the latest available secondary data1.

The PHSA aims to provide all health sector partners, including local and national authorities, nongovernmental organizations (NGOs), donor agencies and United Nations agencies with a common and comprehensive understanding of the public health situation in a crisis in order to inform evidence- based collective humanitarian health response planning. The PHSA may also be used to feed other sectoral and intersectoral products, such as providing the health input to the Humanitarian Needs Overview, and is also used in support of the WHO (re-)grading process.

The PHSA is conducted in response to a sudden-onset2 Emergency, defined by the WHO Emergency Response Framework (ERF) as “a situation impacting the lives and well-being of a large number of people or significant percentage of a population requiring substantial multi-sectoral assistance. For WHO to respond, there must be clear health consequences”.

The PHSA updates and replaces the previous Public Health Risk Assessment (PHRA) prepared by WHO. Like the PHRA, the PHSA includes a risk assessment of the major threats faced by a population; additionally, the PHSA expands on the PHRA by including the elements of humanitarian response capacity. The PHSA does not include recommendations about priority interventions, as the PHSA is meant to serve as a springboard for on-the-ground response joint response planning amongst all health cluster/sector partners, informed by local capacities/resources/limitations/political considerations.

There are two versions of the PHSA: a short-form or “initial” PHSA, and a long-form or “full” PHSA. This SOP covers both.

Timing of initial and repeat PHSAs

The initial short-form PHSA should be completed within 24-72 hours of the onset of an acute emergency, or as soon thereafter as practicable. If it is delayed beyond this, it ceases to serve its function as a platform for joint planning, as planning will, out of necessity, take place after this time even in the absence of an evidence base. Thus, the initial PHSA does not have to be perfect: an imperfect PHSA is better than nothing, as long as the limitations are made clear. Release of the initial PHSA should not be delayed due to incomplete information; instead it should point to areas requiring additional (primary) data collection.

The full long-form PHSA should be initiated as soon as the short-form PHSA has been released, and should be completed within 14 days of the onset of an acute emergency, The template is designed to easily allow expansion of the existing fields of the short-form PHSA, thus it is preferable to do the two forms sequentially rather than attempting to prepare both documents in parallel.

In protracted crises where a PHSA has never been done (either because the decision to undertake a PHSA is driven by a sudden escalation of the existing crisis, or simply because there is an outstanding

1 It may be complemented by primary data once available

2 Or sudden deterioration in a protracted crisis

need to prepare a PHSA), the initiators of the PHSA may consider preparing an initial short-form PHSA, or they may wish to proceed directly to the full long-form PHSA.

Countries that are not currently in crisis, but are vulnerable, or anticipate a specific crisis (e.g. a looming humanitarian crisis due to escalating violence), may wish to prepare a PHSA in advance. In this case, one should fill out as much of the long-form PHSA template as possible, recognizing that many sections will not apply because there is no specific crisis and there are no crisis-attributable issues. For example, the sections on Health Status and Threats can be completed, without commenting on crisis-emergent threats, or completing the risk tables. One can also complete the pre-crisis baseline information about health system needs. N.B. – although one cannot complete the section on humanitarian health response, it can be helpful to catalogue the existing development partners in the field, many of whom are likely to be involved in any eventual humanitarian response.

Geographic scope of PHSA

In multi-country crises, a separate PHSA should be conducted for each affected country, as each country will have a unique response architecture and may have variations in health risks. Reference should be made to the overall multi-national response architecture, if present.

Where crises are confined to a well-demarcated sub-national portion of a country3, the PHSA should clearly indicate in title and content that the analysis covers only that sub-national area. If and when data are included that are not disaggregated sub-nationally (i.e., only national data are available, for example about the prevalence of a given disease), this limitation should be clearly noted.

Some countries will display considerable heterogeneity within a large crisis, in terms of both health threats and response. Where sufficient information exists to create sub-national analyses, such analyses are encouraged. Suggested options for providing sub-national information include: narrative commentary within the text of a single national PHSA; separate risk tables for different sub-national regions; or separate sub-national PHSAs. In the case of the latter, there should first be a single national PHSA to inform high-level planning.

Relationship of PHSA to other Risk Assessments

There is often confusion about the relationship of PHSA to the Rapid Risk Assessment (RRA) and the Strategic Tool for Assessing Risk (STAR). The relationships are clarified here.

The Rapid Risk Assessment (RRA) is undertaken by the Detection, Verification and Assessment (DVA) team of the Health Emergency Information and Risk Assessment (HIM) department of the WHO Emergencies Programme (WHE). It is undertaken in response to an acute public health Event, defined by the ERF to be “any event that may have negative consequences for human health. The term includes events that have not yet lead to disease in humans but have the potential to cause human disease through exposure to infected or contaminated food, water, animals, manufactured products or environments.” A PHSA is not appropriate in the setting of an individual public health event (e.g. a localized cholera outbreak), as a PHSA is a comprehensive assessment of all of the public health issues and the response landscape in a given context, and is most applicable to settings with activated health coordination mechanisms (e.g., Health Clusters); in most cases it does not make sense to speak about the other public health issues (e.g., what is the mental health situation in relation to the localized cholera outbreak) or response landscape (e.g., what has been the effect of attacks on healthcare in relation to the localized cholera outbreak). In such situations where an acute public health event takes on a larger humanitarian dimension (e.g., the West Africa Ebola outbreak causing massive health system and societal disruption), a PHSA may be warranted.

3 A recent example would be the humanitarian crisis in northeast Nigeria, which was confined to the states of Borno, Yobe and Adamawa.

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The Strategic Tool for Assessing Risk (STAR), led by the WHE’s Country Preparedness and IHR (CPI) department, is undertaken in countries that are vulnerable to (or in some cases already experiencing) emergencies. It provides a systematic, transparent and evidence-based approach to identify and classify priority risks, in order to inform preparedness activities. The method involves bringing together relevant experts from multiple sectors (e.g., human health, agriculture, animal health) to assess a range of possible risks, through a Delphi-like methodology. The final output is a spreadsheet that ranks the risks and specifies the types of preparedness activities to be undertaken for each risk. The STAR differs from the PHSA in that the final matrix provides no evidence / data on the magnitude of the listed threats (even if such data were implicit in the risk ranking). If a STAR is undertaken prior to a PHSA, it can serve as an excellent basis for defining which public health threats are significant to include in the PHSA section on Threats; if a STAR matrix is already available, it is recommended to be included as an annex in the long-form PHSA. Alternatively, if a STAR is undertaken after a PHSA, the PHSA can provide the evidence base for informing the STAR’s risk prioritization. Thus, the tools are complementary.

Use of PHSA in WHO Grading and Re-Grading

Generally it is expected that the PHSA will be done after initial grading of a new emergency; further, it is most applicable to the setting of an activated coordination mechanism (e.g., Health Cluster), which is unlikely to be present at the very onset of a new emergency. Thus, the PHSA is rarely helpful in determining the initial grade. However, the PHSA is very useful at the time of re-grading, in order to provide the evidence on the scale of a health crisis, which informs the regrading decision.

Distribution of PHSA

While being based primarily on secondary data, a PHSA may nevertheless contain information that is not in the public domain, and as such may be sensitive, particularly to the corresponding Ministry of Health / national government. Regardless of initial authorship of the PHSA (WCO, RO or HQ), primary ownership of the PHSA rests with the relevant WCO. Thus, the extent of distribution of the PHSA should be governed by the WCO, within the parameters below. It is expected that the WCO will negotiate any sensitivities with the relevant party/ies prior to public distribution.

All PHSAs will be posted to the WHE Emergencies Dashboard (

https://extranet.who.int/emergency-bi/

) for access by authorized WHE personnel according to the permissions associated with the Dashboard (e.g. senior management, and personnel with direct involvement in the response in a given country); uploading will be handled by the HIM/MAP team at HQ. Prior to posting, confirmation will be sought, on a “no objections” basis, from the Health Cluster Coordinator (HCC) (or other named focal point for PHSA in-country) to ensure a mutually agreed version is uploaded. Senior management may, on an exceptional basis, share a PHSA with external partners (e.g. other UN agency senior leadership or donor) on a confidential basis; the in-country focal point will be notified prior to sharing. The focal point should alert HQ/HIM/MAP whenever there is a substantial update to the PHSA, requiring reposting. A WHO- Internal version of the PHSA does not require signoff prior to posting.

As the purpose of the PHSA is to provide a common understanding of the health situation amongst response partners, it is expected that the WCO will distribute the PHSA, at a minimum, within the country Health Cluster / Sector / other health coordination architecture. This is also an important component of improving the visibility of WHO as the authoritative source of health information. Prior to sharing, the PHSA should be approved by the HCC, the WHE Team Leader and the WHO Representative (unless authority has been delegated).

It should be recognized that sharing within the Health Cluster is tantamount to sharing with the government, even where the government is not formally a part of the Cluster; thus, relevant sensitivities should first be addressed by the HCC/focal point or WHO Representative before sharing. In any case, it

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should be made clear that the PHSA is a working document and is therefore subject to incompleteness and occasional errors; it should not be considered a definitive reference document.

Ideally, a PHSA should be shared publicly by the WCO, e.g. on humanitarianresponse.info or the WCO / country Health Cluster website. In such cases where a small change would allow an otherwise sensitive PHSA to be shared publicly (e.g. changing “cholera” to “acute watery diarrhoea” or redacting a short section of the PHSA), this is encouraged. Prior to public sharing, the PHSA should be signed off by the HCC/focal point and WHE Team Lead, and approved by the WHO Representative. It should be made clear that the PHSA is a working document and is therefore subject to incompleteness and occasional errors; it should not be considered a definitive reference document.

Presenting imprecise or conflicting data

It is understood that a needs

assessment,

at least initially, takes place in a dynamic, information-poor environment. As such, it is acceptable and indeed preferable to provide rough ranges for percentages, totals and other statistics, whenever this would be a more honest way of portraying the actual accuracy of available data, than by reporting a misleadingly precise single figure.

For statistics and data, a minimum to maximum range based on all the available sources should be provided, as well as a central (most likely) estimate that approximately gives more weight to higher- quality sources (e.g. “measles vaccination coverage was most probably around 45 -50%, but individual estimates ranged from 34% to 65%”).

For perceptions and experiences as well as events and other facts, summary statements of the evidence should be provided, that reflect the degree of agreement among sources, and /or point out major disagreements (e.g. “sources agree that beneficiaries are most concerned with the inability to access hospitals”, or “some sources reported drug stock -outs at all major hospitals, though one source denied this was happening”).

For the purposes of the PHSA, the reader should assume that information presented is credible unless explicitly stated otherwise (i.e. it is not necessary to state “these data are credible” after each item; only uncertain information should be flagged).

Finding source data

General repositories of information that are particularly helpful include:

· vSHOC / Sharepoint (for existing crises)

· humanitarianresponse.info

· WHO Country Office records (e.g., annual reports)

· Ministry of Health website

· Risk profiles (especially STAR profile where available)

· Internet searches

o When searching Google or other internet search engines for data-rich or assessment reports (as opposed to news reports), it is useful to rely on the advanced search feature of the search engine, and search for files with typical extensions (e.g. , x, .ppt, ). Several searches with alternative key terms are better than only a single search.

See templates below for suggested sources for specific data elements.

Guidance on filling the templates

Text that appears in blue indicates that there is a hyperlink attached. “Ctrl” and click on the text to access the information.

Keep note of which data sources that are used as the PHSA is prepared; leaving it to the end will make the process of referencing very laborious. See Annex 1 for more information on referencing.

In all instances, the most up-to-date information is preferred, however if this is not available give the latest available statistic; taking into consideration that this may be identified as an information gap in Section 6 (see following template). Note that all information that cannot be provided should be identified as an information gap.

If data are confidential and/or the source is not revealed, clarify with the source if the data can be anonymised, or only used for analysis.

Under each heading, guidance will be provided as to potential information sources.

Short-form PHSA

Previous versions of the PHSA were not fit-for-purpose, taking longer than required to guide immediate operational decisions. For this reason, a “short” or “initial” PHSA template has been developed; meant for information to be gathered quickly to address this gap.

The process of developing a Public Health Situation Analysis (PHSA) should be completed at all three levels (WCOs, ROs and HQ) in order to maximise expertise and technical input. The ideal situation is for the short-form PHSA to be completed at country level within the first 24-72 hours of a crisis, with assistance and input from ROs and HQ when requested. Following this, a long-form PHSA should be developed within two weeks (see below).

The different sections of the short-form PHSA include:

1. Summary of the crisis

2. Map of the affected country/region

3. Health Status and Priority Threats

4. Health System Needs

5. Humanitarian Health Response (3/4W matrix)

6. Information gaps & recommended information sources

7. Key References

8. Contacts

(
Public

Health

Situation

Analysis-

Short

Form

COUNTRY

NAME
Last

update:
)

Initiated by: Country Office □ Regional Office □ HQ □

Type of emergency (see Annex 2 of this document)

Conflict

Main health hazards

· Give a bullet point list of the main emerging health hazards (or hazards that are likely to become an issue) resulting from the crisis

UN

Level

WHO

Grade

Security level(s)

For the UNDSS website (dss.un.org), enter UN
username and password. Fill out the following table:

INFORM

risk

,
out of 10.
at (date).
Download the excel sheet. Include risk class (e.g. Very High)
Rank: Include rank of country

Food security

Location(s)

Level

Displacement

Extreme (6)

Drought

High

(5)

Flood

Substantial (4)

Moderate (3)

Low (2)

1. Summary of Crisis

Provide a summary of the key features and facts about the crisis (max 200 words), including:

· Geographical areas affected, or most likely to be affected by the crisis (e.g. key districts)

· Start date (and duration; if applicable) of the crisis

· Major humanitarian consequences and concerns;

· Underlying causative factors and drivers of the emergency (e.g. conflict, drought, earthquake, or other pre-existing vulnerabilities etc.), including key operational constraints

· Major Public Health issues and/or disease outbreaks arising due to the crisis, information on vulnerable groups by age group, gender, ethnic group or any other vulnerable group, if applicable

· Level of destruction of health facilities, if applicable

For initial research,

ACAPS

,

Humanitarian Response,

ReliefWeb,

OCHA,

WHO,

Health Cluster

, are useful websites. Key documents on these websites include the Humanitarian Response Plan (HRP), and Humanitarian Needs Overview (HNO), and Situation Reports.

ECHO

also provides useful information. The WHO emergency portal,

vSHOC

compiles information, including Situation reports, which are highly useful.

2. Map of Affected Country/Region

(
Humanitarian

Profile:
Population in

need:

(disaggregated by sex and age if

possible
):

or

population breakdown by age, gender,

urban,

rural.
Population

in

need

of

humanitarian

health

assistance:

(
disaggregated

by

sex

and

age

if

possible
)
Deaths

(
estimates
):
Injuries

(
estimates
):
IDP’s:
Refugees:
Returnees:
(The

HNO/HRP

is

useful

to

find

this

information).

Another

good

source

is

the

“RW

Crises”

phone

app.
)Provide a country map, clearly showing the different regions and districts affected. if you need help please liaise with the MAP team:

maps@who.int.

Useful websites:

ReliefWeb

(type in the “search” bar the country that you are looking for)

(Insert Map)

(
3.

Health

Status

and

Threats
)

In this section, the
existing health status
of the population and
possible health threats
should be noted, which will indicate major areas for health action to respond and recover from crisis.

In this section, an overview of the Public Health Profile and the core determinants of health present in the affected country, district or region should be presented, based on reliable sources of information. Information and statistics both pre- and post-crisis are essential, to understand what could potentially be aggravated by the current crisis. If data is available disaggregated by sex and age, this is very useful; particularly if the numbers are particularly skewed towards one group.

If the most recent available data are not up-to-date, this can be added as a qualifier when providing information, e.g. “according to the most recently available data, …”, if there is no information available, add “no statistics are available, but rates are likely to be high/low”.


Note

: Low confidence information should be specifically noted as such.


For health (and other determinants) profiles/pre-crisis

:

ACAPS

, click on the relevant country, and then “Country Profile”, is a very useful source, as well as the

Global Health Observatory

and

WHO Country

profiles.

The

CIA World Factbook,

“People and society” section is useful for key and comparison statistics, and

DHS

survey

s provide information by district.


For countries that are in crisis

: Situation reports released by

OCHA

(type in the necessary country), and/or EWARS bulletins found through
WHO
(click on the respective country, and then “Situation Reports” and/or “EWARS bulletins”) are extremely useful, as well as

WHO Country Plans.

Updates for the AFRO region can be found

here.

Note
: additional headings can be added, or unnecessary headings removed if necessary, depending on the context. For each sub-heading, aim for an average maximum of 100 words, noting however that some sections may be larger and/or more contextually important than others.


Note:
In displacement contexts, the burden of endemic diseases should be found for both the displaced and the host populations, if available. For a mass translocation of people, i.e. where the majority of people are displaced (e.g., Rohingya in Cox’s Bazar, Bangladesh), disease profiles from the place of origin (e.g. Rakhine state, Myanmar) are more relevant for most diseases; the main exceptions are diseases associated with the physical environment (e.g., Cox’s Bazar), such as most vector-borne diseases, zoonotic diseases, and environmental health issues such as toxin exposure.

Note
: If the crisis is focused on a specific i.e. district in country, compare this to the national and or regional averages, if possible, including if there are districts which are facing different health needs, disaggregate information by district.

If known, relate this information to any obvious or potential determinants of health (i.e. measles due to poor vaccination coverage, cholera due to poor WASH infrastructures or environmental factors such as the rainy season).


Population mortality

Where available, this information usually comes from SMART surveys available from the country Health or Nutrition Clusters. Include crude mortality rate (CMR; emergency threshold is >1/10 000/day) and under-5 mortality rate (U5MR; emergency threshold is >2/10 000/day).


Vaccination coverage

If information can be found, note most up-to-date information on

vaccination coverage

, including, if applicable, how this relates to the coverage necessary for herd immunity threshold.

Key Risks in the coming month*

Public Geographi Likelihood** Public health** Level of Rationale

Health cal Scope consequence risk***

risk

(e.g. (e.g. (e.g. Likely) (e.g.

AWD) Countrywid Moderate) e)

(e.g. Poor WASH

conditions)

(e.g. Measles)

(e.g. Low vaccination coverage)

(e.g. Countrywid (e.g. (e.g. High)

Malaria) e Almost certain)

(e.g. Malaria season, lack of treatment)

(e.g ARI) (e.g. Very (e.g. Low) likely)

(e.g. overcrowding)

(e.g (e.g. Not

Mental likely)

Health)

(e.g. Injuries)

(e.g. NCDs and cancer)

(e.g Lack of treatment)

Red: could result in high levels of excess mortality or morbidity in the upcoming month. Orange: could result in considerable levels of excess mortality or morbidity. Yellow: could make a minor contribution to excess mortality or morbidity Green: will probably not result in any excess mortality or morbidity/relatively normal satiation in the upcoming month.

Guidance on filling out the ‘Key Risks in the coming month’ table (see above):

This table shows potential sources of future morbidity and mortality based on the context and an analysis of health risks, and is based on 3 Level expert judgement.

The ‘likelihood column’ indicates What is the likelihood that this condition will arise due to the crisis? See Annex 3 for more information.

The ‘level of risk column’ is also dependent on the type of crisis, i.e. acute or protracted.

See Annex 4 for more details on how to fill out this table.

In situations where a crisis has just occurred, for example, increased HIV, TB and NCD burden will not result in high levels of excess mortality as it will take a while for these conditions to deteriorate. In more protracted crises, however, this will become more of a burden as individuals cannot access their medicines so their situation will deteriorate.

Depending on the overall public health profile of the country, the level of risk will depend on whether a small or large proportion of the population have/are likely to get the condition.

The narratives below should be consistent with, and expand upon, the table above.

Epidemic-prone diseases

Note any current or recent epidemics or outbreaks (within the past two years (past 10 for long-form), particularly of vaccine-preventable diseases) in the affected area, including dates. If quickly ascertainable, provide data on prevalence and/or number of confirmed and suspect cases (and alert cases if applicable), case fatality rate (CFR), locations, and any other descriptive epidemiology; including key populations affected (e.g. by gender or age). If possible, describe patterns.
ProMED is a

useful source. Where applicable, mention overcrowding as a risk factor (which may increase risk air-

borne diseases).

Endemic infectious diseases

List endemic infectious diseases that are most likely to be aggravated by the current event. Further, note any other endemic infectious diseases; including Neglected Tropical Diseases (NTDs) and vector- borne diseases. One way to determine the endemic diseases to include is to determine the leading infectious causes of outpatient consultation, in order of proportional morbidity. If quickly ascertainable, break down by region if possible, including incidence, prevalence, CFR, and peak seasons of disease transmission if applicable. For Malaria, note dominant species and associated resistance patterns, seasonal transmission, and potential migration of people from low endemicity to hyperendemic areas and vice versa. For zoonotic diseases, note the extent of disease/deaths in animals. Information about Malaria species and resistance patterns in country can be found

here


Malnutrition and Child Health

Note the prevalence of Severe Acute Malnutrition (SAM) particularly for children under 5 (crisis threshold 2%), Global Acute Malnutrition (crisis threshold 15%), stunting (crisis threshold >20% for areas that are moderately/borderline food insecure),; if quickly ascertainable, provide location and populations who are most affected, number of people requiring food assistance and where they are located, noting

IPC

projections

if available.

Nutrition Landscape Information System,

and SMART surveys are useful sources. Much of this information may be held by the Nutrition Cluster if present.

If quickly ascertainable, note breastfeeding rates, infant mortality rate, and leading causes of child mortality.

UNICEF

is a useful source.


Sexual and reproductive health

Note any quickly ascertainable information on total fertility rate (TFR), unmet need for family planning , ANC coverage (particularly noting the recommended 4 visits), births attended by skilled health personnel, delivery of births at a health facility, leading cause of maternal deaths, noting if there is anything significant about the figures, i.e. lowest in the region. Also note anything that could change due to the crisis.

UNFPA

and
UNICEF are useful sources. Maternal mortality ratio (MMR) can also be added if known, although crisis-specific data are rarely available early in a crisis.


Tuberculosis and HIV

Tuberculosis (TB): Note incidence (new cases) and prevalence (current cases) of

TB

, MDR/RR TB cases, TB treatment coverage. Where applicable, mention overcrowding as a risk factor (which may increase risk of TB spread).

HIV: Note incidence (new cases), and prevalence (current cases) of

HIV,

treatment coverage, number of people receiving ART, prevention of mother to child transmission (pMTCT) rates.


Non-communicable diseases (NCDs)

Depending on which resource provides the most up to date information:

NCD country profile

,

NCD

Progress Monitor

. If quickly ascertainable, note the burden of major NCDs (e.g. diabetes mellitus, CVD, cancers, respiratory diseases, hypertension), and essential medicines which are /are not be available in country, if possible.


Trauma

Crisis-attributable injuries: Indicate the confirmed and/or estimated number of injuries and casualties that have arisen from the crisis and most prevalent injury patterns. In unstable security situations, consider whether the pattern of warfare could cause substantial numbers of injuries over the next month. Consider using data from health bulletins if available.

Violence: Note patterns and locations of violence in country.

Gender-based violence (GBV):
GBV includes: intimate partner violence, rape, child marriage, female genital mutilation, exploitation etc. Note the current types of violence that are most prevalent. Note if these figures are likely to be exacerbated due to the crisis, note negative coping

mechanisms which may lead to increased violence or GBV Consider using information from health bulletins, or

GBV sub-cluster

information where available.


Mental health

Note the extent of mental health conditions in populations, including locations and key populations where this may be most prominent.


Water Sanitation and Hygiene (WASH)

Comment on overall WASH situation. If quickly ascertainable, note extent, location, and status of WASH infrastructure (particularly the availability of safe and/or improved drinking water and basic sanitation), rainfall patterns, and any other increases in WASH needs which may arise from the crisis. Note hygiene and sanitation practices, if available. Where applicable, mention how overcrowding as a risk factor which may lead to increased risk of disease.


Other

Note other determinants of health, contextual factors, or cross-cutting issues which are highly relevant to the situation, such as protection concerns e.g. land mines, security threats, cultural factors which may exacerbate risk of disease transmission (e.g. unsafe burial practices, eating of bushmeat), operational constraints prior to or as a result of the conflict (e.g. lack of road maintenance which may affect humanitarian assistance), natural hazards and/or any other extreme weather exposures which may exacerbate the crisis, or any other major pre-existing vulnerabilities and/or threats.

4. (
Main

figures

on

disruption

of

key

health

system

components
D
a
m
a
g
e

t
o

h
ea
l
t
h

fa
c
i
l
i
t
i
e
s
:

t
o

w
h
a
t
extent,

including

locations

of

damage

that

has

occurred
Health

workforce
:

note

the

extent

of

health

workforce

in

country
Attacks
against health workers:

indicate numbers,
locations
and

frequency of attacks.
Surveillance

system

for

attacks

on

health

care

is

useful.
Drugs

and

other

supplies:

e.g.

disrupted

supply

chain,

shortage

of

drugs
)Health System Status & Local health system disruptions Pre-crisis

Provide as much information as can quickly be found

on % of country covered by Primary Health Care and hospital services, number of hospital beds per 100,000 population, number of nurses and doctors working in the affected area, barriers to accessing healthcare i.e. financial, transport.

In-crisis

Provide summary statistics on the state of the health system in country,

· main figures on the disruption of key health system components, and the locations of these disruptions (see box beside),

· to what extent could crisis risk factors could reduce coverage and utilization of health services,

· Report on any critical, local disease control (eradication/elimination) programmes that could be disrupted as a result of the crisis.

For latest HeRAMS reports, please see the

HeRAMS website

(accessible through Google Chrome); or contact:

herams@who.int

.

5.
Humanitarian Health Response (3/4W matrix) Health response coordination N. of partners

If available, provide information on the leadership and governance structure of the health response, and partner coordination.

Health response actors
Include the Who-does-What-Where(When) (3/4W) map/list, and the number of partners working in the health cluster.

Useful websites:
ReliefWeb (type in the “search” bar the country that you are looking for).

In cases where the 3/4W map/list is not available, to cover partner engagement the following may be useful:

· Mapping initial assessment coverage, to identify areas which are not covered

· locations of EMTs, in-country health sector partner coverage (pre- and post- event).

· Expected deployments (vSHOC can show WHO planned deployments; consult partners for other).

· Development partners (who may already have projects and/or experience), to fulfil the humanitarian-development nexus.

(Insert 3/4W matrix)

6.
Information gaps & information source

Prioritize information gaps evident from secondary data search, and identify the corresponding tool, guidance document and/or source of information that can be used to address this. Sometimes these information gaps are already hinted at or provided elsewhere, such as on ACAPS or Situation Reports.
The information gaps that are indicated should be useful to address what information can be collected in future assessments.
For example; if there is no information on measles cases, but measles is flagged as an issue, the corresponding tool would be to set up EWARS to identify cases of measles.

Consult
PHIS Toolkit for guidance on specific tools used to fill specific gaps. If possible, add a hyperlink to the recommended tool so that it can be accessed easily (In Word: “Insert”, “Links”, “Link”, and then copy and paste the desired hyperlink).

Additional guidance can be sought from the WHO HQ or RO HIM/MDC PHIS country focal points.

See Annex 8 on more information on methods to collect primary data.

Gap

Recommended tools/guidance for primary data collection

Health Status & threats for affected population

(e.g.Measles or other epidemic- prone diseases and other critical conditions)

(e.g.
EWARS
)

(e.g. Mental Health)

(e.g.
Assessment for mental health tool)

(e.g. GBV prevalence)

GBVIMS

(e.g. HIV Statistics- 2018)

(e.g. UNAIDS)

Health Resources & availability

(e.g. Health Resources)

(e.g.
HeRAMS
)

Health System Performance (access, coverage, output, quality, and utilization of

health services)

7. Key References

This section requires a very basic reference list, in the following format: Source, name of document, year. In-text citations are not required for the short form PHSA.

8. Contacts

For example:

Health Cluster Coordinator:

Health Cluster Information Management Officer:

[Insert Country Name] Public Health Information Services Focal Point (WHO Geneva, RO):

(
6.

Additional

Resources
)

(
7.

Annex

1

WHO

recommended

surveillance

case

definitions
)

Acute diarrhoea

Acute diarrhoea (passage of three or more loose stools in the past 24 hours) with or without dehydration.

Suspected cholera

· In an area where cholera is not known to be present: a person aged > 5 years with severe dehydration or death from acute watery diarrhoea with or without vomiting.

· In an area where there is a cholera outbreak: a person aged > 5 years with acute watery diarrhoea with or without vomiting.

· To confirm a case of cholera: isolation of Vibrio cholerae O1 or O139 from a diarrhoeal stool sample.

Bloody diarrhoea

Acute diarrhoea with visible blood in the stool. To confirm a case of epidemic bacillary dysentery:

· take a stool specimen for culture and blood for serology,

· isolation of Shigella dysenteriae type 1.

Acute flaccid paralysis (suspected poliomyelitis)

Acute flaccid paralysis in a child aged < 15 years, including Guillain–Barré syndrome, or any acute paralytic illness in a person of any age in whom poliomyelitis is suspected.

Acute Haemorrhagic Fever Syndrome

Acute onset of fever (duration of less than 3 weeks) and any of the following:

· haemorrhagic or purpuric rash,

· vomiting with blood,

· cough with blood,

· blood in stools

· epistaxis, or

· other haemorrhagic symptoms.

Acute Jaundice Syndrome

Illness with acute onset of jaundice and absence of any known precipitating factors and/or fever.

Pneumonia

· for infants aged 7-59 days, breathing 60 or more times per minute (even without history of cough and or difficult breathing)

· In children 2 months to less than five years old with history of cough or difficulty breathing and one or more of the following

· for infants aged 2 months to 1 year, breathing 50 or more times per minute, or chest in- drawing

· for children aged 1 to 5 years, breathing 40 or more times per minute, or chest in-drawing

· no stridor, no general danger signs (see below).

Severe pneumonia

· History of cough or difficulty breathing and one or more of the following:

(
29
)

· inability to drink or breastfeed,

· intractable vomiting,

· convulsions, lethargy or unconsciousness, or

· stridor in an otherwise calm child.

Malaria

Person with current fever or history of fever within the past 48 hours (with or without other symptoms such as nausea, vomiting and diarrhoea, headache, back pain, chills, muscle pain) with positive laboratory test for malaria parasites (blood film, thick or thin smear, or rapid diagnostic test).

· In children:

· Uncomplicated malaria: Fever and no general danger signs such as lethargy or unconsciousness, convulsions, or inability to eat or drink. Where possible, confirm malaria with laboratory test.

· Severe malaria: Fever and general danger signs (lethargy or unconsciousness, convulsions, or inability to eat or drink).

Measles

· Fever and maculopapular rash (i.e. non-vesicular) with cough, coryza (i.e. runny nose), or conjunctivitis (i.e. red eyes).

· Any person in whom a clinician suspects measles infection.

· To confirm a case of measles: Presence of measles-specific IgM antibodies.

Meningitis

· Suspected case:

· sudden onset of fever (>38.5 °C) with stiff neck.

· in patients aged < 12 months, fever accompanied by a bulging fontanelle.

· Probable case of bacterial meningitis:

· suspected case of acute meningitis, as defined above, with turbid cerebrospinal fluid.

· Probable case of meningococcal meningitis:

· suspected case of meningitis, as defined above and one or more of the following:

· ongoing epidemic of meningococcal meningitis

· Gram stain showing Gram-negative diplococci, or

· petechial or purpural rash.

· Confirmed case of meningococcal meningitis: suspected or probable case, as defined above, with either positive CSF antigen detection for Neisseria meningitidis or positive CSF culture or blood with identification of N. meningitidis.

Tetanus

· Adult tetanus: Either of the following signs 3–21 days following an injury or wound: trismus of the facial muscles or risus sardonicus (characteristic abnormal grin) or painful muscular contractions.

· Neonatal tetanus: Any neonate with normal ability to suck and cry during the first 2 days of life who, between day 3 and day 28, cannot suck normally, or any neonate who becomes stiff or has spasms or both.

Unexplained Fever

Fever (body temperature >38.5 °C) for >48 hours and without other known aetiology.

Unexplained cluster of health events

An aggregation of cases with similar symptoms and signs of unknown cause that are closely grouped in time and place.

Annex 1: References and Citations

Microsoft Word has a built-in function which keeps track of references and citations which is useful. Note that for the short from PHSA, in-text citations are not a requirement, but for the long form should be used. In Microsoft 2016, it is found under the “References” tab, “Citations & Bibliography”. The “Numerical Reference” (ISO690) is the easiest Style of citation to use. When a source is added, click on “Manage Sources”, “New” and then fill in the corresponding information. Then, add the citation in the relevant section by clicking on “Insert Citation”, and choose the relevant citation.

Annex 2: Crisis Typology Icons Legend

Population displacement

Cold wave

Population return

Food Security

Cyclone

Landslide/mudslide

Drought

Snow avalanche

Nutrition

Earthquake

Snowfall

Epidemic

Storm

Fire

Storm surge

Flash flood

Technological disaster

Flood

Tornado

Heatwave

Tsunami

Heavy rain

Violent wind

Conflict

Volcano

Annex 3: Additional guidance for the analysis of disease threats

(
Risk

factor
Effects
Impact of

risk
Timing (once risk

factor

is

occurring)
Specific

mechanism

(s)
Increasing

acute

malnutrition
+++
I
mm
e
d
i
a
t
e
Poor maternal nutrition leading to low birth

weight,

obstetric

and

neonatal

complications.
Worsening

feeding and care

practices
+++
I
mm
e
d
i
a
t
e
Reduced breastfeeding (due to stress and

mental health problems, lack of privacy,

increased

workload,

inappropriate

donations

of

breast

milk

substitutes)

leading

to

increased

risk
of

neonatal

and

infant

mortality.
Worsening
mental

health
+
A few

weeks
Obstetric

complications.
I
n
c
r
e
a
se
d

r
i
s
k

of

n
e
ona
t
a
l

a
n
d

i
n
f
a
n
t

m
or
t
a
l
i
t
y
due

to

compromised

care.
Overcrowding
+
I
mm
e
d
i
a
t
e
I
n
c
r
e
a
se
d

tr
a
n
s
m
i
s
s
i
on

of

n
e
ona
t
a
l

i
n
f
e
c
t
i
o
n
s.
Inadequate

shelter
+
A few

weeks
I
n
c
r
e
a
se
d

r
i
s
k

of

m
a
la
r
i
a

d
u
r
i
n
g

p
r
e
g
n
a
n
c
y,
resulting

in

worse

birth

outcomes.
I
n
c
r
e
a
se
d

s
e
v
e
r
i
t
y

of

n
e
on
a
t
a
l

p
n
e
u
m
on
i
a
.
I
n
c
r
e
a
se
d

r
i
s
k

of

n
e
ona
t
a
l

de
h
y
d
r
a
t
i
on

or
hypothermia.
Inadequate

WASH

services
++
I
mm
e
d
i
a
t
e
I
n
c
r
e
a
se
d

r
i
s
k

of

p
e
r
i

n
a
t
a
l

a
n
d

n
e
ona
t
a
l
infections (especially when exclusive

breastfeeding

prevalence

is

low).
Poor

menstrual

hygiene.
Increased

SGBV

frequency
++
I
mm
e
d
i
a
t
e
I
n
c
r
e
a
se
d

un
w
a
n
t
ed

p
r
e
g
n
a
n
c
i
e
s

an
d

u
n
sa
f
e
abortions.
Disability

due

to

SGBV

physical

trauma.
Reduced

access

to

health

services
+++
I
mm
e
d
i
a
t
e
Untreated

obstetric

and

neonatal

complications.
Missed antenatal preventive care.

I
n
c
r
e
a
se
d

un
sa
f
e

abo
r
t
i
ons,

la
c
k

of

pos
t

abortion

care.
Untreated

sexually

transmitted

infections.
)Table 1.

Typic al

effect s of the main crisis- emer gent risk factor

s on

repro

ductiv e, mater nal and neon atal health

outco mes.

Table 2. Main risk factors causing increases in the severity of infectious diseases, and their timing.

Table 3. Main crisis-emergent risk factors causing an increase in transmission of infectious diseases, and their timing.

Infections disease (epidemic prone)

Risk factors: Impact and timing of risk

Increasing

acute malnutrition

Overcrowdin g

Insufficient vaccination coverage

Poor WASH conditions

Airborne-droplet transmission

Pneumococcal disease

+++
Immediate

+++
Immediate

+++
Immediate if already present in country.

+
Immediate

Hib disease

++
Immediate

++
Immediate

+
Immediate

Other bacterial respiratory
pathogens

+++
Immediate

+++
Immediate

++
Immediate

Risk factor

Risk impact and timing

Airborne-droplet transmitted diseases

Faecal-oral transmitted diseases

Vector-borne diseases

Increasing acute malnutrition

+++
Immediate

+++
Immediate

++
Immediate

Disrupted curative services

+++
Immediate

+++
Immediate

+++
Immediate

High HIV burden with extensive HIV treatment interruptions

++
3-6mo

++
3-6mo

+
3-6mo

Inadequate shelter (exposure to cold)

++
Immediate

Inhalation of indoor smoke (inappropriate cooking or heating fuels)

+
Immediate

Smoke inhalation from volcanic eruption

+
Immediate

NCD treatment interruptions

+
3-6mo

Measles

+++
Immediate

+++
Immediate

+++
Immediate if already present in country.

++
Immediate

Pertussis

++
Immediate

+++
Immediate

+
Immediate

Meningococcal meningitis

+++
Immediate

+++
Immediate if already present in country.

Influenza

?

+++
Seasonal

?

Faecal-oral transmission

Cholera

++
Immediate

+++
Immediate

+++

+++
Immediate

Shigellosis4

+++
Immediate

+++
Immediate

+++
Immediate

Typhoid fever

+++
Immediate

++
Immediate

+++
Immediate

Rotavirus

++
Immediate

++
Immediate

+++
Immediate if already present in country.

Polio

+++
Immediate

+++
Immediate

E. coli, other common enteric
pathogens

+++
Immediate

+++
Immediate

+++
Immediate

Hepatitis A and E

?

+++
Immediate

Helminths, schistosomiasis

++
Immediate

++
Immediate

+++
Immediate

Vector-borne transmission

Malaria

++
Immediate

+
(2mo)

Other mosquito- borne diseases

?

++
Immediate if already present in country.

++
(2mo)

Annex 4: Scoring the magnitude of health threats /needs
Note that this is applicable to both the short and long-form PHSA.

Answers to questions in the Crisis-emergent Health Status and Threats section should be scored in terms of the extent to which the health problem or group of diseases could result in health impacts, i.e. the magnitude of crisis-attributable excess mortality and/or excess mental health problems.

Such a scoring is essential to establish health sector priorities, but is objectively difficult to do, as it requires putting together information from all sections of the Key Questions, and considering various causal pathways and interactions among risk factors and even disease groups.

In order to undertake the scoring, the following parameters should be considered together:

4 All else being equal, transmission risk is highest during the dry season.

The baseline burden of disease (think of how many DALYs lost this disease or group of diseases was responsible for before the crisis). The baseline disease burden is however irrelevant for crisis- emergent health problems, including trauma injuries or combatant – perpetrated SGBV. It is also relatively unimportant for epidemic-prone diseases.

The extent to which crisis-emergent risk factors could increase this burden of disease. To what extent could different risk factors occur? What is their risk impact, i.e. relevance to this particular disease or group of diseases (see e.g. Annex 3)? Note that the combination of different risk factors has a multiplicative effect;

What is known or can be assumed now about access to curative and preventive health services relevant to this disease or group of diseases;

What further disruptions to the health system could occur, and the effect they would have on this disease or group of diseases, in addition to the above.

Table
1 provides guidance on how to attribute scores.

Table 1. Guidance for scoring the magnitude of health threat or need for different groups of health problems.

Magnitude of threat /
need

Meaning

Notes

High

Could result in high levels of excess
mortality and/or mental health problems.

Could be one of the top driv ers of worsened
health status, and single-handedly result in a substantial increase in all-cause mortality, or substantial worsening of mental health and functioning.
Think of a very severe epidemic; a large
proportion of cases of life-threatening disease going without treatment; huge increases in infectious disease burden due to combinations of important risk factors (ov ercrowding,

Intermediate

Could result in considerable levels
of excess mortality and/or mental

Could single-handedly result in a moderate
increase in all-cause mortality, or moderate

Low

Could make a minor contribution
to excess mortality and/or mental health problems.

Small but non-negligible increase.

None

Will very probably not result in any
excess mortality or mental health problems.

Whatever the baseline, no crisis-emergent
risk factors could occur that the pre-crisis health system wouldn’t be able to cope with.
Alternatively, the number of trauma injuries

Unclear

No plausible assessment can be made at this time.

Either the baseline is unknown, or it is
impossible to say at this stage how the crisis could affect it, if at all.
Alternatively, it is impossible to knowwhether

Four important points to remember while scoring are:

The magnitude of threat / need is time-dependent. It may increase as new crisis risk factors emerge, or vice versa. This should be reflected, particularly in the long-form PHSA (i.e. different magnitudes of threat should be reported, corresponding to different times).

For the vast majority of questions, one should be able to at least make a plausible assumption about what could happen as a result of the crisis. Only a few questions should be scored as ‘Unclear’.

One should resist the temptation to score every question as ‘High’, unless this is truly warranted. Remember that scoring all or most questions as ‘High’ would imply catastrophic levels of excess mortality: is this really a plausible development? Differentiating between different magnitudes of threat

/ need, on the other hand, helps to identify relative priorities for the humanitarian health response.

One should provide a score without thinking about the mitigating impact of the humanitarian health response. At this stage, one analysing needs for the health sector and pointing out what could happen in the absence of an adequate response.

Annex 5: Table 1a and 1b: Expected evolution of crisis emergent health threats over time
Note that this is only applicable to the long-form PHSA

Below is an example of the expanded Tables 1a and 1b of the long-form PHSA. It builds on the short-form PHSA by providing a longer time horizon. Where there are predicted changes in risk, the box should be used to indicate the justification for the prediction.

Timing is primarily based either on predictable seasonality (such as rainy season and malaria, or lean season and malnutrition) or on predictable evolution from onset. An example of the latter would be trauma injuries after a sudden-onset natural disaster: the timing of need would be immediate, and indeed would dramatically decrease after one week, since the window for treatment (though not

rehabilitation) is very short for most life-threatening injuries. Another example would be for NCDs, TB and HIV, where initial impact may be low, but may increase over time as the morbidity associated with disruption of treatment increases (as does the transmission of TB and HIV as a consequence of treatment disruption). Occasionally, timing may be based on some known upcoming event, e.g., the risk of violence associated with an upcoming election.

If no plausible prediction can be made about the course of a given threat (e.g., an outbreak with a rare pathogen), it is better to leave it grey than make unfounded predictions.

To understand the key health threats, it is important to understand the pre-crisis burden of disease for the main groups of disease, expressed as Disability Adjusted Life Years (DALYs) lost. These can be found

here.

Table 3a. Magnitude1 of expected somatic health threats and their expected evolution over time 2.

Health problem

Month(s), starting now

1 2

3-6

6-12

Worse WASH situation

Dry season may exacerbate WASH situation where lack of fresh water for
drinking/washing

Rainy season may exacerbate WASH situation where flooding occurs

Worse sexual and
reproductive health outcomes

No major changes expected

Worse malnutrition and child health

Low crop yields threaten already
bad nutritional situation

Lean season from May to August

Most SAM cases last year in
September- November

Increased burden
of endemic infectious diseases

Malaria is the chief
threat

Rainy season to
exacerbate malaria

Risk of epidemics

Meningitis is biggest threat; others measles, cholera, yellow
fever, hepatitis E

Cholera in rainy season

Increased HIV and TB burden

Interruption in treatment may
cause increased transmission

Increased NCD
burden

Interruption in
treatment may cause increased
morbidity

Trauma

Violent trauma
likely to continue

Modest decrease
in violence during rainy season

1 Red: Could result in high levels of excess mortality/morbidity. Orange: Could result in considerable levels of excess mortality/morbidity. Yellow: Could make a minor contribution to excess mortality/morbidity. Green: Will very probably not result in any excess mortality/morbidity. Grey: No plausible assessment can be made at this time.

2Changes in risk over time shows the expected progression after an acute onset emergency, or predicable seasonality of morbidity.

For each of the above domains, it is useful to include a brief narrative about the health and WASH problem prior to the crisis, in order to provide context and aid in operational engagement with the existing system. Questions to address are included below under “pre-crisis” (note: not all answers may fit

neatly within the stated category). Use the questions below to guide your narrative; they need not all be answered explicitly.

The narratives below should be consistent with, and expand upon, the table above. WASH situation

Pre-crisis

· What is the WASH situation at present?

Crisis-emergent

· To what extent could the rainy season (e.g. flooding), or the dry season (e.g. lack of fresh water) lead to a worsening WASH situation?

· To what extent could other crisis risk factors lead to a worsening WASH situation, and when?

Sexual and reproductive health outcomes

Pre-crisis

· What was the crude birth rate?

· What was the maternal mortality ratio?

· What was the prevalence of contraceptive use?

Crisis-emergent

· To what extent could crisis risk factors worsen reproductive, maternal and neonatal health outcomes, and when?

For a proper understanding of sexual and reproductive health needs, in-depth


assessment

is recommended to refine initial needs analysis.

Malnutrition and child health

Pre-crisis

· What was the prevalence of acute malnutrition (severe, moderate and global) among children 6-50 months old?

· What was the proportion of women aged 15-49 years with low body mass index (<18.5kg/m2)?

· What was the proportion of children exclusively breastfeed until 6mo of age?

· What was the under 5y (child) mortality ratio?

Crisis-emergent

· To what extent could any worsening food insecurity have an effect on nutritional status, and when?

· To what extent could worsening feeding and care practices have an effect on nutritional status, and when?

· To what extent could nutritional status deteriorate in different age groups (infants, other children, pregnant and lactating women, people living with HIV, general population) and when?

Burden of endemic infectious diseases

Pre-crisis

· What were the top three infectious cause of outpatient consultation, in order of proportional morbidity?

Crisis-emergent

· To what extent could crisis risk factors increase the burden of the main endemic infectious diseases?

Risk of epidemics

Pre-crisis

· What, if any, confirmed epidemics have occurred in the affected area (in the case of displaced people, both the area of origin and the host community) over the last 10 years?

· What was the severity of any epidemics (total known cases and deaths)?

Crisis-emergent

· Which epidemic-prone diseases could cause outbreaks, with what attack rate, severity, and when? Are any happening now?

· Which local infectious disease eradication/elimination programmes could be at risk of setbacks, and when?

HIV and TB burden

Pre-crisis

· What was the HIV prevalence in the general population, and how many people were in need of antiretroviral treatment?

· What was the annual incidence of active TB (total number and rate)?

Crisis-emergent

· How many people’s HIV/TB treatment has been or may soon be interrupted, and when could their health outcomes start to deteriorate?

NCD burden

Pre-crisis

· What were the most important groups of NCDs?

· What was the prevalence of diabetes?

· What was the prevalence of hypertension?

Crisis-emergent

· How many people’s type 1 (insulin-dependent) and type 2 diabetes treatment has been or may soon be interrupted, and when could their health outcomes start to deteriorate?

· How many people’s hypertension treatment has been or may soon be interrupted, and when could their health outcomes start to deteriorate?

· To what extent could other crisis risk factors increase NCD burden, and when?

Trauma

Pre-crisis

· What is known about the incidence of SGBV, including during any crises that may have occurred in the same population previously?

Crisis-emergent

· How many people are known or projected to have sustained life-threatening trauma injuries, and could substantial numbers of trauma injuries continue to occur over the foreseeable future?

· What is the observed or expected typology o trauma injuries?

· Is there evidence of combatants perpetrating SGBV on the affected population?

· To what extent could other crisis risk factors increase SGBV frequency, and when?

Table 4b. Magnitude1 of expected mental health and psychosocial support threats and their expected evolution over time.

Month(s), starting now

1

2

3-6

6-12

Mental Health and psychosocial support problem

Worse mental health problems

Post-traumatic stress, untreated chronic mental health disorders

Worse psychosocial

support problems

1Red: Could result in high levels of excess mental health/psychosocial support problems. Orange: Could result in considerable levels of excess mental health/psychosocial support problems. Yellow: Could make a minor contribution to excess mental health/psychosocial support problems. Green: Will very probably not result in any excess mental health/psychosocial support problems. Grey: No plausible assessment can be made at this time.

The narratives below should be consistent with, and expand upon, the table above. Mental health problems

Pre-crisis

· If possible, include a discussion of the essential concerns, beliefs, and cultural issues that aid providers should be aware of when providing psychosocial support.

Crisis-emergent

· To what extent could the prevalence and severity of mental health problems increase and when?

· To what extend could substance addictions become more frequent, and when?

· What is known about the safety and ongoing care of patients in mental health care institutions?

Psychosocial support problems

Pre-crisis

· If possible, include a discussion of the essential concerns, beliefs, and cultural issues that aid providers should be aware of when providing psychosocial support.
Crisis-emergent

· To what extent could other crisis risk factors increase the frequency of psychosocial support problems, and when?

Understanding of mental health and psychosocial support threats requires in-depth assessment, typically conducted by the IASC

Mental Health and Psychosocial Support Working Group,

an inter-cluster entity set up in many crises, to which the Health Cluster should refer.

Annex 6: Table 2 of the long form PHSA: Scoring the magnitude of disruption to key health system components

Note that this section is only applicable to the long-form PHSA.

Answers to questions in the Crisis-emergent Health Resources and Availability and Health System Performance sections should be scored in terms of the extent to which the health system component or parameter the question relates to (parameter, e.g. quality of health services, or health system component, e.g. the existing epidemic

alert and response

system) is known or may be assumed to undergo crisis-attributable disruptions. Alternatively, the extent to w h i c h people are without feasible access to certain health services, or to which health system performance may be declining, should be scored. Table 4 provides guidance for this scoring.

Table 2. Guidance for scoring the extent of disruption or lack of access to a given health system feature or service.

No plausible assessment can be made at this time.

Extent of disruption

Meaning

High

The majority of the health system feature / health service has been or

could be

rendered non-functional.

Most people / patients do not have access to healthcare.

A major reduction in health service coverage or quality could occur.

Intermediate

A substantial minority of the health system feature / health service has been or

could be rendered non-functional.

A substantial minority of people / patients do not have access to healthcare. A moderate reduction in health service coverage or quality could occur.

Low

A small minority of the health system feature / health service has been or could be

rendered non-functional.

A small minority of people / patients do not have access tohealthcare. A small reduction in health service coverage or quality could occur.

None

The vast majority or entirety of the health system feature / service is very probably

still as functional as before thecrisis.

No risk factors for reduction in health service coverage or quality have been identified.

Unclear

It is important, while scoring, to remember that:

1. For the vast majority of questions, one should be able to at least make a plausible assumption about what could happen as a result of the crisis. Only a few questions should be scored as ‘Unclear’.

2. All scores should express the effect of the crisis, not the baseline situation, however challenging the latter may have been. In other words, a health system feature (e.g. pharmaceutical supply) that is weak at baseline should not automatically be scored ‘High’, unless the crisis has severely disrupted it.

3. One should provide a score without thinking about the mitigating impact of the humanitarian health response. At this stage, one analysing needs for the health sector and pointing out what could happen in the absence of ( or scaling back of, in the case of a PHSA undertaken mid- crisis) an adequate response.

Annex 7: Table 2 of the long form PHSA: Expected evolution of disruptions to key health system components over time

Note that this section is only applicable to the long-form PHSA.

Below is an example of the expanded Table 4 of the long-form PHSA. It builds on the short-form PHSA by providing a longer time horizon. Where there are predicted changes in disruptions, the box should be used to indicate the justification for the prediction. Timing of changes in disruption is more difficult to predict than timing of changes to disease threats, however there are situations where prediction can be made. For example, certain health system components are predictably less functional during rainy seasons when roads become impassable. Another example is that financing shortfalls can sometimes be predicted several months in advance (in the absence of mitigating measures).

Table 2. Overview of disruptions to key health system components.

Disruption

Month(s), starting now

1

2

3-6

6-12

Disrupted management

Inadequate referral services in remote areas

Reduction in financing

CERF expires

Inability of non- state providers to maintain services

Many existing facilities destroyed (see below)

Lack of funding may cause NGOs
to shut down services

Disruption to supply
chain (including pharmaceuticals)

Supply chain

coordinated by Central Medical Store, functioning but still gaps

Arrival of rainy
season will hamper transport of supplies

Return to dry
season

Degraded alert and response

Security challenges prevent complete coverage of surveillance and response

Rainy season will make it more difficult to receive surveillance data and mount responses to
outbreaks

Return to dry season

Migration of human resources for health

Some health staff reluctant to work in conflict areas

Damage to health facilities

50% of health facilities are destroyed

Fewer attacks typically occur during rainy season

Attacks rise again during dry season

Attacks against
health

There have been
50 reports of attacks against health workers

Fewer attacks
typically occur during rainy season

Attacks rise again
during dry season

Access to
healthcare

Access may be
harder during the rainy season

1Red: The majority of the health system feature / health service has been or could be rendered non-functional. Most people / patients do not have access to healthcare. A major reduction in health service coverage or quality could occur. Orange: A substantial minority of the health system feature / health service has been or could be rendered non-functional. A substantial minority of people / patients do not have access to healthcare. A moderate reduction in health service coverage or quality could occur. Yellow: A small minority of the health system feature / health service has been or could be rendered non-functional. A small minority of people / patients do not have access to

healthcare. A small reduction in health service coverage or quality could occur. Green: The vast majority or entirety of the health system feature / health service is very probably still as functional as before the crisis. No risk factors for reduction in health service coverage or quality have been identified. Grey: No plausible assessment can be made at this time.

For each of the above domains, it is useful to include a brief narrative about the health system status prior to the crisis, in order to provide context and aid in operational engagement with the existing system. Questions to address are included below under “pre-crisis” (note: not all answers may fit neatly within the stated category). Use the questions below to guide your narrative; they need not all be answered explicitly.

Once initial needs are established, in-depth


analysis

of the disrupted health system is recommended, especially in the context of early recovery planning.

The narratives below should be consistent with, and expand upon, the table above. Management structure

Pre-crisis

· Who is in charge of the health system at different hierarchical levels?

· How decentralised are health policy and resource allocation?

· What health services are meant to be provided at community level/secondary/tertiary levels?

Crisis-emergent

· Are health authorities still in place and/or able to take, transmit and execute decisions?

Financing

Pre-crisis

· What is the usual financing model (e.g., are some services free? Where do facilities receive their funding?)?

Crisis-emergent

· To what extent could financial resources for health services, at any level, be reduced, and when?

· To what extent could people’s ability to afford either the direct (user fees, drug costs) or indirect (e.g. travel, sustenance of patients) costs of healthcare be curtailed, and when?

Role of non-state providers

Pre-crisis

· What proportion of health facilities is public versus private? What proportion relies on non-state actor support (which actors?)?

Crisis-emergent

· To what extent do existing non-state providers, if any, seem able to maintain service provision?

Supply chain

Pre-crisis

· How are pharmaceuticals/medical supplies procured, stored and supplied to public health facilities? Is there a national medical store?

· How dependent is the health system on locally produced pharmaceuticals? Are there issues with pharmaceutical quality?

Crisis-emergent

· What disruptions to the medical supply chain are occurring or likely to occur, and when?

Alert and response

Pre-crisis

· What is the name of any epidemic surveillance system, and what was its actual functionality in the affected area?

· How prompt and effective was the health system’s response to past epidemics?

Crisis-emergent

· To what extent has the health system’s epidemic surveillance, alert and response capability been compromised?

Human resources for health

Pre-crisis

· How many doctors/nurses/etc., including specialists, were working in the affected area? (inc. ratios of staff to population)

Crisis-emergent

· To what extent is or could displacement / migration of human resources for health away from the affected population occur?

Functionality of health services

Pre-crisis

· How many health facilities, by level (primary, EmOC [basic or comprehensive emergency obstetric care], secondary, tertiary) were functional in the affected area, and where were they?

· Were there existing areas without access to functioning facilities?

Crisis-emergent

· How many health facilities, where, and at which level (primary, EmOC, secondary, tertiary) are known or projected to have been damaged as a result of the crisis?

· How many people are known or projected to be without realistic access to functional health services (primary, secondary, tertiary, EmOC, mental health, etc., as available)

Resilience of the health system to damage

Pre-crisis

· In the event of mass casualty events, what specialised trauma surgery and rehabilitation facilities can injury cases realistically access? What is their approximate capacity?

· What evidence, if any, is there of emergency preparedness and resilience in the health system (e.g. emergency supply stocks; contingency plans; safe hospitals)?

Crisis-emergent

· To what extent have any components of health services (staff, infrastructure, assets, or patients themselves) been attacked or looted, and what is the pattern of attacks to date?

Access to healthcare

Pre-crisis

· What is the current situation in relation to healthcare access?

Crisis-emergent

· To what extent could crisis-emergent factors affect access to healthcare?

Humanitarian health system performance

Humanitarian health system performance is omitted from the short-form PHSA because no information in this domain is typically available at the onset of a new crisis. It is typically also not available within the first 14 days of a crisis, but it is included in the long-form PHSA because it may be added as information becomes available, and it is a crucial component of accountability of the humanitarian response.

Utilization of services

Pre-crisis

Describe the existing and crisis-emergent utilisation of preventive and curative health services, including:

· outpatient utilisation rate (consultations per person per year)

· Number of procedures (c-sections, births attended by skilled attendants, trauma surgeries) performed

Crisis-emergent

· To what extent could crisis risk factors reduce utilisation of preventive and curative services, and when

Quality of humanitarian health services

· What has been the coverage of humanitarian vaccination campaigns?

· Case fatality rates from known conditions compared with benchmarks (e.g., <1% for cholera, <10% for complicated SAM)

· Anything else known about quality of health service delivery, and competency of human resources for health

Crisis-emergent

· To what extent could crisis risk factors reduce the quality of health services, and when?

Annex 8: Appropriate methods for the collection of primary data

Table 6. Appropriate methods for collection of statistics and data, by type of information. From Checchi et al., Lancet

Conflict analysis
(tracking of media and other informant reports)

Type of information

Prospective surveillance

Population sample survey

Analysis of programme data

Other methods

Affected population size and composition

Community-based

demographic surveillance

Residential structure

tally plus structure occupancy estimation

Vaccination or

nutritional screening data combined w ith expected age structure

Area estimation plus

population density estimation

Various qualitative or convenience methods

Exposure to armed

attacks

Facility-based

surveillance of injuries and attacks against health

Retrospective

survey

of individual exposure to injury

Conflict analysis

(tracking of media and other informant reports)

Sexual and gender based violence

Facility-based

surveillance of SGBV cases

Retrospective survey

of individual exposure to SGBV

Food security and

feeding practices

Household

livelihoods, resilience and coping, food access, food consumption and feeding practices survey

Agricultural production

monitoring

M arket analysis Household focus groups

Desk-based food security risk assessment

Nutritional status

Repeated

anthropometric sampling from sentinel communities

Anthropometric

survey

Trend analysis from

community- or facility- based anthropometric screening, and

CM AM admissions

Desk-based nutritional

risk assessment

Physical health

Early Warning Alert

and Response Netw ork system

(EWARS) for epidemic

alert and response

Survey to measure

point prevalence of chronic diseases or retrospective incidence of acute disease syndromes

Analysis of facility-

based morbidity and mortality data

Desk-based disease risk

assessment and situation analysis Tracing and tracking of people in need of treatment continuation

Mental health

Collecting data

covering serious mental health symptoms as part of general facility-based health surveillance.

Adding questions

covering serious mental health symptoms to general health surveys

Analysis of HM IS

morbidity data

Literature (desk) review

Services mapping Participatory assessment

Service availability and functionality

HeRAM S (w ith

updated geographical database of facilities)

Who What Where

When (4W)

Service coverage

Coverage survey

(vaccination, health services, nutritional programme, etc.)

Comparison of actual

programme outputs vs. target beneficiaries

Focus groups, other

qualitative methods for exploring service utilisation and barriers

Service effectiveness

Analysis of HM IS data

(e.g. on curerates)

Facility audits and spot

checks, patient exit interviews

Population mortality

Community-based
demographic surveillance

Passive “body count” surveillance

Retrospective

mortality survey (verbal autopsies as add-on to explore causes of death)

Census (post-w ar)and

demographic modelling

Capture-recapture analysis

Indirect (model-based) estimation

KINE5370 Global Health

Summer 2022

Instructor Information

Instructor(s)

Laura Phipps, DrPH, MPH, CPH, RS

Office Number

PEB 304

Office Telephone Number

817-272-5481

Email Address:

laura.phipps@uta.edu

Office Hours

By appointment.

Course Information

Section Information

KINE 3354, Section 001

Time and Place of Class Meetings

MTWTh, 8:00 – 10:00 a.m.; meeting days as noted on Canvas


Description of Course Content:

As demonstrated with the recent COVID-19 pandemic, today’s public health practice requires an awareness of health threats beyond U.S. borders. “Global health” implies health concerns and solutions that are shared worldwide. In this course, from a graduate level perspective, you will study global health priorities among different populations, cultures, and health systems. You will examine health challenges and disease threats faced in resource-constrained countries, and the roles of health determinants, socioeconomics and health equity in improving health outcomes. In addition, you will learn and apply the foundational elements of global health, including globalization and health, water, sanitation, the burden of infectious and chronic diseases, human rights and global health partnerships.

In this course, we will look at the historical, social, environmental, economic and political forces that have shaped today’s global health policies, programs and organizations. We will seek to understand the context of global health to better understand disease and illness at both the individual and societal levels and to evaluate the next steps that should be taken to address health issues. Many programs and initiatives undertaken by richer countries to help poorer countries have done more harm than good, but it does not have to be this way. We will explore ways in which health programs can be locally sustainable and ultimately improve the social and physical structures of the community.

Student Learning Outcomes:

Upon completion of this course, students should be able to:

· Discuss how globalization has changed disease patterns and transmission.

· Describe the impact of social determinants of health (SDOHs) on global diseases and health outcomes.

· Explain the global 2030 Sustainable Development Goals and the effects of SDOHs on attaining the SDGs.

· Evaluate the ethical factors and sustainability of programs and policies implemented in poorer communities.

· Explain the key characteristics of major health systems in the world and their relationship to health care financing and access to care.

· Discuss the biosocial approach perspective for global health.

· Describe the international infrastructure of global health and role of global health leader organizations in health outcomes.

· Describe the burden of infectious disease by global region.

· Explain importance and challenges of global health partnerships and non-governmental organizations in disease prevention and control.

· Research, format and write global health assessments and other global health documents.


Required Book:

** IMPORTANT NOTE: You will need to purchase the required book as an online text through Perusall, as you and your colleagues will collaboratively annotate the text throughout the course. The link to buy the book is in Canvas; you can access the link to the first chapter in Module 1.

Crisp, Nigel. Turning the World Upside Down Again: Global health in a time of pandemics, climate change and political turmoil, 2e. London: Royal Society of Medicine Press, 2010. ISBN-13: 978-1032212951

The book costs $14.98 for 180-day online access.

“In Turning the World Upside Down Nigel Crisp argued that the most affluent and powerful countries in the world can learn a great deal about health from lower income countries with their different insights and experiences and their ability to innovate free from vested interests and received wisdom.

In Turning the World Upside Down Again, he argues that they need to go further and listen to and learn from disempowered communities in their own countries. He describes how combining the learning from different countries and communities can lead us to a new ecologically based vision for health and new and practical ways of improving health for ourselves, our communities and our planet.

This second edition, 12 years after the first, is extensively re-written and fully updated, drawing on examples from around the world and reflecting what has already been learned from the COVID-19 pandemic and from the onset of climate change.

Turning the World Upside Down Again continues the search for understanding begun in the first edition and describes how western scientific medicine, which has served us so well in the 20th Century, must adapt and evolve further and faster to cope with the demands of the 21st Century.”

Recommended Books:

Farmer, P., Kleinman, A., Kim, J., & Basilico, M. Reimagining Global Health: An Introduction. Oakland, California: University of California Press, 2013. ISBN: 9780520271999

Bringing together the experience, perspective and expertise of Paul Farmer, Jim Yong Kim, and Arthur Kleinman, Reimagining Global Health provides an original, compelling introduction to the field of global health. Drawn from a Harvard course developed by their student Matthew Basilico, this work provides an accessible and engaging framework for the study of global health. Insisting on an approach that is historically deep and geographically broad, the authors underline the importance of a transdisciplinary approach, and offer a highly readable distillation of several historical and ethnographic perspectives of contemporary global health problems.

Packard, Randall M. A History of Global Health: Interventions into the Lives of Other Peoples. Baltimore, Maryland: Johns Hopkins University Press, 2016. ISBN-13: 978-1421420332

In A History of Global Health, Randall M. Packard argues that global-health initiatives have saved millions of lives but have had limited impact on the overall health of people living in underdeveloped areas, where health-care workers are poorly paid, infrastructure and basic supplies such as disposable gloves, syringes, and bandages are lacking, and little effort has been made to address the underlying social and economic determinants of ill health. Global-health campaigns have relied on the application of biomedical technologies―vaccines, insecticide-treated nets, vitamin A capsules―to attack specific health problems but have failed to invest in building lasting infrastructure for managing the ongoing health problems of local populations.

Nading, Alex M. Mosquito Trails: Ecology, Health, and the Politics of Entanglement. Oakland, California: University of California Press, 2014. ISBN-13: 978-0520282629

Drawing on two years of ethnographic research in urban Nicaragua and challenging current global health approaches to animal-borne illness, Mosquito Trails tells the story of a group of community health workers who struggle to come to terms with dengue epidemics amid poverty, political change, and economic upheaval. Blending theory from medical anthropology, political ecology, and science and technology studies, Nading develops the concept of “the politics of entanglement” to describe how Nicaraguans strive to remain alive to the world around them despite global health strategies that seek to insulate them from their environments. This innovative ethnography illustrates the continued significance of local environmental histories, politics, and household dynamics to the making and unmaking of a global pandemic.

Recommended especially for graduate students who want to: 1.) work directly among at-risk populations within a community; and 2.) understand, engage with, and improve the tangled connections between social, cultural, and political causes of disease and health disparity at the boots-on-the-ground level.

Technology Requirements

It is a requirement and responsibility of each student to have access to a computer and a high-speed Internet connection on a daily basis. Review UT Arlington’s hardware recommendations:

http://www.uta.edu/oit/cs/hardware/student-laptop-recommend.php

and Canvas browser requirements:

https://uta.instructure.com/courses/17157#https://uta.instructure.com/courses/17157

You will use your NetID and password to login to Canvas at https://elearn.uta.edu/. It is your responsibility to become familiar with Canvas and how to access course components. There are several Canvas resources for students including https://www.uta.edu/provost/Canvas/canvas-students/index.php

This course requires the use of word processing and presentation software that is compatible with Microsoft Office formats. Students may purchase this software (in person or by mail) at a significant discount from the UT Arlington bookstore http://www.uta.edu/bookstore.


Descriptions of major assignments and examinations

·
Perusall book discussions:

With Perusall, you can discuss the concepts and events in the required course books in the style of a book club or book discussion group, but your discussion is conducted remotely, on your own time, and online.

Perusall is an online platform in which you and your colleagues will collaboratively annotate the required books on your own several times a week. Collaboration can provide you with help whenever you need it, make learning more enjoyable, enable you to help others (which research shows is also a great way for you to learn), and enhance discussions during class.

If you have a question or information to share about a passage in the readings, highlight the text and type in a comment as an annotation. You can also respond to a classmate’s annotation in discussion threads in real time or upvote questions you find helpful. Good annotations contribute to the class by stimulating discussion, explaining your thought processes, helping others, and drawing attention to good points. (Adapted from Perusall.com)

_______________

When we come together for class, we will all be able to draw from the comments and questions posed by you and your colleagues during our conversations for more informed and richer discussions.

You can directly access the book Turning the World Upside Down: The search for global health in the 21st Century by Nigel Crisp on Perusall through links in the Canvas Modules. You will need to register and rent the books the first time you access the website.

·
Analytical discussion points:


Below are some ideas of what to look for and comment on in the text to help jump start your conversation. Note that you can post observations that do not fall under any the following categories.

1.
Major themes and arguments.

· Which statement(s) do you think encapsulate the overarching argument posited by the author in a particular section? Does this argument support or contradict other concepts in the book?

· Under what conditions would you agree or disagree with the thesis/theses underlying a major argument?

· Did the author successfully justify major arguments with evidence and/or reason? Why or why not?

2.
Connections & examples
.

· How does a concept or viewpoint support or undermine a viewpoint in an assigned journal article or other text?

· How does a concept or viewpoint exemplify or contradict a different situation in the field?

· How does a concept or event relate to your Humanitarian Crisis Project country or crisis?

· How does a statement or event in the text relate to one of your personal or professional experiences?

3.
Questions
that came up during the reading of the text. For example:

· Clarifying question about an unclear point regarding an argument or idea in the text.

· Reflective question regarding a given idea that explores such topics as underlying reasons for an event or perspective, potential consequences, apparent contradictions, etc.

· Challenging question you want to pose to your colleagues for their perspectives.

4.
Consequences

· Why do you think a key action that produced significant improvements in health was successful? What was accounted for that worked in this case?

· In what ways did an action have unintended environmental, social, political, or economic consequences that negatively impacted health? What do you think was missing? What should have happened or what external factor should have been considered?

5.
Affirmative analysis
. For example:

· On which points do you agree with the author, and why?

· What significant ideas or facts did the author introduce to you? If applicable, how do they relate to your career?

· Which arguments or events do you consider to be particularly germane to the thesis of the chapter? Why?

· Where did the author provide you with a new or alternative perspective on an issue? How did your perspective change?

6.
Critical analysis
. For example:

· On which point(s) do you disagree with the author, and why?

· Where does the author appear to present a point with questionable accuracy or logic? What perspective is missing?

· Where does the author present an argument that appears to be based on unwarranted assumptions or bias? What background information is missing?

· Does a statement contradict (or appear to contradict) a different or more supported viewpoint? Are the viewpoints irreconcilable, or are there contextual nuances that might justify the contradictions?

·
Peer responses on Perusall
:

The best feature of Perusall is the opportunity to dialogue with your colleagues about the concepts, viewpoints and events presented in the text. You can have multi-level conversations about the author’s and your colleagues’ ideas. Use your discussion responses to provide professional feedback for your colleagues’ questions, comments and reasoning, as you will need to do as a practitioner in the field.

You could:

· Answer clarifying questions or provide your perspective on reflective and challenging questions posed by your colleagues.

· Respond to statements that you agree with for which you can provide additional support and perspective.  

· Provide an alternative perspective on a concept you either disagree with or that you consider to be more nuanced than your peer indicated and could change under different conditions.

· Give real-world examples that support or contradict a given statement.

· Ask follow-up questions, either a clarifying question for the author or a reflective or challenging question you want to pose to your group members for their perspectives.

You can notify the original poster with an @____, which is particularly useful when answering a question as it will trigger an e-mail to the original poster. The poster is then able to respond in turn without leaving the e-mail platform.

Note that along with posting full responses, you can acknowledge your colleagues and their ideas with short phrases, #______, memes and emojis.

Overall scoring will be based on the top five comments you post for each chapter of the book. Insightful comments (along the lines of the descriptions above) spread throughout the chapter will receive full credit. Additional comments are encouraged for interaction with your colleagues and will not affect the score.

·
Humanitarian Crisis Project

You will gain practical experience in global health assessments by developing a fact sheet, public health situation analysis and technical brief that will be similar to those developed and used by the Humanitarian Coordinator (HC) for a Humanitarian Country Team (HCT) of a resource-poor low/middle-income country.

“The Humanitarian Country Team (HCT) is a strategic and operational decision-making and oversight forum established and led by the HC. Composition includes representatives from the UN, IOM, international NGOs, the Red Cross/Red Crescent Movement…. The HCT is responsible for agreeing on common strategic issues related to humanitarian action.

The HCT, under the leadership of the Humanitarian Coordinator (HC) is the centrepiece of the humanitarian coordination architecture. A well-functioning HCT that is timely, effective and efficient, and contributes to longer-term recovery will alleviate human suffering and protect the lives, livelihoods and dignity of populations in need.” (

https://www.humanitarianresponse.info/en/operations/cameroon/humanitarian-country-team-hct

)

You will act as an international advocate for victims of a humanitarian crisis by researching the crisis, assessing the people’s most critical needs and designing an action to address a specific humanitarian need. Consider these deliverables being presented to fellow humanitarian actors and NGO leadership to educate them regarding the current crisis situation and ultimately prioritize and target humanitarian resources and funding. Each of the deliverables below will overlap and build on the knowledge you gained, research you conducted and sources you used in the previous assignment.

Country & Crisis

Research and choose a long-term humanitarian crisis in a resource-poor, middle- or low-income country. Note that many humanitarian crises are the result of armed conflict and/or slow-onset natural disasters. This is the country and humanitarian crisis on which you will focus for your deliverables for the Humanitarian Crisis Project.

Record your choice on the class MS Teams site on the form posted in the channel entitled “Humanitarian Crisis Project.”

Country & Crisis Overview Fact Sheet

You will submit a 2-page fact sheet of your country and crisis on a discussion board for your colleagues. This will provide your colleagues with a fact sheet/cheat sheet that gives background information and context to the humanitarian response recommendations you will present at a later date. The research you conduct for the fact sheet can also be used as foundational work for your Public Health Situation Analysis.

The fact sheet should include helpful graphics, charts and maps as applicable to the information. Text should be written in text boxes for quick visual access. A template for the fact sheet is on Canvas (adapted from

Fact Sheets

). The color, format, headings, etc. should be modified to suit your needs. The fact sheet should reflect what you think your colleagues should know to understand the impact of the crisis on the people in that country and include such information as:

1. Brief overview of the country’s demographic information, particularly as relevant to the crisis.

2. Main characteristics of the region’s humanitarian crisis.

3. Brief overview of the country’s economic status and, as applicable, general effect(s) on the crisis.

4. Brief overview of the country’s history and/or political structure and, as applicable, general effect(s) on the crisis.

5. Map(s) portraying the location affected by the crisis and the area you will focus on for your humanitarian crisis project.

6. Additional background information, statistics, etc. as you deem appropriate.

Facts should be followed by a superscript citation number. The list of references should be on a separate page from the fact sheet. All specific facts, graphics and maps must be appropriately and correctly cited.

You will sign up for a day to share your fact sheet and give a 5-10 minute overview of your country and its humanitarian crisis at the beginning of a class session.

Public Health Situation Analysis

You will utilize the short form of the World Health Organization (WHO) Public Health Situation Analysis
official document to conduct a thorough analysis of a humanitarian crisis in a limited-resource country and a public health needs assessment. You will gain experience using secondary data sources and databases to collect information. The WHO template and instructions are on Canvas and will be discussed in class.

You will be able to use the information and sources gathered for your PHSA in your technical brief. The brief’s rubric is in the Canvas Modules.

Note that the target sector for the technical brief refers to a sector of concern that you believe significantly impacts the health of the target population; it should come from the “3. Health Status and Threats” list in your PHSA (e.g., vaccination coverage, malnutrition and child health, NCDs, etc.). You may choose to target a sector that is not in the Health Status list (e.g., housing, food security, nutrition, transportation, infrastructure, etc.) and include it in the PHSA list under “Other.”

Humanitarian Action Technical Brief

Suppose that, as your country’s HC, you have been charged to make evidence-based recommendations on the development of a program to address a critical health problem. From your Public Health Situation Analysis, choose the sector that you think currently has the highest needs and would provide the most ROI for invested time, funding, and attention. Develop a technical brief describing a program that addresses these needs.

The following is a guide to the content of your technical brief:

Section I: Overview of Crisis.

Include SDOHs and relevant historical, environmental, social and political context. Expand on information previously provided in the fact sheet. Include a map of the crisis region(s) and applicable graphs.

Section II: Target Sector and Population

Provide an overview and then more specific, regional information regarding the sector that your humanitarian action will target. Why will this sector most influence the health and well-being of the target population? What is the relationship between this sector and health, and what are the primary factors that have caused problems found in this sector?

Section III: Stakeholder Analysis

Who are the local, regional, national and international leaders and agencies that influence this sector? Which NGOs are involved and what are their roles? How are the NGOs connected – are there political influences, alliances, or competitive factors that other humanitarian actors should be aware of? Who are the most powerful stakeholders? Conversely, which stakeholders may be highly affected but not influential? A stakeholder analysis table would be beneficial to you and your audience.

Section IV: Current Humanitarian Response

Describe the major humanitarian response activities that are currently being done to address the problems in this sector of the humanitarian crisis. Explain evidence-based interventions that currently address this problem in your chosen setting. Be as specific as you can. What does the literature suggest about the efficacy of these interventions for this problem in a resource-poor setting?

Section V: Recommended Humanitarian Action

Evidence-based conclusions and recommendations: based on your understanding of the problem and what you now know about possible interventions, describe what you would recommend as the best evidence-based action and specifically state your reasons for this. Given what is being done now, what alternative action might you propose for this problem, or, what might you do differently to optimize the effectiveness of existing interventions? You should evaluate, compare, and contrast the existing interventions as the basis for proposing an optimum effective intervention. Discuss any potential barriers to implementation anticipated in your chosen setting and suggestions on how to overcome these. End with a concluding paragraph that summarizes the need for your action plan.

Technical Brief format:

· The brief must include major sections and subsection headings to structure your essay in the order specified above.

· The text should reference multiple relevant and clearly labeled graphics for clarity.

· The paper should be 2,500 words, single-spaced, 11-point, with 1-inch margins on all sides. The word requirement does not include the cover page, graphs or illustrations, or references. Include page numbers on each page.

· The technical brief should have at least 15 citations from peer-reviewed journals and other sources such as books and reputable websites such as the WHO, CDC, PAHO, etc.

· All content should be given a proper citation using an official citation style such as the American Medical Association, Biology Editors Association, American Psychological Association, etc.

· This paper is a professional document so it needs to be free of grammatical and spelling errors. It must use a technical writing style as exemplified by recently published public health articles and articles sponsored by international agencies. If needed, please visit the UTA Writing Center for help with writing. You should be prepared to write multiple drafts of the paper before you submit it. Please start the writing process early in the course.

Humanitarian Action Technical Brief presentation

On the last day of class, you will give an online presentation to your colleagues as though to fellow humanitarian leaders, advocating for your country’s people in crisis and providing evidence for the need for supportive funding and resources for the actions you chose to target in your technical brief. The presentation should last ~15 minutes and consist primarily of compelling and informative graphics—e.g., photographs, charts, maps—and short, sharp bullet points with limited text. You want to create a powerful, influential presentation.


Grading Policy
:

To maintain a class culture of consistency that is fair and allows students to be confident with what to expect, everyone will be held to the same due dates and standards. There will be no make-up tests or quizzes except in the case of a university-approved excused absence with appropriate documentation or with instructor approval.
Late assignments will be accepted with an 11% penalty automatically applied by Canvas for each day past the due date.

Note that there are no extra credit points at the end of the semester. You will need to turn in assignments on time and participate in the class consistently throughout the semester to earn a good final grade. If you find that you have missed two assignments or classes within a short time frame, this should be a red flag for you to evaluate if something needs to be adjusted. If you have a commitment that will not allow you to consistently engage with this class, it may be best to take the class in a future semester.

· Technical Problems:


Because technology is vulnerable to experiencing difficulties, you should not wait until the last minute to submit an assignment.
If you experience technical difficulties contact Canvas Support to help resolve the issue. They are open 24 hours a day. All technical issues must be resolved prior to an assignment or test due date and time
.
Assignments or tests which are submitted late due to technical issues are subject to a point deduction up to and including a zero.
Plan to submit your assignment well before the due time, especially if your setting has a history of an unstable internet connection. DO NOT WAIT UNTIL THE LAST MINUTE TO SUBMIT AN ASSIGNMENT! Give yourself or your group a buffer of time to accommodate technical glitches.
Out of fairness to other students, assignments submitted more than 3 minutes past the due time will be subject to the 1-day late penalty.

Turning in a blank assignment, the wrong assignment, or an assignment in an unreadable format on Canvas before the due date will be subject to a 3-day late penalty (33%) point deduction. It is understood that honest mistakes can be made, which is why the assignment will still be accepted; however, it is your academic responsibility to double-check every submission to ensure that it is correct and readable.

· Participation:
You are expected to substantively participate in course discussions and other learning activities. It is expected that students will: a) actively share thoughts and ideas, b) integrate course materials into discussions, and c) share pertinent personal/professional experiences.
Because of the interactive nature of the class, your class participation is calculated into your grade not simply because of the information you gain by attending the class but because of the opportunities for you to benefit the class through your engagement with the course topics and your colleagues. This class is not just a place for you to pick up knowledge but to sharpen your professional skills by actively contributing to the discussion and the knowledge gained by your colleagues through your questions, comments and valuable observations informed by your background and experiences.
Likewise, in-class activities are designed for you to practice applying course concepts to field situations in a small-group setting, to demonstrate your ability to apply the concepts, and to build your colleagues’ professional thought processes with your insights and unique perspectives. Your active participation in one of these small-group collaborations is documented by taking a picture of the handout with your name on it and uploading the picture to the appropriate in-class assignment page on Canvas. You should confirm that the picture of a small-group handout with your name on it is properly uploaded before leaving the classroom.

Grading:

Assignment

Percentage of grade

Due Date

In-class Participation
Attendance, class participation, group activities

10%

TWUDA Perusall book discussions, Reflection

15%

Throughout course, as noted on Canvas

Case Study #1
Case Study #2

15%

July 21
Aug. 4

Humanitarian Crisis Project (60%):

Country & Crisis
Country Overview Fact Sheet

10%

July 17
July 24

WHO Public Health Situation Analysis

20%

Aug. 4

Humanitarian Action Technical Brief

20%

Aug. 11

Humanitarian Action Technical Brief Presentation

10%

Aug. 11 or 13

All students:
Students are expected to keep track of their performance throughout the semester and seek guidance from available sources (including the instructor and teaching assistant) if their performance drops below satisfactory levels; see “Student Support Services,” below.

Expectations for Out-of-Class Study: Beyond the time required to attend each class meeting, students enrolled in this course should expect to spend at least an additional 20 hours per week of their own time in course-related activities, including reading required materials, completing assignments, preparing for exams, etc., due to the condensed nature of this course.

Grade Grievances: Any appeal of a grade in this course must follow the procedures and deadlines for grade-related grievances as published in the current University Catalog.

Drop Policy: Students may drop or swap (adding and dropping a class concurrently) classes through self-service in MyMav from the beginning of the registration period through the late registration period. After the late registration period, students must see their academic advisor to drop a class or withdraw. Undeclared students must see an advisor in the University Advising Center. Drops can continue through a point two-thirds of the way through the term or session. It is the student’s responsibility to officially withdraw if they do not plan to attend after registering. Students will not be automatically dropped for non-attendance. Repayment of certain types of financial aid administered through the University may be required as the result of dropping classes or withdrawing. For more information, contact the Office of Financial Aid and Scholarships (http://wweb.uta.edu/aao/fao/).

Disability Accommodations: UT Arlington is on record as being committed to both the spirit and letter of all federal equal opportunity legislation, including The Americans with Disabilities Act (ADA), The Americans with Disabilities Amendments Act (ADAAA), and Section 504 of the Rehabilitation Act. All instructors at UT Arlington are required by law to provide “reasonable accommodations” to students with disabilities, so as not to discriminate on the basis of disability. Students are responsible for providing the instructor with official notification in the form of a letter certified by the Office for Students with Disabilities (OSD). Only those students who have officially documented a need for an accommodation will have their request honored. Students experiencing a range of conditions (Physical, Learning, Chronic Health, Mental Health, and Sensory) that may cause diminished academic performance or other barriers to learning may seek services and/or accommodations by contacting:
The Office for Students with Disabilities, (OSD)
www.uta.edu/disability or calling 817-272-3364. Information regarding diagnostic criteria and policies for obtaining disability-based academic accommodations can be found at www.uta.edu/disability.

Counseling and Psychological Services, (CAPS) www.uta.edu/caps/ or calling 817-272-3671 is also available to all students to help increase their understanding of personal issues, address mental and behavioral health problems and make positive changes in their lives.

Non-Discrimination Policy: The University of Texas at Arlington does not discriminate on the basis of race, color, national origin, religion, age, gender, sexual orientation, disabilities, genetic information, and/or veteran status in its educational programs or activities it operates. For more information, visit 
uta.edu/eos
.

Title IX Policy: The University of Texas at Arlington (“University”) is committed to maintaining a learning and working environment that is free from discrimination based on sex in accordance with Title IX of the Higher Education Amendments of 1972 (Title IX), which prohibits discrimination on the basis of sex in educational programs or activities; Title VII of the Civil Rights Act of 1964 (Title VII), which prohibits sex discrimination in employment; and the Campus Sexual Violence Elimination Act (SaVE Act). Sexual misconduct is a form of sex discrimination and will not be tolerated.
For information regarding Title IX, visit www.uta.edu/titleIX or contact Ms. Jean Hood, Vice President and Title IX Coordinator at (817) 272-7091 or jmhood@uta.edu.

Academic Integrity: Students enrolled all UT Arlington courses are expected to adhere to the UT Arlington Honor Code:

I pledge, on my honor, to uphold UT Arlington’s tradition of academic integrity, a tradition that values hard work and honest effort in the pursuit of academic excellence.

I promise that I will submit only work that I personally create or contribute to group collaborations, and I will appropriately reference any work from other sources. I will follow the highest standards of integrity and uphold the spirit of the Honor Code.

UT Arlington faculty members may employ the Honor Code in their courses by having students acknowledge the honor code as part of an examination or requiring students to incorporate the honor code into any work submitted. Per UT System Regents’ Rule 50101, §2.2, suspected violations of university’s standards for academic integrity (including the Honor Code) will be referred to the Office of Student Conduct. Violators will be disciplined in accordance with University policy, which may result in the student’s suspension or expulsion from the University. Additional information is available at https://www.uta.edu/conduct/.

Plagiarism: What is considered plagiarism? Here are some examples:
· Copying and pasting information from a website or another source, then revising it so it sounds like your original idea.
· Doing an assignment /essay/take home test with another student then submitting separate assignments that contain the same ideas, language, phrases, etc.
· Quoting a passage without quotation marks or citations, so that it looks like your own.
· Paraphrasing a passage without citing it, so that it looks like your own.
· Hiring another person to do your work for you, or purchasing a paper through any of the on- or off-line sources.

Copying another student’s paper or any portion of it is plagiarism. Copying a portion of published material (e.g., books or journals) without adequately documenting the source is plagiarism.

If the author’s ideas are rephrased, by transposing words or expressing the same idea using different words, the idea must be attributed to the author by proper referencing giving the author’s name and date of publication via in-text citation, according to APA format. In addition, authors whose words or ideas have been used in the preparation of a paper or exam must be listed in the references cited at the end of the paper or exam question. Students are expected to review the plagiarism module from the UT Arlington Central Library via http://library.uta.edu/plagiarism/index.html.

In this course and in all BSPH program courses, a student who commits plagiarism, either intentionally or involuntarily, will be referred to the UTA Office of Community Standards (OCS) for their review process. If the student is found responsible for plagiarism, the assignment in question will receive an automatic zero. If the OCS does not complete the review process prior to the end of the course, the student will receive an “Incomplete” grade until the review process is completed.

Unicheck is an electronic system which helps to identify plagiarized assignments. All student assignments are subject to being submitted to Unicheck
at any time
to evaluate for plagiarism. Plagiarism may also be determined by reviewing references directly and does not require the use of Unicheck.

Classroom Behavior: Participation is important to the success of this course. To be able to fully participate, read the assigned material prior to class so you can be prepared to discuss the information in class. Respectful interactions are expected. Disrespect for others will not be tolerated. We can disagree with each other’s opinions during class discussion and still be respectful.

Talking, using cell phones, or using laptops for purposes other than educational content of this course will not be tolerated. The instructor reserves the right to require that this behavior cease and to administratively drop any student from the course who does not maintain appropriate behavior in this regard.

E-mails to the instructor should be written in a professional manner. The course title should be referenced in the e-mail, the instructor should be addressed by name and the closing should include your name.

Electronic Communication: UT Arlington has adopted MavMail as its official means to communicate with students about important deadlines and events, as well as to transact university-related business regarding financial aid, tuition, grades, graduation, etc. All students are assigned a MavMail account and are responsible for checking the inbox regularly. There is no additional charge to students for using this account, which remains active even after graduation. Information about activating and using MavMail is available at http://www.uta.edu/oit/cs/email/mavmail.php.

Campus Carry: Effective August 1, 2016, the Campus Carry law (Senate Bill 11) allows those licensed individuals to carry a concealed handgun in buildings on public university campuses, except in locations the University establishes as prohibited. Under the new law, openly carrying handguns is not allowed on college campuses. For more information, visit http://www.uta.edu/news/info/campus-carry/

Student Feedback Survey: At the end of each term, students enrolled in face-to-face and online classes categorized as “lecture,” “seminar,” or “laboratory” are directed to complete an online Student Feedback Survey (SFS). Instructions on how to access the SFS for this course will be sent directly to each student through MavMail approximately 10 days before the end of the term. Each student’s feedback via the SFS database is aggregated with that of other students enrolled in the course. Students’ anonymity will be protected to the extent that the law allows. UT Arlington’s effort to solicit, gather, tabulate, and publish student feedback is required by state law and aggregate results are posted online. Data from SFS is also used for faculty and program evaluations. For more information, visit http://www.uta.edu/sfs.

Emergency Exit Procedures: Should we experience an emergency event that requires us to vacate the building, students should exit the room and move toward the nearest exit, which is to the right of the room. When exiting the building during an emergency, one should never take an elevator but should use the stairwells. Faculty members and instructional staff will assist students in selecting the safest route for evacuation and will make arrangements to assist individuals with disabilities.

Student Support Services: [Required for all undergraduate courses] UT Arlington provides a variety of resources and programs designed to help students develop academic skills, deal with personal situations, and better understand concepts and information related to their courses. Resources include tutoring, major-based learning centers, developmental education, advising and mentoring, personal counseling, and federally funded programs. For individualized referrals, students may visit the reception desk at University College (Ransom Hall), call the Maverick Resource Hotline at 817-272-6107, send a message to resources@uta.edu, or view the information at http://www.uta.edu/universitycollege/resources/index.php.

The IDEAS Center (2nd Floor of Central Library) offers free tutoring to all students with a focus on transfer students, sophomores, veterans and others undergoing a transition to UT Arlington. To schedule an appointment with a peer tutor or mentor email IDEAS@uta.edu or call (817) 272-6593.
The English Writing Center (411LIBR): The Writing Center Offers free tutoring in 20-, 40-, or 60-minute face-to-face and online sessions to all UTA students on any phase of their UTA coursework. Our hours are 9 am to 8 pm Mon.-Thurs., 9 am-3 pm Fri. and Noon-6 pm Sat. and Sun. Register and make appointments online at http://uta.mywconline.com. Classroom Visits, workshops, and specialized services for graduate students are also available. Please see www.uta.edu/owl for detailed information on all our programs and services.
The Library’s 2nd floor Academic Plaza offers students a central hub of support services, including IDEAS Center, University Advising Services, Transfer UTA and various college/school advising hours. Services are available during the library’s hours of operation. http://library.uta.edu/academic-plaza

Resources helpful to students for research and citing APA sources:

· Public Health Guide http://libguides.uta.edu/publichealth  – explains how to create a plan for finding literature and which databases they should search.
· APA Guide http://libguides.uta.edu/apa – created for UTA-specific questions about use of APA and includes quick answers and short video introductions to concepts.

Course Schedule

Below is the expected schedule for our course this semester; final reading selections and assignments are listed in the Canvas Modules and Assignments pages. Additional guest speakers may be added to the schedule as available.
** Note that the written schedule below contains anticipated readings, assignments, and due dates. These elements may change as needed. You are responsible to complete the reading selections, assignments and due dates posted on Canvas.
2

KINE 5370 Course Schedule, Summer 2022

TENTATIVE

As the instructor for this course, I reserve the right to adjust this schedule in any way that serves the educational needs of the students enrolled in this course. –Dr. Phipps

Date

Topic(s)

Readings & Assignments Due

*Refer to Canvas for final assignments and due dates

MODULE 1 – Intro to Global Health
·
What does the field of global health entail, how did we get here, and why does it matter?

Monday
July 11
(no in-class session)

· Refer to Canvas Module 1, page 1 for Readings
· Perusall – Crisp Chap. 1 Intro
· Begin researching country crisis

· Refer to Canvas, Week 1 for readings

· TWUD Chap. 1 (Introduction) – should be looked over for discussion in first class, Wed. July 13
· Class introduction post on MS Teams site, due Monday, July 11, 11:59 p.m.
· Entries should be read and replied to before class on Wednesday

Wednesday

July 13

· Course introduction
· Introduction to global health
· 2030 Sustainable Development Goals (SDGs)
· Effects of globalization on SDGs

Date

Topic(s)

Readings & Assignments Due

*Refer to Canvas for final assignments and due dates

MODULE 2 – Global Health Issues
·
What are the most pressing health problems in developing countries and what needs to be done to combat them?

Monday

July 18

· WASH (Water, Sanitation, Hygiene) issues
· Vector-borne & infectious diseases
· Chronic disease
· Water & solid waste disposal
· Nutrition
· Wednesday: Case Study – Tobacco Control in South Africa

· Refer to Canvas, Week 2 Module for readings

· TWUDA Perusall Discussion, Chap. 2-3, due Friday, July 15, 11:59 p.m
· Humanitarian Crisis: Country & Crisis, due Sunday, July 17, 11:59 p.m. [on MS Teams]

Wednesday
July 20
(no in-class session)

· Case Study #1: Tobacco Control in South Africa & questions, due Thursday, July 21, 11:59 p.m.
· TWUDA Perusall Discussion, Chap. 4 & 5, due Wednesday, July 20, 11:59 p.m.

Date

Topic(s)

Readings & Assignments Due

*Refer to Canvas for final assignments and due dates

MODULE 3: Biosocial Approach to Global Health
·
How should historical, cultural, economic, political, and social forces be factored into the development and implementation of a health program or policy?

Monday

July 25

· Social Determinants of Health (SDOHs)
· Effects of SDOHs on health outcomes
· Biosocial approach framework
· Ethical issues in global health
· Wednesday: Humanitarian Crisis Country Overview presentations (round robin)

· Refer to Canvas, Week 3 Module for readings

· Humanitarian Crisis: Country Overview Fact Sheet, due Sunday, July 24, 11:59 p.m.
· TWUDA Perusall Discussion, Chap. 6 & 7, due Monday, July 25, 11:59 p.m.

Wednesday

July 27

·

MODULE 4: Global Healthcare Delivery Systems & Leadership

How can various ways in which healthcare services are delivered to and accessed by individuals both improve and weaken health outcomes?

Date

Topic(s)

Readings & Assignments Due

*Refer to Canvas for final assignments and due dates

Monday

Aug. 1

· International healthcare systems
· National healthcare models
· International infrastructure of global health
· Global health leader organizations
· Local health leadership decision-making
· Wednesday: Case study – Iran’s Triangular Clinic

· Refer to Canvas, Module 4 for readings

· TWUDA Perusall Discussion, Chap. 8 & 9, due Saturday, July 30, 11:59 p.m.

* Humanitarian crisis country overview presentations, as needed

Wednesday
Aug. 3
(no in-class session)

·

· Case Study #2: Iran’s Triangular Clinic & questions, due Thursday, August 4, 11:59 p.m.

Date

Topic(s)

Readings & Assignments Due

*Refer to Canvas for final assignments and due dates

MODULE 5: Partnerships, Programs & Research
·
How should international collaborations, programs and research projects be designed so they are sustainable and do not harm the communities they are trying to help?

Monday

Aug. 8

· Global health partnerships
· International collaboration
· Sustainable program design & implementation

· Monday & Wednesday: Humanitarian Response Technical Brief, Pecha Kucha presentations

· Refer to Canvas, Module 5 for Assigned Readings

· TWUDA Perusall Discussion, Chap. 10 & 11, due Thursday, Aug. 4, 11:59 p.m.
· Humanitarian Crisis: Public Health Situation Analysis, due Friday, Aug. 5, 11:59 p.m.
· Humanitarian Action Technical Brief summary, due Sunday, Aug. 7, 11:59 p.m.

· TWUDA Perusall Reading, Chap. 12 & 13, Reflection due Tuesday, Aug. 9, 11:59 p.m.

Wednesday

Aug. 10

·

·

· Humanitarian Action Technical Brief presentation peer evaluations, due Thursday, Aug. 11, 11:59 p.m.

· Humanitarian Action Technical Brief, due Thursday, Aug. 11, 11:59 p.m.

Emergency Phone Numbers: In case of an on-campus emergency, call the UT Arlington Police Department at 817-272-3003 (non-campus phone), 2-3003 (campus phone). You may also dial 911. Non-emergency number 817-272-3381
STUDENT RESOURCES

Library Home Page 
library.uta.edu

Academic Help

Academic Plaza Consultation Services library.uta.edu/academic-plaza
Ask Us ask.uta.edu/
Library Tutorials library.uta.edu/how-to
Subject and Course Research Guides 
libguides.uta.edu

Subject Librarians library.uta.edu/subject-librarians
Writing Center http://www.uta.edu/owl/
Public Health Guide http://libguides.uta.edu/publichealth  – explains how to create a plan for finding literature and which databases to search.
APA Guide http://libguides.uta.edu/apa – created for UTA-specific questions about use of APA and includes quick answers and short video introductions to concepts.

Resources

A to Z List of Library Databases libguides.uta.edu/az.php
Course Reserves pulse.uta.edu/vwebv/enterCourseReserve.do
FabLab fablab.uta.edu/
Special Collections library.uta.edu/special-collections
Study Room Reservations openroom.uta.edu/

(
8/29/2018
)

Public Health Information Services

Public Health Situation Analysis Standard Operating Procedures

Anonymous

WORLD HEALTH ORGANIZATION

Table

of Contents

(

2

)

(
Public

Health

Situation

Analysis-

Short

Form

COUNTRY

NAME
Last

update:
)

Initiated by: Country Office □ Regional Office □ HQ □

Type of emergency (see Annex 2 of this document)

Conflict

Main health hazards

· Give a bullet point list of the main emerging health hazards (or hazards that are likely to become an issue) resulting from the crisis

UN

Level

WHO

Grade

Security level(s)

For the UNDSS website (dss.un.org), enter UN
username and password. Fill out the following table:

INFORM

risk

,
out of 10.
at (date).
Download the excel sheet. Include risk class (e.g. Very High)
Rank: Include rank of country

Food security

Location(s)

Level

Displacement

Extreme (6)

Drought

High

(5)

Flood

Substantial (4)

Moderate (3)

Low (2)

1. Summary of Crisis

Provide a summary of the key features and facts about the crisis (max 200 words), including:

· Geographical areas affected, or most likely to be affected by the crisis (e.g. key districts)

· Start date (and duration; if applicable) of the crisis

· Major humanitarian consequences and concerns;

· Underlying causative factors and drivers of the emergency (e.g. conflict, drought, earthquake, or other pre-existing vulnerabilities etc.), including key operational constraints

· Major Public Health issues and/or disease outbreaks arising due to the crisis, information on vulnerable groups by age group, gender, ethnic group or any other vulnerable group, if applicable

· Level of destruction of health facilities, if applicable

For initial research,

ACAPS

,

Humanitarian Response,

ReliefWeb,

OCHA,

WHO,

Health Cluster

, are useful websites. Key documents on these websites include the Humanitarian Response Plan (HRP), and Humanitarian Needs Overview (HNO), and Situation Reports.

ECHO

also provides useful information. The WHO emergency portal,

vSHOC

compiles information, including Situation reports, which are highly useful.

2. Map of Affected Country/Region

(
Humanitarian

Profile:
Population in

need:

(disaggregated by sex and age if

possible
):

or

population breakdown by age, gender,

urban,

rural.
Population

in

need

of

humanitarian

health

assistance:

(
disaggregated

by

sex

and

age

if

possible
)
Deaths

(
estimates
):
Injuries

(
estimates
):
IDP’s:
Refugees:
Returnees:
(The

HNO/HRP

is

useful

to

find

this

information).

Another

good

source

is

the

“RW

Crises”

phone

app.
)Provide a country map, clearly showing the different regions and districts affected. if you need help please liaise with the MAP team:

maps@who.int.

Useful websites:

ReliefWeb

(type in the “search” bar the country that you are looking for)

(Insert Map)

(
10
)

(
3.

Health

Status

and

Threats
)

In this section, the
existing health status
of the population and
possible health threats
should be noted, which will indicate major areas for health action to respond and recover from crisis.

In this section, an overview of the Public Health Profile and the core determinants of health present in the affected country, district or region should be presented, based on reliable sources of information. Information and statistics both pre- and post-crisis are essential, to understand what could potentially be aggravated by the current crisis. If data is available disaggregated by sex and age, this is very useful; particularly if the numbers are particularly skewed towards one group.

If the most recent available data are not up-to-date, this can be added as a qualifier when providing information, e.g. “according to the most recently available data, …”, if there is no information available, add “no statistics are available, but rates are likely to be high/low”.


Note

: Low confidence information should be specifically noted as such.


For health (and other determinants) profiles/pre-crisis

:

ACAPS

, click on the relevant country, and then “Country Profile”, is a very useful source, as well as the

Global Health Observatory

and

WHO Country

profiles.

The

CIA World Factbook,

“People and society” section is useful for key and comparison statistics, and

DHS

survey

s provide information by district.


For countries that are in crisis

: Situation reports released by

OCHA

(type in the necessary country), and/or EWARS bulletins found through
WHO
(click on the respective country, and then “Situation Reports” and/or “EWARS bulletins”) are extremely useful, as well as

WHO Country Plans.

Updates for the AFRO region can be found

here.

Note
: additional headings can be added, or unnecessary headings removed if necessary, depending on the context. For each sub-heading, aim for an average maximum of 100 words, noting however that some sections may be larger and/or more contextually important than others.


Note:
In displacement contexts, the burden of endemic diseases should be found for both the displaced and the host populations, if available. For a mass translocation of people, i.e. where the majority of people are displaced (e.g., Rohingya in Cox’s Bazar, Bangladesh), disease profiles from the place of origin (e.g. Rakhine state, Myanmar) are more relevant for most diseases; the main exceptions are diseases associated with the physical environment (e.g., Cox’s Bazar), such as most vector-borne diseases, zoonotic diseases, and environmental health issues such as toxin exposure.

Note
: If the crisis is focused on a specific i.e. district in country, compare this to the national and or regional averages, if possible, including if there are districts which are facing different health needs, disaggregate information by district.

If known, relate this information to any obvious or potential determinants of health (i.e. measles due to poor vaccination coverage, cholera due to poor WASH infrastructures or environmental factors such as the rainy season).


Population mortality

Where available, this information usually comes from SMART surveys available from the country Health or Nutrition Clusters. Include crude mortality rate (CMR; emergency threshold is >1/10 000/day) and under-5 mortality rate (U5MR; emergency threshold is >2/10 000/day).


Vaccination coverage

If information can be found, note most up-to-date information on

vaccination coverage

, including, if applicable, how this relates to the coverage necessary for herd immunity threshold.

Key Risks in the coming month*

Public Geographi Likelihood** Public health** Level of Rationale

Health cal Scope consequence risk***

risk

(e.g. (e.g. (e.g. Likely) (e.g.

AWD) Countrywid Moderate) e)

(e.g. Poor WASH

conditions)

(e.g. Measles)

(e.g. Low vaccination coverage)

(e.g. Countrywid (e.g. (e.g. High)

Malaria) e Almost certain)

(e.g. Malaria season, lack of treatment)

(e.g ARI) (e.g. Very (e.g. Low) likely)

(e.g. overcrowding)

(e.g (e.g. Not

Mental likely)

Health)

(e.g. Injuries)

(e.g. NCDs and cancer)

(e.g Lack of treatment)

Red: could result in high levels of excess mortality or morbidity in the upcoming month. Orange: could result in considerable levels of excess mortality or morbidity. Yellow: could make a minor contribution to excess mortality or morbidity Green: will probably not result in any excess mortality or morbidity/relatively normal satiation in the upcoming month.

Guidance on filling out the ‘Key Risks in the coming month’ table (see above):

This table shows potential sources of future morbidity and mortality based on the context and an analysis of health risks, and is based on 3 Level expert judgement.

The ‘likelihood column’ indicates What is the likelihood that this condition will arise due to the crisis? See Annex 3 for more information.

The ‘level of risk column’ is also dependent on the type of crisis, i.e. acute or protracted.

See Annex 4 for more details on how to fill out this table.

In situations where a crisis has just occurred, for example, increased HIV, TB and NCD burden will not result in high levels of excess mortality as it will take a while for these conditions to deteriorate. In more protracted crises, however, this will become more of a burden as individuals cannot access their medicines so their situation will deteriorate.

Depending on the overall public health profile of the country, the level of risk will depend on whether a small or large proportion of the population have/are likely to get the condition.

The narratives below should be consistent with, and expand upon, the table above.

Epidemic-prone diseases

Note any current or recent epidemics or outbreaks (within the past two years (past 10 for long-form), particularly of vaccine-preventable diseases) in the affected area, including dates. If quickly ascertainable, provide data on prevalence and/or number of confirmed and suspect cases (and alert cases if applicable), case fatality rate (CFR), locations, and any other descriptive epidemiology; including key populations affected (e.g. by gender or age). If possible, describe patterns.
ProMED is a

useful source. Where applicable, mention overcrowding as a risk factor (which may increase risk air-

borne diseases).

Endemic infectious diseases

List endemic infectious diseases that are most likely to be aggravated by the current event. Further, note any other endemic infectious diseases; including Neglected Tropical Diseases (NTDs) and vector- borne diseases. One way to determine the endemic diseases to include is to determine the leading infectious causes of outpatient consultation, in order of proportional morbidity. If quickly ascertainable, break down by region if possible, including incidence, prevalence, CFR, and peak seasons of disease transmission if applicable. For Malaria, note dominant species and associated resistance patterns, seasonal transmission, and potential migration of people from low endemicity to hyperendemic areas and vice versa. For zoonotic diseases, note the extent of disease/deaths in animals. Information about Malaria species and resistance patterns in country can be found

here


Malnutrition and Child Health

Note the prevalence of Severe Acute Malnutrition (SAM) particularly for children under 5 (crisis threshold 2%), Global Acute Malnutrition (crisis threshold 15%), stunting (crisis threshold >20% for areas that are moderately/borderline food insecure),; if quickly ascertainable, provide location and populations who are most affected, number of people requiring food assistance and where they are located, noting

IPC

projections

if available.

Nutrition Landscape Information System,

and SMART surveys are useful sources. Much of this information may be held by the Nutrition Cluster if present.

If quickly ascertainable, note breastfeeding rates, infant mortality rate, and leading causes of child mortality.

UNICEF

is a useful source.


Sexual and reproductive health

Note any quickly ascertainable information on total fertility rate (TFR), unmet need for family planning , ANC coverage (particularly noting the recommended 4 visits), births attended by skilled health personnel, delivery of births at a health facility, leading cause of maternal deaths, noting if there is anything significant about the figures, i.e. lowest in the region. Also note anything that could change due to the crisis.

UNFPA

and
UNICEF are useful sources. Maternal mortality ratio (MMR) can also be added if known, although crisis-specific data are rarely available early in a crisis.


Tuberculosis and HIV

Tuberculosis (TB): Note incidence (new cases) and prevalence (current cases) of

TB

, MDR/RR TB cases, TB treatment coverage. Where applicable, mention overcrowding as a risk factor (which may increase risk of TB spread).

HIV: Note incidence (new cases), and prevalence (current cases) of

HIV,

treatment coverage, number of people receiving ART, prevention of mother to child transmission (pMTCT) rates.


Non-communicable diseases (NCDs)

Depending on which resource provides the most up to date information:

NCD country profile

,

NCD

Progress Monitor

. If quickly ascertainable, note the burden of major NCDs (e.g. diabetes mellitus, CVD, cancers, respiratory diseases, hypertension), and essential medicines which are /are not be available in country, if possible.


Trauma

Crisis-attributable injuries: Indicate the confirmed and/or estimated number of injuries and casualties that have arisen from the crisis and most prevalent injury patterns. In unstable security situations, consider whether the pattern of warfare could cause substantial numbers of injuries over the next month. Consider using data from health bulletins if available.

Violence: Note patterns and locations of violence in country.

Gender-based violence (GBV):
GBV includes: intimate partner violence, rape, child marriage, female genital mutilation, exploitation etc. Note the current types of violence that are most prevalent. Note if these figures are likely to be exacerbated due to the crisis, note negative coping

mechanisms which may lead to increased violence or GBV Consider using information from health bulletins, or

GBV sub-cluster

information where available.


Mental health

Note the extent of mental health conditions in populations, including locations and key populations where this may be most prominent.


Water Sanitation and Hygiene (WASH)

Comment on overall WASH situation. If quickly ascertainable, note extent, location, and status of WASH infrastructure (particularly the availability of safe and/or improved drinking water and basic sanitation), rainfall patterns, and any other increases in WASH needs which may arise from the crisis. Note hygiene and sanitation practices, if available. Where applicable, mention how overcrowding as a risk factor which may lead to increased risk of disease.


Other

Note other determinants of health, contextual factors, or cross-cutting issues which are highly relevant to the situation, such as protection concerns e.g. land mines, security threats, cultural factors which may exacerbate risk of disease transmission (e.g. unsafe burial practices, eating of bushmeat), operational constraints prior to or as a result of the conflict (e.g. lack of road maintenance which may affect humanitarian assistance), natural hazards and/or any other extreme weather exposures which may exacerbate the crisis, or any other major pre-existing vulnerabilities and/or threats.

4. (
Main

figures

on

disruption

of

key

health

system

components
D
a
m
a
g
e

t
o

h
ea
l
t
h

fa
c
i
l
i
t
i
e
s
:

t
o

w
h
a
t
extent,

including

locations

of

damage

that

has

occurred
Health

workforce
:

note

the

extent

of

health

workforce

in

country
Attacks
against health workers:

indicate numbers,
locations
and

frequency of attacks.
Surveillance

system

for

attacks

on

health

care

is

useful.
Drugs

and

other

supplies:

e.g.

disrupted

supply

chain,

shortage

of

drugs
)Health System Status & Local health system disruptions Pre-crisis

Provide as much information as can quickly be found

on % of country covered by Primary Health Care and hospital services, number of hospital beds per 100,000 population, number of nurses and doctors working in the affected area, barriers to accessing healthcare i.e. financial, transport.

In-crisis

Provide summary statistics on the state of the health system in country,

· main figures on the disruption of key health system components, and the locations of these disruptions (see box beside),

· to what extent could crisis risk factors could reduce coverage and utilization of health services,

· Report on any critical, local disease control (eradication/elimination) programmes that could be disrupted as a result of the crisis.

For latest HeRAMS reports, please see the

HeRAMS website

(accessible through Google Chrome); or contact:

herams@who.int

.

5.
Humanitarian Health Response (3/4W matrix) Health response coordination N. of partners

If available, provide information on the leadership and governance structure of the health response, and partner coordination.

Health response actors
Include the Who-does-What-Where(When) (3/4W) map/list, and the number of partners working in the health cluster.

Useful websites:
ReliefWeb (type in the “search” bar the country that you are looking for).

In cases where the 3/4W map/list is not available, to cover partner engagement the following may be useful:

· Mapping initial assessment coverage, to identify areas which are not covered

· locations of EMTs, in-country health sector partner coverage (pre- and post- event).

· Expected deployments (
vSHOC
can show WHO planned deployments; consult partners for other).

· Development partners (who may already have projects and/or experience), to fulfil the humanitarian-development nexus.

(Insert 3/4W matrix)

6.
Information gaps & information source

Prioritize information gaps evident from secondary data search, and identify the corresponding tool, guidance document and/or source of information that can be used to address this. Sometimes these information gaps are already hinted at or provided elsewhere, such as on ACAPS or Situation Reports.
The information gaps that are indicated should be useful to address what information can be collected in future assessments.
For example; if there is no information on measles cases, but measles is flagged as an issue, the corresponding tool would be to set up EWARS to identify cases of measles.

Consult
PHIS Toolkit for guidance on specific tools used to fill specific gaps. If possible, add a hyperlink to the recommended tool so that it can be accessed easily (In Word: “Insert”, “Links”, “Link”, and then copy and paste the desired hyperlink).

Additional guidance can be sought from the WHO HQ or RO HIM/MDC PHIS country focal points.

See Annex 8 on more information on methods to collect primary data.

Gap

Recommended tools/guidance for primary data collection

Health Status & threats for affected population

(e.g.Measles or other epidemic- prone diseases and other critical conditions)

(e.g.
EWARS
)

(e.g. Mental Health)

(e.g.
Assessment for mental health tool)

(e.g. GBV prevalence)

GBVIMS

(e.g. HIV Statistics- 2018)

(e.g. UNAIDS)

Health Resources & availability

(e.g. Health Resources)

(e.g.
HeRAMS
)

Health System Performance (access, coverage, output, quality, and utilization of

health services)

7. Key References

This section requires a very basic reference list, in the following format: Source, name of document, year. In-text citations are not required for the short form PHSA.

8. Contacts

For example:

Health Cluster Coordinator:

Health Cluster Information Management Officer:

[Insert Country Name] Public Health Information Services Focal Point (WHO Geneva, RO):

(
6.

Additional

Resources
)

(
7.

Annex

1

WHO

recommended

surveillance

case

definitions
)

Acute diarrhoea

Acute diarrhoea (passage of three or more loose stools in the past 24 hours) with or without dehydration.

Suspected cholera

· In an area where cholera is not known to be present: a person aged > 5 years with severe dehydration or death from acute watery diarrhoea with or without vomiting.

· In an area where there is a cholera outbreak: a person aged > 5 years with acute watery diarrhoea with or without vomiting.

· To confirm a case of cholera: isolation of Vibrio cholerae O1 or O139 from a diarrhoeal stool sample.

Bloody diarrhoea

Acute diarrhoea with visible blood in the stool. To confirm a case of epidemic bacillary dysentery:

· take a stool specimen for culture and blood for serology,

· isolation of Shigella dysenteriae type 1.

Acute flaccid paralysis (suspected poliomyelitis)

Acute flaccid paralysis in a child aged < 15 years, including Guillain–Barré syndrome, or any acute paralytic illness in a person of any age in whom poliomyelitis is suspected.

Acute Haemorrhagic Fever Syndrome

Acute onset of fever (duration of less than 3 weeks) and any of the following:

· haemorrhagic or purpuric rash,

· vomiting with blood,

· cough with blood,

· blood in stools

· epistaxis, or

· other haemorrhagic symptoms.

Acute Jaundice Syndrome

Illness with acute onset of jaundice and absence of any known precipitating factors and/or fever.

Pneumonia

· for infants aged 7-59 days, breathing 60 or more times per minute (even without history of cough and or difficult breathing)

· In children 2 months to less than five years old with history of cough or difficulty breathing and one or more of the following

· for infants aged 2 months to 1 year, breathing 50 or more times per minute, or chest in- drawing

· for children aged 1 to 5 years, breathing 40 or more times per minute, or chest in-drawing

· no stridor, no general danger signs (see below).

Severe pneumonia

· History of cough or difficulty breathing and one or more of the following:

(
29
)

· inability to drink or breastfeed,

· intractable vomiting,

· convulsions, lethargy or unconsciousness, or

· stridor in an otherwise calm child.

Malaria

Person with current fever or history of fever within the past 48 hours (with or without other symptoms such as nausea, vomiting and diarrhoea, headache, back pain, chills, muscle pain) with positive laboratory test for malaria parasites (blood film, thick or thin smear, or rapid diagnostic test).

· In children:

· Uncomplicated malaria: Fever and no general danger signs such as lethargy or unconsciousness, convulsions, or inability to eat or drink. Where possible, confirm malaria with laboratory test.

· Severe malaria: Fever and general danger signs (lethargy or unconsciousness, convulsions, or inability to eat or drink).

Measles

· Fever and maculopapular rash (i.e. non-vesicular) with cough, coryza (i.e. runny nose), or conjunctivitis (i.e. red eyes).

· Any person in whom a clinician suspects measles infection.

· To confirm a case of measles: Presence of measles-specific IgM antibodies.

Meningitis

· Suspected case:

· sudden onset of fever (>38.5 °C) with stiff neck.

· in patients aged < 12 months, fever accompanied by a bulging fontanelle.

· Probable case of bacterial meningitis:

· suspected case of acute meningitis, as defined above, with turbid cerebrospinal fluid.

· Probable case of meningococcal meningitis:

· suspected case of meningitis, as defined above and one or more of the following:

· ongoing epidemic of meningococcal meningitis

· Gram stain showing Gram-negative diplococci, or

· petechial or purpural rash.

· Confirmed case of meningococcal meningitis: suspected or probable case, as defined above, with either positive CSF antigen detection for Neisseria meningitidis or positive CSF culture or blood with identification of N. meningitidis.

Tetanus

· Adult tetanus: Either of the following signs 3–21 days following an injury or wound: trismus of the facial muscles or risus sardonicus (characteristic abnormal grin) or painful muscular contractions.

· Neonatal tetanus: Any neonate with normal ability to suck and cry during the first 2 days of life who, between day 3 and day 28, cannot suck normally, or any neonate who becomes stiff or has spasms or both.

Unexplained Fever

Fever (body temperature >38.5 °C) for >48 hours and without other known aetiology.

Unexplained cluster of health events

An aggregation of cases with similar symptoms and signs of unknown cause that are closely grouped in time and place.

Annex 1: References and Citations

Microsoft Word has a built-in function which keeps track of references and citations which is useful. Note that for the short from PHSA, in-text citations are not a requirement, but for the long form should be used. In Microsoft 2016, it is found under the “References” tab, “Citations & Bibliography”. The “Numerical Reference” (ISO690) is the easiest Style of citation to use. When a source is added, click on “Manage Sources”, “New” and then fill in the corresponding information. Then, add the citation in the relevant section by clicking on “Insert Citation”, and choose the relevant citation.

Annex 2: Crisis Typology Icons Legend

Population displacement

Cold wave

Population return

Food Security

Cyclone

Landslide/mudslide

Drought

Snow avalanche

Nutrition

Earthquake

Snowfall

Epidemic

Storm

Fire

Storm surge

Flash flood

Technological disaster

Flood

Tornado

Heatwave

Tsunami

Heavy rain

Violent wind

Conflict

Volcano

Annex 3: Additional guidance for the analysis of disease threats

(
Risk

factor
Effects
Impact of

risk
Timing (once risk

factor

is

occurring)
Specific

mechanism

(s)
Increasing

acute

malnutrition
+++
I
mm
e
d
i
a
t
e
Poor maternal nutrition leading to low birth

weight,

obstetric

and

neonatal

complications.
Worsening

feeding and care

practices
+++
I
mm
e
d
i
a
t
e
Reduced breastfeeding (due to stress and

mental health problems, lack of privacy,

increased

workload,

inappropriate

donations

of

breast

milk

substitutes)

leading

to

increased

risk
of

neonatal

and

infant

mortality.
Worsening
mental

health
+
A few

weeks
Obstetric

complications.
I
n
c
r
e
a
se
d

r
i
s
k

of

n
e
ona
t
a
l

a
n
d

i
n
f
a
n
t

m
or
t
a
l
i
t
y
due

to

compromised

care.
Overcrowding
+
I
mm
e
d
i
a
t
e
I
n
c
r
e
a
se
d

tr
a
n
s
m
i
s
s
i
on

of

n
e
ona
t
a
l

i
n
f
e
c
t
i
o
n
s.
Inadequate

shelter
+
A few

weeks
I
n
c
r
e
a
se
d

r
i
s
k

of

m
a
la
r
i
a

d
u
r
i
n
g

p
r
e
g
n
a
n
c
y,
resulting

in

worse

birth

outcomes.
I
n
c
r
e
a
se
d

s
e
v
e
r
i
t
y

of

n
e
on
a
t
a
l

p
n
e
u
m
on
i
a
.
I
n
c
r
e
a
se
d

r
i
s
k

of

n
e
ona
t
a
l

de
h
y
d
r
a
t
i
on

or
hypothermia.
Inadequate

WASH

services
++
I
mm
e
d
i
a
t
e
I
n
c
r
e
a
se
d

r
i
s
k

of

p
e
r
i

n
a
t
a
l

a
n
d

n
e
ona
t
a
l
infections (especially when exclusive

breastfeeding

prevalence

is

low).
Poor

menstrual

hygiene.
Increased

SGBV

frequency
++
I
mm
e
d
i
a
t
e
I
n
c
r
e
a
se
d

un
w
a
n
t
ed

p
r
e
g
n
a
n
c
i
e
s

an
d

u
n
sa
f
e
abortions.
Disability

due

to

SGBV

physical

trauma.
Reduced

access

to

health

services
+++
I
mm
e
d
i
a
t
e
Untreated

obstetric

and

neonatal

complications.
Missed antenatal preventive care.

I
n
c
r
e
a
se
d

un
sa
f
e

abo
r
t
i
ons,

la
c
k

of

pos
t

abortion

care.
Untreated

sexually

transmitted

infections.
)Table 1.

Typic al

effect s of the main crisis- emer gent risk factor

s on

repro

ductiv e, mater nal and neon atal health

outco mes.

Table 2. Main risk factors causing increases in the severity of infectious diseases, and their timing.

Risk factor

Risk impact and timing

Airborne-droplet transmitted diseases

Faecal-oral transmitted diseases

Vector-borne diseases

Increasing acute malnutrition

+++
Immediate

+++
Immediate

++
Immediate

Disrupted curative services

+++
Immediate

+++
Immediate

+++
Immediate

High HIV burden with extensive HIV treatment interruptions

++
3-6mo

++
3-6mo

+
3-6mo

Inadequate shelter (exposure to cold)

++
Immediate

Inhalation of indoor smoke (inappropriate cooking or heating fuels)

+
Immediate

Smoke inhalation from volcanic eruption

+
Immediate

NCD treatment interruptions

+
3-6mo

Table 3. Main crisis-emergent risk factors causing an increase in transmission of infectious diseases, and their timing.

Infections disease (epidemic prone)

Risk factors: Impact and timing of risk

Increasing

acute malnutrition

Overcrowdin g

Insufficient vaccination coverage

Poor WASH conditions

Airborne-droplet transmission

Pneumococcal disease

+++
Immediate

+++
Immediate

+++
Immediate if already present in country.

+
Immediate

Hib disease

++
Immediate

++
Immediate

+
Immediate

Other bacterial respiratory
pathogens

+++
Immediate

+++
Immediate

++
Immediate

Measles

+++
Immediate

+++
Immediate

+++
Immediate if already present in country.

++
Immediate

Pertussis

++
Immediate

+++
Immediate

+
Immediate

Meningococcal meningitis

+++
Immediate

+++
Immediate if already present in country.

Influenza

?

+++
Seasonal

?

Faecal-oral transmission

Cholera

++
Immediate

+++
Immediate

+++

+++
Immediate

Shigellosis4

+++
Immediate

+++
Immediate

+++
Immediate

Typhoid fever

+++
Immediate

++
Immediate

+++
Immediate

Rotavirus

++
Immediate

++
Immediate

+++
Immediate if already present in country.

Polio

+++
Immediate

+++
Immediate

E. coli, other common enteric
pathogens

+++
Immediate

+++
Immediate

+++
Immediate

Hepatitis A and E

?

+++
Immediate

Helminths, schistosomiasis

++
Immediate

++
Immediate

+++
Immediate

Vector-borne transmission

Malaria

++
Immediate

+
(2mo)

Other mosquito- borne diseases

?

++
Immediate if already present in country.

++
(2mo)

Annex 4: Scoring the magnitude of health threats /needs
Note that this is applicable to both the short and long-form PHSA.

Answers to questions in the Crisis-emergent Health Status and Threats section should be scored in terms of the extent to which the health problem or group of diseases could result in health impacts, i.e. the magnitude of crisis-attributable excess mortality and/or excess mental health problems.

Such a scoring is essential to establish health sector priorities, but is objectively difficult to do, as it requires putting together information from all sections of the Key Questions, and considering various causal pathways and interactions among risk factors and even disease groups.

In order to undertake the scoring, the following parameters should be considered together:

4 All else being equal, transmission risk is highest during the dry season.

The baseline burden of disease (think of how many DALYs lost this disease or group of diseases was responsible for before the crisis). The baseline disease burden is however irrelevant for crisis- emergent health problems, including trauma injuries or combatant – perpetrated SGBV. It is also relatively unimportant for epidemic-prone diseases.

The extent to which crisis-emergent risk factors could increase this burden of disease. To what extent could different risk factors occur? What is their risk impact, i.e. relevance to this particular disease or group of diseases (see e.g. Annex 3)? Note that the combination of different risk factors has a multiplicative effect;

What is known or can be assumed now about access to curative and preventive health services relevant to this disease or group of diseases;

What further disruptions to the health system could occur, and the effect they would have on this disease or group of diseases, in addition to the above.

Table
1 provides guidance on how to attribute scores.

Table 1. Guidance for scoring the magnitude of health threat or need for different groups of health problems.

Magnitude of threat /
need

Meaning

Notes

High

Could result in high levels of excess
mortality and/or mental health problems.

Could be one of the top driv ers of worsened
health status, and single-handedly result in a substantial increase in all-cause mortality, or substantial worsening of mental health and functioning.
Think of a very severe epidemic; a large
proportion of cases of life-threatening disease going without treatment; huge increases in infectious disease burden due to combinations of important risk factors (ov ercrowding,

Intermediate

Could result in considerable levels
of excess mortality and/or mental

Could single-handedly result in a moderate
increase in all-cause mortality, or moderate

Low

Could make a minor contribution
to excess mortality and/or mental health problems.

Small but non-negligible increase.

None

Will very probably not result in any
excess mortality or mental health problems.

Whatever the baseline, no crisis-emergent
risk factors could occur that the pre-crisis health system wouldn’t be able to cope with.
Alternatively, the number of trauma injuries

Unclear

No plausible assessment can be made at this time.

Either the baseline is unknown, or it is
impossible to say at this stage how the crisis could affect it, if at all.
Alternatively, it is impossible to knowwhether

Four important points to remember while scoring are:

The magnitude of threat / need is time-dependent. It may increase as new crisis risk factors emerge, or vice versa. This should be reflected, particularly in the long-form PHSA (i.e. different magnitudes of threat should be reported, corresponding to different times).

For the vast majority of questions, one should be able to at least make a plausible assumption about what could happen as a result of the crisis. Only a few questions should be scored as ‘Unclear’.

One should resist the temptation to score every question as ‘High’, unless this is truly warranted. Remember that scoring all or most questions as ‘High’ would imply catastrophic levels of excess mortality: is this really a plausible development? Differentiating between different magnitudes of threat

/ need, on the other hand, helps to identify relative priorities for the humanitarian health response.

One should provide a score without thinking about the mitigating impact of the humanitarian health response. At this stage, one analysing needs for the health sector and pointing out what could happen in the absence of an adequate response.

Annex 5: Table 1a and 1b: Expected evolution of crisis emergent health threats over time
Note that this is only applicable to the long-form PHSA

Below is an example of the expanded Tables 1a and 1b of the long-form PHSA. It builds on the short-form PHSA by providing a longer time horizon. Where there are predicted changes in risk, the box should be used to indicate the justification for the prediction.

Timing is primarily based either on predictable seasonality (such as rainy season and malaria, or lean season and malnutrition) or on predictable evolution from onset. An example of the latter would be trauma injuries after a sudden-onset natural disaster: the timing of need would be immediate, and indeed would dramatically decrease after one week, since the window for treatment (though not

rehabilitation) is very short for most life-threatening injuries. Another example would be for NCDs, TB and HIV, where initial impact may be low, but may increase over time as the morbidity associated with disruption of treatment increases (as does the transmission of TB and HIV as a consequence of treatment disruption). Occasionally, timing may be based on some known upcoming event, e.g., the risk of violence associated with an upcoming election.

If no plausible prediction can be made about the course of a given threat (e.g., an outbreak with a rare pathogen), it is better to leave it grey than make unfounded predictions.

To understand the key health threats, it is important to understand the pre-crisis burden of disease for the main groups of disease, expressed as Disability Adjusted Life Years (DALYs) lost. These can be found

here.

Table 3a. Magnitude1 of expected somatic health threats and their expected evolution over time 2.

Health problem

Month(s), starting now

1 2

3-6

6-12

Worse WASH situation

Dry season may exacerbate WASH situation where lack of fresh water for
drinking/washing

Rainy season may exacerbate WASH situation where flooding occurs

Worse sexual and
reproductive health outcomes

No major changes expected

Worse malnutrition and child health

Low crop yields threaten already
bad nutritional situation

Lean season from May to August

Most SAM cases last year in
September- November

Increased burden
of endemic infectious diseases

Malaria is the chief
threat

Rainy season to
exacerbate malaria

Risk of epidemics

Meningitis is biggest threat; others measles, cholera, yellow
fever, hepatitis E

Cholera in rainy season

Increased HIV and TB burden

Interruption in treatment may
cause increased transmission

Increased NCD
burden

Interruption in
treatment may cause increased
morbidity

Trauma

Violent trauma
likely to continue

Modest decrease
in violence during rainy season

1 Red: Could result in high levels of excess mortality/morbidity. Orange: Could result in considerable levels of excess mortality/morbidity. Yellow: Could make a minor contribution to excess mortality/morbidity. Green: Will very probably not result in any excess mortality/morbidity. Grey: No plausible assessment can be made at this time.

2Changes in risk over time shows the expected progression after an acute onset emergency, or predicable seasonality of morbidity.

For each of the above domains, it is useful to include a brief narrative about the health and WASH problem prior to the crisis, in order to provide context and aid in operational engagement with the existing system. Questions to address are included below under “pre-crisis” (note: not all answers may fit

neatly within the stated category). Use the questions below to guide your narrative; they need not all be answered explicitly.

The narratives below should be consistent with, and expand upon, the table above. WASH situation

Pre-crisis

· What is the WASH situation at present?

Crisis-emergent

· To what extent could the rainy season (e.g. flooding), or the dry season (e.g. lack of fresh water) lead to a worsening WASH situation?

· To what extent could other crisis risk factors lead to a worsening WASH situation, and when?

Sexual and reproductive health outcomes

Pre-crisis

· What was the crude birth rate?

· What was the maternal mortality ratio?

· What was the prevalence of contraceptive use?

Crisis-emergent

· To what extent could crisis risk factors worsen reproductive, maternal and neonatal health outcomes, and when?

For a proper understanding of sexual and reproductive health needs, in-depth


assessment

is recommended to refine initial needs analysis.

Malnutrition and child health

Pre-crisis

· What was the prevalence of acute malnutrition (severe, moderate and global) among children 6-50 months old?

· What was the proportion of women aged 15-49 years with low body mass index (<18.5kg/m2)?

· What was the proportion of children exclusively breastfeed until 6mo of age?

· What was the under 5y (child) mortality ratio?

Crisis-emergent

· To what extent could any worsening food insecurity have an effect on nutritional status, and when?

· To what extent could worsening feeding and care practices have an effect on nutritional status, and when?

· To what extent could nutritional status deteriorate in different age groups (infants, other children, pregnant and lactating women, people living with HIV, general population) and when?

Burden of endemic infectious diseases

Pre-crisis

· What were the top three infectious cause of outpatient consultation, in order of proportional morbidity?

Crisis-emergent

· To what extent could crisis risk factors increase the burden of the main endemic infectious diseases?

Risk of epidemics

Pre-crisis

· What, if any, confirmed epidemics have occurred in the affected area (in the case of displaced people, both the area of origin and the host community) over the last 10 years?

· What was the severity of any epidemics (total known cases and deaths)?

Crisis-emergent

· Which epidemic-prone diseases could cause outbreaks, with what attack rate, severity, and when? Are any happening now?

· Which local infectious disease eradication/elimination programmes could be at risk of setbacks, and when?

HIV and TB burden

Pre-crisis

· What was the HIV prevalence in the general population, and how many people were in need of antiretroviral treatment?

· What was the annual incidence of active TB (total number and rate)?

Crisis-emergent

· How many people’s HIV/TB treatment has been or may soon be interrupted, and when could their health outcomes start to deteriorate?

NCD burden

Pre-crisis

· What were the most important groups of NCDs?

· What was the prevalence of diabetes?

· What was the prevalence of hypertension?

Crisis-emergent

· How many people’s type 1 (insulin-dependent) and type 2 diabetes treatment has been or may soon be interrupted, and when could their health outcomes start to deteriorate?

· How many people’s hypertension treatment has been or may soon be interrupted, and when could their health outcomes start to deteriorate?

· To what extent could other crisis risk factors increase NCD burden, and when?

Trauma

Pre-crisis

· What is known about the incidence of SGBV, including during any crises that may have occurred in the same population previously?

Crisis-emergent

· How many people are known or projected to have sustained life-threatening trauma injuries, and could substantial numbers of trauma injuries continue to occur over the foreseeable future?

· What is the observed or expected typology o trauma injuries?

· Is there evidence of combatants perpetrating SGBV on the affected population?

· To what extent could other crisis risk factors increase SGBV frequency, and when?

Table 4b. Magnitude1 of expected mental health and psychosocial support threats and their expected evolution over time.

Month(s), starting now

1

2

3-6

6-12

Mental Health and psychosocial support problem

Worse mental health problems

Post-traumatic stress, untreated chronic mental health disorders

Worse psychosocial

support problems

1Red: Could result in high levels of excess mental health/psychosocial support problems. Orange: Could result in considerable levels of excess mental health/psychosocial support problems. Yellow: Could make a minor contribution to excess mental health/psychosocial support problems. Green: Will very probably not result in any excess mental health/psychosocial support problems. Grey: No plausible assessment can be made at this time.

The narratives below should be consistent with, and expand upon, the table above. Mental health problems

Pre-crisis

· If possible, include a discussion of the essential concerns, beliefs, and cultural issues that aid providers should be aware of when providing psychosocial support.

Crisis-emergent

· To what extent could the prevalence and severity of mental health problems increase and when?

· To what extend could substance addictions become more frequent, and when?

· What is known about the safety and ongoing care of patients in mental health care institutions?

Psychosocial support problems

Pre-crisis

· If possible, include a discussion of the essential concerns, beliefs, and cultural issues that aid providers should be aware of when providing psychosocial support.
Crisis-emergent

· To what extent could other crisis risk factors increase the frequency of psychosocial support problems, and when?

Understanding of mental health and psychosocial support threats requires in-depth

assessment,

typically conducted by the IASC

Mental Health and Psychosocial Support Working Group,

an inter-cluster entity set up in many crises, to which the Health Cluster should refer.

Annex 6: Table 2 of the long form PHSA: Scoring the magnitude of disruption to key health system components

Note that this section is only applicable to the long-form PHSA.

Answers to questions in the Crisis-emergent Health Resources and Availability and Health System Performance sections should be scored in terms of the extent to which the health system component or parameter the question relates to (parameter, e.g. quality of health services, or health system component, e.g. the existing epidemic

alert and response

system) is known or may be assumed to undergo crisis-attributable disruptions. Alternatively, the extent to w h i c h people are without feasible access to certain health services, or to which health system performance may be declining, should be scored. Table 4 provides guidance for this scoring.

Table 2. Guidance for scoring the extent of disruption or lack of access to a given health system feature or service.

No plausible assessment can be made at this time.

Extent of disruption

Meaning

High

The majority of the health system feature / health service has been or

could be

rendered non-functional.

Most people / patients do not have access to healthcare.

A major reduction in health service coverage or quality could occur.

Intermediate

A substantial minority of the health system feature / health service has been or

could be rendered non-functional.

A substantial minority of people / patients do not have access to healthcare. A moderate reduction in health service coverage or quality could occur.

Low

A small minority of the health system feature / health service has been or could be

rendered non-functional.

A small minority of people / patients do not have access tohealthcare. A small reduction in health service coverage or quality could occur.

None

The vast majority or entirety of the health system feature / service is very probably

still as functional as before thecrisis.

No risk factors for reduction in health service coverage or quality have been identified.

Unclear

It is important, while scoring, to remember that:

1. For the vast majority of questions, one should be able to at least make a plausible assumption about what could happen as a result of the crisis. Only a few questions should be scored as ‘Unclear’.

2. All scores should express the effect of the crisis, not the baseline situation, however challenging the latter may have been. In other words, a health system feature (e.g. pharmaceutical supply) that is weak at baseline should not automatically be scored ‘High’, unless the crisis has severely disrupted it.

3. One should provide a score without thinking about the mitigating impact of the humanitarian health response. At this stage, one analysing needs for the health sector and pointing out what could happen in the absence of ( or scaling back of, in the case of a PHSA undertaken mid- crisis) an adequate response.

Annex 7: Table 2 of the long form PHSA: Expected evolution of disruptions to key health system components over time

Note that this section is only applicable to the long-form PHSA.

Below is an example of the expanded Table 4 of the long-form PHSA. It builds on the short-form PHSA by providing a longer time horizon. Where there are predicted changes in disruptions, the box should be used to indicate the justification for the prediction. Timing of changes in disruption is more difficult to predict than timing of changes to disease threats, however there are situations where prediction can be made. For example, certain health system components are predictably less functional during rainy seasons when roads become impassable. Another example is that financing shortfalls can sometimes be predicted several months in advance (in the absence of mitigating measures).

Table 2. Overview of disruptions to key health system components.

Disruption

Month(s), starting now

1

2

3-6

6-12

Disrupted management

Inadequate referral services in remote areas

Reduction in financing

CERF expires

Inability of non- state providers to maintain services

Many existing facilities destroyed (see below)

Lack of funding may cause NGOs
to shut down services

Disruption to supply
chain (including pharmaceuticals)

Supply chain

coordinated by Central Medical Store, functioning but still gaps

Arrival of rainy
season will hamper transport of supplies

Return to dry
season

Degraded alert and response

Security challenges prevent complete coverage of surveillance and response

Rainy season will make it more difficult to receive surveillance data and mount responses to
outbreaks

Return to dry season

Migration of human resources for health

Some health staff reluctant to work in conflict areas

Damage to health facilities

50% of health facilities are destroyed

Fewer attacks typically occur during rainy season

Attacks rise again during dry season

Attacks against
health

There have been
50 reports of attacks against health workers

Fewer attacks
typically occur during rainy season

Attacks rise again
during dry season

Access to
healthcare

Access may be
harder during the rainy season

1Red: The majority of the health system feature / health service has been or could be rendered non-functional. Most people / patients do not have access to healthcare. A major reduction in health service coverage or quality could occur. Orange: A substantial minority of the health system feature / health service has been or could be rendered non-functional. A substantial minority of people / patients do not have access to healthcare. A moderate reduction in health service coverage or quality could occur. Yellow: A small minority of the health system feature / health service has been or could be rendered non-functional. A small minority of people / patients do not have access to

healthcare. A small reduction in health service coverage or quality could occur. Green: The vast majority or entirety of the health system feature / health service is very probably still as functional as before the crisis. No risk factors for reduction in health service coverage or quality have been identified. Grey: No plausible assessment can be made at this time.

For each of the above domains, it is useful to include a brief narrative about the health system status prior to the crisis, in order to provide context and aid in operational engagement with the existing system. Questions to address are included below under “pre-crisis” (note: not all answers may fit neatly within the stated category). Use the questions below to guide your narrative; they need not all be answered explicitly.

Once initial needs are established, in-depth


analysis

of the disrupted health system is recommended, especially in the context of early recovery planning.

The narratives below should be consistent with, and expand upon, the table above. Management structure

Pre-crisis

· Who is in charge of the health system at different hierarchical levels?

· How decentralised are health policy and resource allocation?

· What health services are meant to be provided at community level/secondary/tertiary levels?

Crisis-emergent

· Are health authorities still in place and/or able to take, transmit and execute decisions?

Financing

Pre-crisis

· What is the usual financing model (e.g., are some services free? Where do facilities receive their funding?)?

Crisis-emergent

· To what extent could financial resources for health services, at any level, be reduced, and when?

· To what extent could people’s ability to afford either the direct (user fees, drug costs) or indirect (e.g. travel, sustenance of patients) costs of healthcare be curtailed, and when?

Role of non-state providers

Pre-crisis

· What proportion of health facilities is public versus private? What proportion relies on non-state actor support (which actors?)?

Crisis-emergent

· To what extent do existing non-state providers, if any, seem able to maintain service provision?

Supply chain

Pre-crisis

· How are pharmaceuticals/medical supplies procured, stored and supplied to public health facilities? Is there a national medical store?

· How dependent is the health system on locally produced pharmaceuticals? Are there issues with pharmaceutical quality?

Crisis-emergent

· What disruptions to the medical supply chain are occurring or likely to occur, and when?

Alert and response

Pre-crisis

· What is the name of any epidemic surveillance system, and what was its actual functionality in the affected area?

· How prompt and effective was the health system’s response to past epidemics?

Crisis-emergent

· To what extent has the health system’s epidemic surveillance, alert and response capability been compromised?

Human resources for health

Pre-crisis

· How many doctors/nurses/etc., including specialists, were working in the affected area? (inc. ratios of staff to population)

Crisis-emergent

· To what extent is or could displacement / migration of human resources for health away from the affected population occur?

Functionality of health services

Pre-crisis

· How many health facilities, by level (primary, EmOC [basic or comprehensive emergency obstetric care], secondary, tertiary) were functional in the affected area, and where were they?

· Were there existing areas without access to functioning facilities?

Crisis-emergent

· How many health facilities, where, and at which level (primary, EmOC, secondary, tertiary) are known or projected to have been damaged as a result of the crisis?

· How many people are known or projected to be without realistic access to functional health services (primary, secondary, tertiary, EmOC, mental health, etc., as available)

Resilience of the health system to damage

Pre-crisis

· In the event of mass casualty events, what specialised trauma surgery and rehabilitation facilities can injury cases realistically access? What is their approximate capacity?

· What evidence, if any, is there of emergency preparedness and resilience in the health system (e.g. emergency supply stocks; contingency plans; safe hospitals)?

Crisis-emergent

· To what extent have any components of health services (staff, infrastructure, assets, or patients themselves) been attacked or looted, and what is the pattern of attacks to date?

Access to healthcare

Pre-crisis

· What is the current situation in relation to healthcare access?

Crisis-emergent

· To what extent could crisis-emergent factors affect access to healthcare?

Humanitarian health system performance

Humanitarian health system performance is omitted from the short-form PHSA because no information in this domain is typically available at the onset of a new crisis. It is typically also not available within the first 14 days of a crisis, but it is included in the long-form PHSA because it may be added as information becomes available, and it is a crucial component of accountability of the humanitarian response.

Utilization of services

Pre-crisis

Describe the existing and crisis-emergent utilisation of preventive and curative health services, including:

· outpatient utilisation rate (consultations per person per year)

· Number of procedures (c-sections, births attended by skilled attendants, trauma surgeries) performed

Crisis-emergent

· To what extent could crisis risk factors reduce utilisation of preventive and curative services, and when

Quality of humanitarian health services

· What has been the coverage of humanitarian vaccination campaigns?

· Case fatality rates from known conditions compared with benchmarks (e.g., <1% for cholera, <10% for complicated SAM)

· Anything else known about quality of health service delivery, and competency of human resources for health

Crisis-emergent

· To what extent could crisis risk factors reduce the quality of health services, and when?

Annex 8: Appropriate methods for the collection of primary data

Table 6. Appropriate methods for collection of statistics and data, by type of information. From Checchi et al., Lancet

Conflict analysis
(tracking of media and other informant reports)

Type of information

Prospective surveillance

Population sample survey

Analysis of programme data

Other methods

Affected population size and composition

Community-based

demographic surveillance

Residential structure

tally plus structure occupancy estimation

Vaccination or

nutritional screening data combined w ith expected age structure

Area estimation plus

population density estimation

Various qualitative or convenience methods

Exposure to armed

attacks

Facility-based

surveillance of injuries and attacks against health

Retrospective

survey

of individual exposure to injury

Conflict analysis

(tracking of media and other informant reports)

Sexual and gender based violence

Facility-based

surveillance of SGBV cases

Retrospective survey

of individual exposure to SGBV

Food security and

feeding practices

Household

livelihoods, resilience and coping, food access, food consumption and feeding practices survey

Agricultural production

monitoring

M arket analysis Household focus groups

Desk-based food security

risk assessment

Nutritional status

Repeated

anthropometric sampling from sentinel communities

Anthropometric

survey

Trend analysis from

community- or facility- based anthropometric screening, and

CM AM admissions

Desk-based nutritional

risk assessment

Physical health

Early Warning Alert

and Response Netw ork system

(EWARS) for epidemic

alert and response

Survey to measure

point prevalence of chronic diseases or retrospective incidence of acute disease syndromes

Analysis of facility-

based morbidity and mortality data

Desk-based disease risk

assessment and situation analysis Tracing and tracking of people in need of treatment continuation

Mental health

Collecting data

covering serious mental health symptoms as part of general facility-based health surveillance.

Adding questions

covering serious mental health symptoms to general health surveys

Analysis of HM IS

morbidity data

Literature (desk) review

Services mapping Participatory assessment

Service availability and functionality

HeRAM S (w ith

updated geographical database of facilities)

Who What Where

When (4W)

Service coverage

Coverage survey

(vaccination, health services, nutritional programme, etc.)

Comparison of actual

programme outputs vs. target beneficiaries

Focus groups, other

qualitative methods for exploring service utilisation and barriers

Service effectiveness

Analysis of HM IS data

(e.g. on curerates)

Facility audits and spot

checks, patient exit interviews

Population mortality

Community-based
demographic surveillance

Passive “body count” surveillance

Retrospective

mortality survey (verbal autopsies as add-on to explore causes of death)

Census (post-w ar)and

demographic modelling

Capture-recapture analysis

Indirect (model-based) estimation

8/29/2018

Public

Health

Information
Services
Public Health Situation Analysis

Standard Operating Procedures

Anonymous
WORLD HEALTH ORGANIZATION

1

Table of

Contents

Public Health Situation Analysis Standard Operating Procedures ……………………………………………………………….. 2

Background ………………………………………………………………………………………………………………………………………………. 2

Timing of initial and repeat PHSAs ……………………………………………………………………………………………………………. 2

Geographic scope of PHSA ……………………………………………………………………………………………………………………… 3

Relationship of PHSA to other risk assessments …………………………………………………………………………………………. 3

Use of PHSA in WHO grading and re-grading ………………………………………………………………………………………….. 4

Distribution of PHSA …………………………………………………………………………………………………………………………………… 4

Presenting imprecise or conflicting data …………………………………………………………………………………………………. 5

Finding source data ………………………………………………………………………………………………………………………………….. 5

Guidance on filling the templates ……………………………………………………………………………………………………………….. 6

Short-form PHSA ……………………………………………………………………………………………………………………………………………. 6

Long-form PHSA …………………………………………………………………………………………………………………………………………. 14

Annex 1: References and Citations …………………………………………………………………………………………………………… 26

Annex 2: Crisis typology icons legend ………………………………………………………………………………………………………. 26

Annex 3: Additional guidance for the analysis of disease threats ……………………………………………………………. 27

Annex 4: Scoring the magnitude of health threats/needs ………………………………………………………………………… 29

Annex 5: Expected evolution of crisis-emergent health threats over time ………………………………………………. 31

Annex 6: Scoring the magnitude of disruption to key health system components ………………………………….. 35

Annex 7: Expected evolution of disruptions to key health system components over time ……………………… 35

Annex 8: Appropriate methods for the collection of primary data…………………………………………………………… 40

2

Public Health Situation Analysis (PHSA)

Standard Operating Procedures

Background
Humanitarian needs assessments are carried out to determine the immediate needs of a population

following an emergency or humanitarian crisis, serving as a basis for operational response. The purpos

e

of the Public Health Situation Analysis (PHSA) specifically is to identify the current health status

and

potential health threats that the population may face, the functioning of the health system, and

the

humanitarian health response. It is a review of the latest available secondary data1.

The PHSA aims to provide all health sector partners, including local and national authorities,

nongovernmental organizations (NGOs), donor agencies and United Nations agencies with a

common

and comprehensive understanding of the public health situation in a crisis in order to inform evidence-

based collective humanitarian health response planning. The PHSA may also be used to feed other

sectoral and intersectoral products, such as providing the health input to the Humanitarian Needs

Overview, and is also used in support of the WHO (re-)grading process.

The PHSA is conducted in response to a sudden-onset2 Emergency, defined by the WHO Emergency

Response Framework (ERF) as “a situation impacting the lives and well-being of a large number of

people or significant percentage of a population requiring substantial multi-sectoral assistance. For

WHO

to respond, there must be clear health consequences”.

The PHSA updates and replaces the previous Public Health Risk Assessment (PHRA) prepared by WHO.

Like the PHRA, the PHSA includes a risk assessment of the major threats faced by a population;

additionally, the PHSA expands on the PHRA by including the elements of humanitarian

response

capacity. The PHSA does not include recommendations about priority interventions, as the PHSA is

meant to serve as a springboard for on-the-ground response joint response planning amongst all

health

cluster/sector partners, informed by local capacities/resources/limitations/political considerations.

There are two versions of the PHSA: a short-form or “initial” PHSA, and a long-form or “full” PHSA. This SOP

covers both.

Timing of initial and repeat PHSAs
The initial short-form PHSA should be completed within 24-72 hours of the onset of an acute emergency,

or as soon thereafter as practicable. If it is delayed beyond this, it ceases to serve its function as a

platform for joint planning, as planning will, out of necessity, take place after this time even in the

absence of an evidence base. Thus, the initial PHSA does not have to be perfect: an imperfect PHSA is

better than nothing, as long as the limitations are made clear. Release of the initial PHSA should not be

delayed due to incomplete information; instead it should point to areas requiring additional (primary)

data collection.

The full long-form PHSA should be initiated as soon as the short-form PHSA has been released, and should

be completed within 14 days of the onset of an acute emergency, The template is designed to easily

allow expansion of the existing fields of the short-form PHSA, thus it is preferable to do the two forms

sequentially rather than attempting to prepare both documents in parallel.

In protracted crises where a PHSA has never been done (either because the decision to undertake a

PHSA is driven by a sudden escalation of the existing crisis, or simply because there is an outstandin

g

1 It may be complemented by primary data once available
2 Or sudden deterioration in a protracted crisis

3

need to prepare a PHSA), the initiators of the PHSA may consider preparing an initial short-form PHSA, or

they may wish to proceed directly to the full long-form PHSA.

Countries that are not currently in crisis, but are vulnerable, or anticipate a specific crisis (e.g. a looming

humanitarian crisis due to escalating violence), may wish to prepare a PHSA in advance. In this cas

e,

one should fill out as much of the long-form PHSA template as possible, recognizing that many sections

will not apply because there is no specific crisis and there are no crisis-attributable issues. For example,

the sections on Health Status and Threats can be completed, without commenting on crisis-emer

gent

threats, or completing the risk tables. One can also complete the pre-crisis baseline information about

health system needs. N.B. – although one cannot complete the section on humanitarian health

response, it can be helpful to catalogue the existing development partners in the field, many of whom

are likely to be involved in any eventual humanitarian response.

Geographic scope of PHSA
In multi-country crises, a separate PHSA should be conducted for each affected country, as each

country will have a unique response architecture and may have variations in health risks. Reference

should be made to the overall multi-national response architecture, if present.

Where crises are confined to a well-demarcated sub-national portion of a country3, the PHSA should

clearly indicate in title and content that the analysis covers only that sub-national area. If and

when

data are included that are not disaggregated sub-nationally (i.e., only national data are available,

for

example about the prevalence of a given disease), this limitation should be clearly noted.

Some countries will display considerable heterogeneity within a large crisis, in terms of both health

threats and response. Where sufficient information exists to create sub-national analyses, such analyses

are encouraged. Suggested options for providing sub-national information include: narrative

commentary within the text of a single national PHSA; separate risk tables for different sub-nation

al

regions; or separate sub-national PHSAs. In the case of the latter, there should first be a single natio

nal

PHSA to inform high-level planning.

Relationship of PHSA to other Risk Assessments
There is often confusion about the relationship of PHSA to the Rapid Risk Assessment (RRA) and the

Strategic Tool for Assessing Risk (STAR). The relationships are clarified here.

The Rapid Risk Assessment (RRA) is undertaken by the Detection, Verification and Assessment (DVA)

team of the Health Emergency Information and Risk Assessment (HIM) department of the WHO

Emergencies Programme (WHE). It is undertaken in response to an acute public health Event, defined by

the ERF to be “any event that may have negative consequences for human health. The term includes

events that have not yet lead to disease in humans but have the potential to cause human

disease

through exposure to infected or contaminated food, water, animals, manufactured products or

environments.” A PHSA is not appropriate in the setting of an individual public health event (e.g. a

localized cholera outbreak), as a PHSA is a comprehensive assessment of all of the public health issues

and the response landscape in a given context, and is most applicable to settings with activated health

coordination mechanisms (e.g., Health Clusters); in most cases it does not make sense to speak about

the other public health issues (e.g., what is the mental health situation in relation to the localized cholera

outbreak) or response landscape (e.g., what has been the effect of attacks on healthcare in relation to

the localized cholera outbreak). In such situations where an acute public health event takes on a larger

humanitarian dimension (e.g., the West Africa Ebola outbreak causing massive health system and

societal disruption), a PHSA may be warranted.

3
A recent example would be the humanitarian crisis in northeast Nigeria, which was confined to the states of Borno, Yobe

and Adamawa.

4

The Strategic Tool for Assessing Risk (STAR), led by the WHE’s Country Preparedness and IHR (CPI)

department, is undertaken in countries that are vulnerable to (or in some cases already experiencing)

emergencies. It provides a systematic, transparent and evidence-based approach to identify and

classify priority risks, in order to inform preparedness activities. The method involves bringing together

relevant experts from multiple sectors (e.g., human health, agriculture, animal health) to assess a range

of possible risks, through a Delphi-like methodology. The final output is a spreadsheet that ranks the risks

and specifies the types of preparedness activities to be undertaken for each risk. The STAR differs from

the PHSA in that the final matrix provides no evidence / data on the magnitude of the listed

threats

(even if such data were implicit in the risk ranking). If a STAR is undertaken prior to a PHSA, it can serve as

an excellent basis for defining which public health threats are significant to include in the PHSA section

on Threats; if a STAR matrix is already available, it is recommended to be included as an annex in the

long-form PHSA. Alternatively, if a STAR is undertaken after a PHSA, the PHSA can provide the evidence

base for informing the STAR’s risk prioritization. Thus, the tools are complementary.

Use of PHSA in WHO Grading and Re-Grading
Generally it is expected that the PHSA will be done after initial grading of a new emergency; further, it is

most applicable to the setting of an activated coordination mechanism (e.g., Health Cluster), which is

unlikely to be present at the very onset of a new emergency. Thus, the PHSA is rarely helpful in

determining the initial grade. However, the PHSA is very useful at the time of re-grading, in order to

provide the evidence on the scale of a health crisis, which informs the regrading decision.

Distribution of PHSA
While being based primarily on secondary data, a PHSA may nevertheless contain information that is not

in the public domain, and as such may be sensitive, particularly to the corresponding Ministry of Health /

national government. Regardless of initial authorship of the PHSA (WCO, RO or HQ), primary ownership of

the PHSA rests with the relevant WCO. Thus, the extent of distribution of the PHSA should be governed by

the WCO, within the parameters below. It is expected that the WCO will negotiate any sensitivities with

the relevant party/ies prior to public distribution.

All PHSAs will be posted to the WHE Emergencies Dashboard (https://extranet.who.int/emergency-bi/)

for access by authorized WHE personnel according to the permissions associated with the Dashboard

(e.g. senior management, and personnel with direct involvement in the response in a given country);

uploading will be handled by the HIM/MAP team at HQ. Prior to posting, confirmation will be sought, on

a “no objections” basis, from the Health Cluster Coordinator (HCC) (or other named focal point for PHSA

in-country) to ensure a mutually agreed version is uploaded. Senior management may, on an

exceptional basis, share a PHSA with external partners (e.g. other UN agency senior leadership or donor)

on a confidential basis; the in-country focal point will be notified prior to sharing. The focal point should

alert HQ/HIM/MAP whenever there is a substantial update to the PHSA, requiring reposting. A WHO-

Internal version of the PHSA does not require signoff prior to posting.

As the purpose of the PHSA is to provide a common understanding of the health situation amongst

response partners, it is expected that the WCO will distribute the PHSA, at a minimum, within the country

Health Cluster / Sector / other health coordination architecture. This is also an important component of

improving the visibility of WHO as the authoritative source of health information. Prior to sharing, the PHSA

should be approved by the HCC, the WHE Team Leader and the WHO Representative (unless authority

has been delegated).

It should be recognized that sharing within the Health Cluster is tantamount to sharing with the

government, even where the government is not formally a part of the Cluster; thus, relevant sensitivities

should first be addressed by the HCC/focal point or WHO Representative before sharing. In any case, it

https://extranet.who.int/emergency-bi/

5

should be made clear that the PHSA is a working document and is therefore subject to incompleteness

and occasional

errors; it should not be considered a definitive reference document.

Ideally, a PHSA should be shared publicly by the WCO, e.g. on humanitarianresponse.info or the WCO /

country Health Cluster website. In such cases where a small change would allow an otherwise sensitive

PHSA to be shared publicly (e.g. changing “cholera” to “acute watery diarrhoea” or redacting a short

section of the PHSA), this is encouraged. Prior to public sharing, the PHSA should be signed off by the

HCC/focal point and WHE Team Lead, and approved by the WHO Representative. It should be made

clear that the PHSA is a working document and is therefore subject to incompleteness and occasional

errors; it should not be considered a definitive reference document.

Presenting imprecise or conflicting data
It is understood that a needs assessment, at least initially, takes place in a dynamic, information-poor

environment. As such, it is acceptable and indeed preferable to provide rough ranges for percentages,

totals and other statistics, whenever this would be a more honest way of portraying the actual accuracy

of available data, than by reporting a misleadingly precise single figure.

For statistics and data, a minimum to maximum range based on all the available sources should be

provided, as well as a central (most likely) estimate that approximately gives more weight to higher-

quality sources (e.g. “measles vaccination coverage was most probably around 45 -50%, but individual

estimates ranged from 34% to 65%”).

For perceptions and experiences as well as events and other facts, summary statements of the evidence

should be provided, that reflect the degree of agreement among sources, and /or point out major

disagreements (e.g. “sources agree that beneficiaries are most concerned with the inability to access

hospitals”, or “some sources reported drug stock -outs at all major hospitals, though one source denied

this was happening”).

For the purposes of the PHSA, the reader should assume that information presented is credible unless

explicitly stated otherwise (i.e. it is not necessary to state “these data are credible” after each item; only

uncertain information should be flagged).

Finding source data
General repositories of information that are particularly helpful include:

 vSHOC / Sharepoint (for existing crises)

 humanitarianresponse.info

 WHO Country Office records (e.g., annual reports)

 Ministry of Health website

 Risk profiles (especially STAR profile where availabl

e)

 Internet searches

o When searching Google or other internet search engines for data-rich or

assessment

reports (as opposed to news reports), it is useful to rely on the advanced search feature of

the search engine, and search for files with typical extensions (e.g. , x, .ppt, ).

Several searches with alternative key terms are better than only a single search.

See templates below for suggested sources for specific data elements.

6

Guidance on filling the templates
Text that appears in blue indicates that there is a hyperlink attached. “Ctrl” and click on the text to

access the information.

Keep note of which data sources that are used as the PHSA is prepared; leaving it to the end will make

the process of referencing very laborious. See Annex 1 for more information on referencing.

In all instances, the most up-to-date information is preferred, however if this is not available give the

latest available statistic; taking into consideration that this may be identified as an information gap in

Section 6 (see following template). Note that all information that cannot be provided should be

identified as an information gap.

If data are confidential and/or the source is not revealed, clarify with the source if the data can be

anonymised, or only used for analysis.

Under each heading, guidance will be provided as to potential information sources.

Short-form PHSA
Previous versions of the PHSA were not fit-for-purpose, taking longer than required to guide immediate

operational decisions. For this reason, a “short” or “initial” PHSA template has been developed; meant

for information to be gathered quickly to address this gap.

The process of developing a Public Health Situation Analysis (PHSA) should be completed at all three

levels (WCOs, ROs and HQ) in order to maximise expertise and technical input. The ideal situation is for

the short-form PHSA to be completed at country level within the first 24-72 hours of a crisis, with

assistance and input from ROs and HQ when requested. Following this, a long-form PHSA should be

developed within two weeks (see below).

The different sections of the short-form PHSA include:

1. Summary of the crisis

2. Map of the affected country/region

3. Health Status and Priority Threats

4. Health System Needs

5. Humanitarian Health Response (3/4W matrix)

6. Information gaps & recommended information sources

7. Key References

8. Contacts

7

Public Health Situation Analysis- Short Form

COUNTRY NAM

E

Last update:

Initiated by: Country Office □ Regional Office □ HQ □

Type of emergency
(see Annex 2 of this

document)

Conflict

Food security

Displacement

Drought

Flood

Main health

hazards

 Give a bullet

point list of

the

main

emerging

health

hazards (or

hazards that

are likely to

become an

issue) resulting

from the crisis

UN

Level

WHO

Grade

Security level(s)

For the UNDSS website

(dss.un.org), enter UN

username and password. Fill

out the following table:

Location(s) Level

Extreme (6)

High

(5)

Substantial

(4)

Moderate

(3)

Low (2)

INFORM

risk, out of 10.
at (date).

Download the

excel sheet.

Include

risk

class (e.g. Very

High)

Rank: Include

rank of country

1. Summary of Crisis

Provide a summary of the key features and facts about the crisis (max 200 words), including:

 Geographical areas affected, or most likely to be affected by the crisis (e.g. key districts)

 Start date (and duration; if applicable) of the crisis

 Major humanitarian consequences and concerns;

 Underlying causative factors and drivers of the emergency (e.g. conflict, drought, earthquake,

or other pre-existing vulnerabilities etc.), including key operational constraints

 Major Public Health issues and/or disease outbreaks arising due to the crisis, information on

vulnerable groups by age group, gender, ethnic group or any other vulnerable group, if

applicable

 Level of destruction of health facilities, if applicable

For initial research, ACAPS , Humanitarian Response, ReliefWeb, OCHA, WHO, Health Cluster, are useful

websites. Key documents on these websites include the Humanitarian Response Plan (HRP), and

Humanitarian Needs Overview (HNO), and Situation Reports. ECHO also provides useful information. The

WHO emergency portal, vSHOC compiles information, including Situation reports, which are highly

useful.

2. Map of Affected Country/Region

Provide a country map, clearly showing the

different regions and districts affected. if you

need help please liaise with the MAP team:

maps@who.int.

Useful websites: ReliefWeb (type in the “search”

bar the country that you are looking for)

(Insert Map)

Humanitarian Profile:
Population in need: (disaggregated by sex and age if

possible): or population breakdown by age, gender,

urban, rural.

Population in need of humanitarian health assistance:

(disaggregated by sex and age if possible)

Deaths (estimates):

Injuries (estimates):

IDP’s:

Refugees:

Returnees:

(The HNO/HRP is useful to find this information). Another

good source is the “RW Crises” phone app.

http://www.unocha.org/where-we-work/current-emergencies

http://www.unocha.org/where-we-work/current-emergencies

https://trip.dss.un.org/dssweb/traveladvisory.aspx

http://www.inform-index.org/

http://www.inform-index.org/

https://www.acaps.org/countries

https://www.humanitarianresponse.info/en/operations

https://reliefweb.int/countries

http://www.unocha.org/where-we-work/ocha-presence

http://www.who.int/hac/crises/en/

http://www.who.int/health-cluster/countries/en/

http://erccportal.jrc.ec.europa.eu/Countries

https://extranet.who.int/vshoc

mailto:maps@who.int

https://reliefweb.int/maps?source=1503&format=12#content

8

3. Health Status and Threats

In this section, the existing health status of the population and possible health threats should be noted,

which will indicate major areas for health action to respond and recover from crisis.

In this section, an overview of the Public Health Profile and the core determinants of health present in

the affected country, district or region should be presented, based on reliable sources of information.

Information and statistics both pre- and post-crisis are essential, to understand what could potentially be

aggravated by the current crisis. If data is available disaggregated by sex and age, this is very useful;

particularly if the numbers are particularly skewed towards one group.

If the most recent available data are not up-to-date, this can be added as a qualifier when providing

information, e.g. “according to the most recently available data, …”, if there is no information

available, add “no statistics are available, but rates are likely to be high/low”.

Note: Low confidence information should be specifically noted as such.

For health (and other determinants) profiles/pre-crisis: ACAPS, click on the relevant country, and then

“Country Profile”, is a very useful source, as well as the Global Health Observatory and WHO Country

profiles. The CIA World Factbook, “People and society” section is useful for key and comparison

statistics, and DHS surveys provide information by district.

For countries that are in crisis: Situation reports released by OCHA (type in the necessary country),

and/or EWARS bulletins found through WHO (click on the respective country, and then “Situation

Reports” and/or “EWARS bulletins”) are extremely useful, as well as WHO Country Plans. Updates for the

AFRO region can be found here.

Note: additional headings can be added, or unnecessary headings removed if necessary, depending

on the context. For each sub-heading, aim for an average maximum of 100 words, noting however that

some sections may be larger and/or more contextually important than others.

Note: In displacement contexts, the burden of endemic diseases should be found for both the

displaced and the host populations, if available. For a mass translocation of people, i.e. where the

majority of people are displaced (e.g., Rohingya in Cox’s Bazar, Bangladesh), disease profiles from the

place of origin (e.g. Rakhine state, Myanmar) are more relevant for most diseases; the main exceptions

are diseases associated with the physical environment (e.g., Cox’s Bazar), such as most vector-borne

diseases, zoonotic diseases, and environmental health issues such as toxin exposure.

Note: If the crisis is focused on a specific i.e. district in country, compare this to the national and or

regional averages, if possible, including if there are districts which are facing different health needs,

disaggregate information by district.

If known, relate this information to any obvious or potential determinants of health (i.e. measles due to

poor vaccination coverage, cholera due to poor WASH infrastructures or environmental factors such as

the rainy season).

Population mortality

Where available, this information usually comes from SMART surveys available from the country Health

or Nutrition Clusters. Include crude mortality rate (CMR; emergency threshold is >1/10 000/day) and

under-5 mortality rate (U5MR; emergency threshold is >2/10 000/day).

Vaccination coverage

If information can be found, note most up-to-date information on vaccination coverage, including, if

applicable, how this relates to the coverage necessary for herd immunity threshold.

https://www.acaps.org/countries

http://apps.who.int/gho/data/node.country

http://www.who.int/countries/en/

http://www.who.int/countries/en/

https://www.cia.gov/library/publications/the-world-factbook/docs/profileguide.html

https://www.dhsprogram.com/Where-We-Work/Country-List.cfm

https://reliefweb.int/updates?source=1503&search=situation%20report#content

http://www.who.int/emergencies/crises/en/

http://www.who.int/emergencies/response-plans/2018/en/

https://www.afro.who.int/health-topics/disease-outbreaks/outbreaks-and-other-emergencies-updates

http://www.who.int/immunization/monitoring_surveillance/data/en/

9

Guidance on filling out the ‘Key Risks in the coming month’ table (see above):

This table shows potential sources of future morbidity and mortality based on the context

and an analysis of health risks, and is based on 3 Level expert judgement.

The ‘likelihood column’ indicates What is the likelihood that this condition will arise due to

the crisis? See Annex 3 for more information.

The ‘level of risk column’ is also dependent on the type of crisis, i.e. acute or protracted.

See Annex 4 for more details on how to fill out this table.

In situations where a crisis has just occurred, for example, increased HIV, TB and NCD

burden will not result in high levels of excess mortality as it will take a while for these

conditions to deteriorate. In more protracted crises, however, this will become more of a

burden as individuals cannot access their medicines so their situation will deteriorate.

Depending on the overall public health profile of the country, the level of risk will depend

on whether a small or large proportion of the population have/are likely to get the

condition.

The narratives below should be consistent with, and expand upon, the table above.

Epidemic-prone diseases

Note any current or recent epidemics or outbreaks (within the past two years (past 10 for long-form),

particularly of vaccine-preventable diseases) in the affected area, including dates. If quickly

ascertainable, provide data on prevalence and/or number of confirmed and suspect cases (and alert

cases if applicable), case fatality rate (CFR), locations, and any other descriptive epidemiology;

including key populations affected (e.g. by gender or age). If possible, describe patterns. ProMED is a

useful source. Where applicable, mention overcrowding as a risk factor (which may increase risk air-

Key Risks in the coming month*

Public

Health
risk

Geographi

cal Scope

Likelihood** Public health**

consequence

Level of

risk***

Rationale

(e.g.

AWD)

(e.g.

Countrywid

e)

(e.g. Likely) (e.g.

Moderate)

(e.g. Poor

WASH

conditions)

(e.g.

Measles)

(e.g. Low

vaccination

coverage)

(e.g.

Malaria)

Countrywid
e
(e.g.

Almost

certain)

(e.g. High) (e.g.

Malaria

season, lack of

treatment)

(e.g ARI) (e.g. Very

likely)

(e.g. Low) (e.g.

overcrowding)

(e.g

Mental

Health)

(e.g. Not

likely)

(e.g.

Injuries)

(e.g.

NCDs and

cancer)

(e.g Lack of

treatment)

Red: could result in high levels of excess mortality or morbidity in the upcoming month.

Orange: could result in considerable levels of excess mortality or morbidity. Yellow: could make

a minor contribution to excess mortality or morbidity Green: will probably not result in any

excess mortality or morbidity/relatively normal satiation in the upcoming month.

http://www.promedmail.org/index.php

10

borne diseases).

Endemic infectious

diseases

List endemic infectious diseases that are most likely to be aggravated by the current event. Further,

note any other endemic infectious diseases; including Neglected Tropical Diseases (NTDs) and vector-

borne diseases. One way to determine the endemic diseases to include is to determine the leading

infectious causes of outpatient consultation, in order of proportional morbidity. If quickly ascertainable,

break down by region if possible, including incidence, prevalence, CFR, and peak seasons of disease

transmission if applicable. For Malaria, note dominant species and associated resistance patterns,

seasonal transmission, and potential migration of people from low endemicity to hyperendemic areas

and vice versa. For zoonotic diseases, note the extent of disease/deaths in animals. Information about

Malaria species and resistance patterns in country can be found here

Malnutrition and Child Health

Note the prevalence of Severe Acute Malnutrition (SAM) particularly for children under 5 (crisis threshold

2%), Global Acute Malnutrition (crisis threshold 15%), stunting (crisis threshold >20% for areas that are

moderately/borderline food insecure),; if quickly ascertainable, provide location and populations who

are most affected, number of people requiring food assistance and where they are located, noting IPC

projections if available. Nutrition Landscape Information System, and SMART surveys are useful sources.

Much of this information may be held by the Nutrition Cluster if present.

If quickly ascertainable, note breastfeeding rates, infant mortality rate, and leading causes of child

mortality. UNICEF is a useful source.

Sexual and

reproductive health

Note any quickly ascertainable information on total fertility rate (TFR), unmet need for family planning ,

ANC coverage (particularly noting the recommended 4 visits), births attended by skilled health

personnel, delivery of births at a health facility, leading cause of maternal deaths, noting if there is

anything significant about the figures, i.e. lowest in the region. Also note anything that could change

due to the crisis. UNFPA and UNICEF are useful sources. Maternal mortality ratio (MMR) can also be

added if known, although crisis-specific data are rarely available early in a crisis.

Tuberculosis and HIV

Tuberculosis (TB): Note incidence (new cases) and prevalence (current cases) of TB, MDR/RR TB

cases, TB treatment coverage. Where applicable, mention overcrowding as a risk factor (which may

increase risk of TB spread).

HIV: Note incidence (new cases), and prevalence (current cases) of HIV, treatment coverage, number

of people receiving ART, prevention of mother to child transmission (pMTCT) rates.

Non-communicable diseases (NCDs)

Depending on which resource provides the most up to date information: NCD country profile, NCD

Progress Monitor. If quickly ascertainable, note the burden of major NCDs (e.g. diabetes mellitus, CVD,

cancers, respiratory diseases, hypertension), and essential medicines which are /are not be available in

country, if possible.

Trauma

Crisis-attributable injuries: Indicate the confirmed and/or estimated number of injuries and casualties

that have arisen from the crisis and most prevalent injury patterns. In unstable security situations,

consider whether the pattern of warfare could cause substantial numbers of injuries over the next

month. Consider using data from health bulletins if available.

Violence: Note patterns and locations of violence in

country.

Gender-based violence (GBV): GBV includes: intimate partner violence, rape, child marriage,

female genital mutilation, exploitation etc. Note the current types of violence that are most

prevalent. Note if these figures are likely to be exacerbated due to the crisis, note negative coping

https://www.cdc.gov/malaria/travelers/country_table/a.html

http://www.ipcinfo.org/ipc-country-analysis/

http://www.ipcinfo.org/ipc-country-analysis/

http://apps.who.int/nutrition/landscape/report.aspx

Home

https://www.unfpa.org/data

Home

http://www.who.int/tb/country/data/profiles/en/

http://www.unaids.org/en/regionscountries/countries

http://www.who.int/nmh/publications/ncd-profiles-2014/en/

https://ncdalliance.org/sites/default/files/resource_files/WHOProgressMonitor2017

https://ncdalliance.org/sites/default/files/resource_files/WHOProgressMonitor2017

11

mechanisms which may lead to increased violence or GBV Consider using information from health

bulletins, or GBV sub-cluster information where available.

Mental health

Note the extent of mental health conditions in populations, including locations and key populations

where this may be most prominent.

Water Sanitation and Hygiene (WASH)

Comment on overall WASH situation. If quickly ascertainable, note extent, location, and statu

s of

WASH infrastructure (particularly the availability of safe and/or improved drinking water and basic

sanitation), rainfall patterns, and any other increases in WASH needs which may arise from the

crisis. Note hygiene and sanitation practices, if available. Where applicable, mention how

overcrowding as a risk factor which may lead to increased risk of disease.

Other

Note other determinants of health, contextual factors, or cross-cutting issues which are highly

relevant to the situation, such as protection concerns e.g. land mines, security threats, cultural

factors which may exacerbate risk of disease transmission (e.g. unsafe burial practices, eating of

bushmeat), operational constraints prior to or as a result of the conflict (e.g. lack of road

maintenance which may affect humanitarian assistance), natural hazards and/or any other

extreme weather exposures which may exacerbate the crisis, or any other major pre-existing

vulnerabilities and/or threats.

4. Health System Status & Local health system disruptions

Pre-crisis

Provide as much information as can quickly be found

on % of country covered by Primary Health Care and

hospital services, number of hospital beds per 100,000

population, number of nurses and doctors working in

the affected area, barriers to accessing healthcare i.e.

financial, transport.

In-crisis

Provide summary statistics on the state of the health

system in country,

 main figures on the disruption of key health

system components, and the locations of these

disruptions (see box beside),

 to what extent could crisis risk factors could

reduce coverage and utilization of health

services,

 Report on any critical, local disease control

(eradication/elimination) programmes that

could be disrupted as a result of the crisis.

For latest HeRAMS reports, please see the HeRAMS website (accessible through Google Chrome); or

contact: herams@who.int.

Main figures on disruption of key health

system components

Damage to health facilities: to what

extent, including locations of damage

that has occurred

Health workforce: note the extent of

health workforce in country

Attacks against health workers:

indicate numbers, locations and

frequency of attacks. Surveillance

system for attacks on health care is

useful.

Drugs and other supplies: e.g. disrupted

supply chain, shortage of drugs

http://gbvaor.net/countries-3/

http://herams.org/

mailto:herams@who.int

https://publicspace.who.int/sites/ssa/SitePages/PublicDashboard.aspx

https://publicspace.who.int/sites/ssa/SitePages/PublicDashboard.aspx

12

5. Humanitarian Health Response (3/4W matrix)

Health response coordination

If available, provide information on the leadership and governance

structure of the health response, and partner coordination.

Health response actors

Include the Who-does-What-Where(When) (3/4W) map/list, and the

number of partners working in the health cluster.

Useful websites: ReliefWeb (type in the “search” bar the country that you are looking for).

In cases where the 3/4W map/list is not available, to cover partner engagement the following may be

useful:

 Mapping initial assessment coverage, to identify areas which are not covered

 locations of EMTs, in-country health sector partner coverage (pre- and post- event).

 Expected deployments (vSHOC can show WHO planned deployments; consult partners for

other).

 Development partners (who may already have projects and/or experience), to fulfil the

humanitarian-development nexus.

(Insert 3/4W matrix)

6. Information gaps & information source

Prioritize information gaps evident from secondary data search, and identify the corresponding tool,

guidance document and/or source of information that can be used to address this. Sometimes these

information gaps are already hinted at or provided elsewhere, such as on ACAPS or Situation Reports.

The information gaps that are indicated should be useful to address what information can be collected

in future assessments.

For example; if there is no information on measles cases, but measles is flagged as an issue, the

corresponding tool would be to set up EWARS to identify cases of measles.

Consult PHIS Toolkit for guidance on specific tools used to fill specific gaps. If possible, add a hyperlink
to the recommended tool so that it can be accessed easily (In Word: “Insert”, “Links”, “Link”, and then

copy and paste the desired hyperlink).

Additional guidance can be sought from the WHO HQ or RO HIM/MDC PHIS country focal points.

See Annex 8 on more information on methods to collect primary data.

Gap Recommended tools/guidance for
primary data

collection

Health Status & threats for

affected population

(e.g.Measles or other epidemic-

prone diseases and other critical

conditions)

(e.g. EWARS)

(e.g. Mental Health)

(e.g. Assessment for mental health tool)

(e.g. GBV prevalence)

GBVIMS

(e.g. HIV Statistics- 2018) (e.g. UNAIDS)

Health Resources &

availability

(e.g. Health Resources)

(e.g. HeRAMS)

Health System Performance

(access, coverage, output,

quality, and utilization of

health services)

N. of partners

https://reliefweb.int/maps?source=1503&format=12#content

https://extranet.who.int/vshoc

http://www.who.int/health-cluster/resources/publications/PHIS-Toolkit/en/

http://www.who.int/emergencies/kits/ewars/en/

http://apps.who.int/iris/bitstream/handle/10665/76796/9789241548533_eng ;sequence=1

http://www.gbvims.com/User%20Guide_ToPrintColor

http://www.who.int/hac/herams/en/

13

7. Key References

This section requires a very basic reference list, in the following format: Source, name of document,

year. In-text citations are not required for the short form PHSA.

8. Contacts

For example:

Health Cluster Coordinator:

Health Cluster Information Management Officer:

[Insert Country Name] Public Health Information Services Focal Point (WHO Geneva, RO):

14

Long-form PHSA

The long-form PHSA builds upon the short-form (hence most fields in the short-form can be copied and

pasted directly into the long-form), adding depth to the information presented in the short-form. In

addition to simply providing more information on the existing topics (e.g., expanding items designated in

the short-form as “if quickly ascertainable…”), garnered from the additional two weeks of time allotted

to produce the long-form PHSA (including time for receiving primary data from initial rapid assessments),

there are a few unique elements to the long-form PHSA; these are described below. Otherwise, the

individual fields in the long-form PHSA follow the guidance for the short-form PHSA.

Each table in the long-form PHSA should be followed by in-depth narrative explaining each problem

(disease, disruption, etc.) highlighted in the table (See Annexes 4-7).

15

Public Health Situation Analysis

[Country Name]

(Insert Date)

(Insert Map or photo)

Type of

emergency
(insert

humanitarian

icons)

Main

health
threats
UN
Level
WHO
Grade

Security Level(s) INFORM

Index

(Rank:)

Location Level

16

Executive Summary

Acronyms and abbreviations

17

Contents

Background …………………………………………………………………………………………………………………………………….. 2

Timing of initial and repeat PHSAs …………………………………………………………………………………………………. 2

Geographic scope of PHSA …………………………………………………………………………………………………………… 3

Use of PHSA in WHO Grading and Re-Grading ……………………………………………………………………………. 3

Distribution of PHSA …………………………………………………………………………………………………………………………. 4

Presenting imprecise or conflicting data ……………………………………………………………………………………… 5

Finding source data ……………………………………………………………………………………………………………………….. 5

Public Health Situation Analysis- Short Form …………………………………………………………………………………………….. 7

COUNTRY NAME …………………………………………………………………………………………………………………………………….. 7

Last update: ……………………………………………………………………………………………………………………………………………. 7

1. Summary of Crisis ……………………………………………………………………………………………………………………………….. 7

2. Map of Affected Country/Region ………………………………………………………………………………………………………….. 7

3. Health Status and Threats ……………………………………………………………………………………………………………………. 8

4. Health System Status & Local health system disruptions ………………………………………………………………………. 11

5. Humanitarian Health Response (3/4W matrix) …………………………………………………………………………………….. 12

6. Information gaps & information source ………………………………………………………………………………………………. 12

7. Key References ………………………………………………………………………………………………………………………………….. 13

8. Contacts ……………………………………………………………………………………………………………………………………………. 13

Executive Summary ………………………………………………………………………………………………………………………….. 16

Acronyms and abbreviations ………………………………………………………………………………………………………….. 16

Preface ………………………………………………………………………………………………………………………………………………. 19

1. Summary of the crisis …………………………………………………………………………………………………………………. 19

i. Key features ……………………………………………………………………………………………………………………………. 19

ii. Humanitarian profile ………………………………………………………………………………………………………………. 19

2. Health status and threats ………………………………………………………………………………………………………….. 19

i. Population mortality ………………………………………………………………………………………………………………. 19

ii. Vaccination coverage ………………………………………………………………………………………………………….. 19

iii. Priority health threats ……………………………………………………………………………………………………………… 19

Water, sanitation and hygiene (WASH) ………………………………………………………………………………… 20

Sexual and reproductive health ………………………………………………………………………………………………. 20

Malnutrition and child health ……………………………………………………………………………………………………. 20

Endemic infectious diseases [delete any non-applicable diseases] …………………………………… 20

Epidemic-prone diseases …………………………………………………………………………………………………………. 20

18

Tuberculosis and HIV ……………………………………………………………………………………………………………….. 21

Non-communicable diseases ……………………………………………………………………………………………….. 21

Trauma ……………………………………………………………………………………………………………………………………….. 21

Mental health ……………………………………………………………………………………………………………………………. 21

Psychosocial support issues …………………………………………………………………………………………………… 21

3. Health system needs …………………………………………………………………………………………………………………. 21

i. People in need of health services ………………………………………………………………………………………… 21

ii. Local health system disruptions …………………………………………………………………………………………….. 21

Disruption of key health system components …………………………………………………………………………. 21

Disrupted management ……………………………………………………………………………………………………………. 22

Reduction in financing ………………………………………………………………………………………………………………. 22

Inability of non-state providers to maintain services ……………………………………………………………… 22

Disruption to supply chain (including pharmaceuticals) ………………………………………………………. 22

Degraded alert and response ………………………………………………………………………………………………….. 22

Migration of human resources for health ………………………………………………………………………………… 22

Damage to health facilities ………………………………………………………………………………………………………. 23

Attacks against health ………………………………………………………………………………………………………………. 23

4. Humanitarian health response …………………………………………………………………………………………………. 23

i. Health response coordination ………………………………………………………………………………………………. 23

ii. Availability / functionality of humanitarian health resources …………………………………………….. 23

Facilities data (e.g., HeRAMS) ………………………………………………………………………………………………….. 23

4Ws ……………………………………………………………………………………………………………………………………………… 23

iii. Humanitarian health system performance ………………………………………………………………………….. 23

Utilisation of services …………………………………………………………………………………………………………………. 23

Quality of humanitarian health services ………………………………………………………………………………….. 23

5. Information gaps ……………………………………………………………………………………………………………………….. 23

6. Additional Resources ………………………………………………………………………………………………………………… 24

7. Annex 1 WHO recommended surveillance case definitions …………………………………………………. 24

19

Preface

Public health threats represent a significant challenge to those providing health-care services in a

crisis. The health issues and risk factors addressed in this document have been selected on the basis

of the known burden of disease in this country, crisis-emergent health issues, and their potential

impact on morbidity, mortality, response and recovery. It is hoped that this PHSA will facilitate the

coordination of activities among all agencies working with the populations affected by the crisis.

The document contains a short summary of the crisis, health status of and threats to the affected

population, health system needs, humanitarian health response, and information gaps. This

document presents the best available data at the time of publication, and may be updated, as

needed.

1. Summary of the crisis

i. Key features

Location (country, region):

Start date of crisis:

Typology:

Brief description of event:

Operational constraints:

ii. Humanitarian profile

(Total population, affected, number of IDPs, refugees, returnees, etc.)

2. Health status and threats

i. Population mortality

ii. Vaccination coverage

iii. Priority health threats

Table 3 summarises the current analysis of the magnitude (in terms of excess morbidity and

mortality) of different health problems impacting the crisis-affected population, grouped into major

disease types. Changes in the projected magnitude of these problems are also shown: these

assume that the humanitarian health response (availability, coverage, quality) remains unchanged

from its current status. Table 1a covers somatic health issues, and Table 1b covers

mental health

and psychosocial support issues.

See Annex 4 and 5 for information on how to fill out table 1a and 1b.

20

Table 1a. Magnitude1 of expected somatic health threats and their expected evolution over time 2.

Health problem

Month(s), starting now

1 2 3-6 6-12

Worse WASH

situation

Worse sexual and

reproductive health

outcomes

Worse

malnutrition

and child

health

Increased

burden

of endemic

infectious diseases

Risk of epidemics

Increased HIV and

TB burden

Increased NCD

burden

Trauma

1 Red: Could result in high levels of excess mortality/morbidity. Orange: Could result in considerable levels of excess
mortality/morbidity. Yellow: Could make a minor contribution to excess mortality/morbidity. Green: Will very

probably not result in any excess mortality/morbidity. Grey: No plausible assessment can be made at this time.

2Changes in risk over time shows the expected progression after an acute onset emergency, or predicable

seasonality of morbidity.

Water, sanitation and hygiene (WASH)

Sexual and reproductive health

Malnutrition and child health

Malnutrition

Child health

Endemic infectious diseases [delete any non-applicable diseases]

Malaria

Other (as relevant)

Epidemic-prone diseases

Measles

Diphtheria

Cholera / acute watery diarrhoea

Vector-borne diseases (e.g., dengue, chikungunya)

Other (as relevant)

21

Tuberculosis and

HIV

Tuberculosis

HIV

Non-communicable diseases

Chronic diseases (e.g., cardiovascular disease, cancer)

Disabilities

Other (as relevant)

Environmental health and technological hazards (if applicable)

Trauma

Crisis-attributable injuries

Violence

Gender-based violence

Table 2b. Magnitude1 of expected mental health and psychosocial support threats and their

expected evolution over time.

Mental Health and

psychosocial

support problem

Month(s), starting now
1 2 3-6 6-12

Worse mental

health problems

Worse psychosocial

support problems

1Red: Could result in high levels of excess mental health/psychosocial support problems. Orange: Could result in

considerable levels of excess mental health/psychosocial support problems. Yellow: Could make a minor

contribution to excess mental health/psychosocial support problems. Green: Will very probably not result in any

excess mental health/psychosocial support problems. Grey: No plausible assessment can be made

at this time.

Mental health

Psychosocial support issues

3. Health system needs

i. People in need of health

services

ii. Local health system disruptions

Disruption of key health system components

Various disruptions to the local health system continue to affect delivery of preventive and curative

health services. These are summarised in Table.

See Annex 6 and 7 for information on how to fill out this table.

22

Table 2. Overview of disruptions to key health system components.

Disruption
Month(s), starting now

1 2 3-6 6-12

Disrupted

management

Reduction in

financing

Inability of non-

state providers to

maintain services

Disruption to supply

chain (including

pharmaceuticals)

Degraded alert

and response

Migration of human

resources for health

Damage to health

facilities

Attacks against

health

Access to

healthcare

1Red: The majority of the health system feature / health service has been or could be rendered non-functional. Most

people / patients do not have access to healthcare. A major reduction in health service coverage or quality could

occur. Orange: A substantial minority of the health system feature / health service has been or could be rendered

non-functional. A substantial minority of people / patients do not have access to healthcare. A moderate reduction

in health service coverage or quality could occur. Yellow: A small minority of the health system feature / health

service has been or could be rendered non-functional. A small minority of people / patients do not have access to

healthcare. A small reduction in health service coverage or quality could occur. Green: The vast majority or entirety

of the health system feature / health service is very probably still as functional as before the crisis. No risk factors for

reduction in health service coverage or quality have been identified. Grey: No plausible assessment can be made

at this time.

Disrupted management

Reduction in financing

Inability of non-state providers to maintain services

Disruption to supply chain (including pharmaceuticals)

Degraded alert and response

Migration of human resources for health

23

Damage to health facilities

Attacks against health

Access to healthcare

4. Humanitarian health response

i. Health response coordination

ii. Availability / functionality of

humanitarian health resources

Facilities data (e.g., HeRAMS)

4Ws

iii.

Humanitarian health system performance

Utilisation of services

Quality of humanitarian health services

Vaccination campaign coverage against target

5. Information gaps

See Annex 8 for more information on methods to collect primary data.

Gap Recommended tools /

guidance for primary data

collection

Health status and threats

Health system needs

Health response coordination

Availability / functionality of

humanitarian health resources

Humanitarian health system

performance

24

6. Additional Resources

7. Annex 1 WHO recommended surveillance case definitions

Acute diarrhoea

Acute diarrhoea (passage of three or more loose stools in the past 24 hours) with or without

dehydration.

Suspected cholera

 In an area where cholera is not known to be present: a person aged > 5 years with severe

dehydration or death from acute watery

diarrhoea with or without vomiting.

 In an area where there is a cholera outbreak: a person aged > 5 years with acute watery

diarrhoea with or without vomiting.

 To confirm a case of cholera: isolation of Vibrio cholerae O1 or O139 from a diarrhoeal stool
sample.

Bloody diarrhoea
Acute diarrhoea with visible blood in the stool. To confirm a case of epidemic bacillary dysentery:

 take a stool specimen for culture and blood for serology,

 isolation of Shigella dysenteriae type

1.

Acute flaccid paralysis (suspected poliomyelitis)

Acute flaccid paralysis in a child aged < 15 years, including Guillain–Barré syndrome, or any

acute

paralytic illness in a person of any age in whom poliomyelitis is suspected.

Acute Haemorrhagic Fever Syndrome
Acute onset of fever (duration of less than 3 weeks) and any of the following:

 haemorrhagic or purpuric rash,

 vomiting with blood,

 cough with blood,

 blood in stools

 epistaxis, or

 other haemorrhagic symptoms.

Acute Jaundice Syndrome

Illness with acute onset of jaundice and absence of any known precipitating factors and/or fever.

Pneumonia

 for infants aged 7-59 days, breathing 60 or more times per minute (even without history of

cough and or difficult breathing)

 In children 2 months to less than five years old with history of cough or difficulty breathing
and one or more of the following

– for infants aged 2 months to 1 year, breathing 50 or more times per minute, or chest in-
drawing

– for children aged 1 to 5 years, breathing 40 or more times per minute, or chest in-drawing
– no stridor, no general danger signs (see below).

Severe pneumonia

 History of cough or difficulty breathing and one or more of the following:

25

– inability to drink or breastfeed,
– intractable vomiting,

– convulsions, lethargy or unconsciousness, or
– stridor in an otherwise calm child.

Malaria

Person with current fever or history of fever within the past 48 hours (with or without other

symptoms such as nausea, vomiting and diarrhoea, headache, back pain, chills, muscle pain)

with positive laboratory test for malaria parasites (blood film, thick or thin smear, or rapid

diagnostic test).

 In children:

– Uncomplicated malaria: Fever and no general danger signs such as lethargy or
unconsciousness, convulsions, or inability to eat or drink. Where possible, confirm

malaria

with laboratory test.

– Severe malaria: Fever and general danger signs (lethargy or unconsciousness,
convulsions, or inability to eat or drink).

Measles

 Fever and maculopapular rash (i.e. non-vesicular) with cough, coryza (i.e. runny nose), or

conjunctivitis (i.e. red eyes).

 Any person in whom a clinician suspects measles infection.

 To confirm a case of measles: Presence of measles-specific IgM antibodies.

Meningitis

 Suspected case:

– sudden onset of fever (>38.5 °C) with stiff neck.

– in patients aged < 12 months, fever accompanied by a bulging fontanelle.  Probable case of bacterial meningitis:

– suspected case of acute meningitis, as defined above, with turbid cerebrospinal fluid.
 Probable case of meningococcal meningitis:

– suspected case of meningitis, as defined above and one or more of the following:
 ongoing epidemic of meningococcal meningitis

 Gram stain showing Gram-negative diplococci, or

 petechial or purpural rash.

 Confirmed case of meningococcal meningitis: suspected or probable case, as defined above,
with either positive CSF antigen detection for Neisseria meningitidis or positive CSF culture or

blood with identification of N. meningitidis.

Tetanus

 Adult tetanus: Either of the following signs 3–21 days following an injury or wound: trismus of the

facial muscles or risus sardonicus (characteristic abnormal grin) or painful muscular

contractions.

 Neonatal tetanus: Any neonate with normal ability to suck and cry during the first 2 days of life

who, between day 3 and day 28, cannot suck normally, or any neonate who becomes stiff or

has spasms or both.

Unexplained Fever

Fever (body temperature >38.5 °C) for >48 hours and without other known aetiology.

Unexplained cluster of health events

An aggregation of cases with similar symptoms and signs of unknown cause that are closely

grouped in time and place.

26

Annex 1: References and Citations
Microsoft Word has a built-in function which keeps track of references and citations which is useful. Note

that for the short from PHSA, in-text citations are not a requirement, but for the long form should be used.

In Microsoft 2016, it is found under the “References” tab, “Citations & Bibliography”. The “Numerical

Reference” (ISO690) is the easiest Style of citation to use. When a source is added, click on “Manage

Sources”, “New” and then fill in the corresponding information. Then, add the citation in the relevant

section by clicking on “Insert Citation”, and choose the relevant citation.

Annex 2: Crisis Typology Icons Legend

Cold wave

Population return

Population displacement

Cyclone

Landslide/mudslide

Food Security

Drought

Snow avalanche

Nutrition

Earthquake

Snowfall

Epidemic

Storm

Fire

Storm surge

Flash flood

Technological

disaster

Flood

Tornado

Heatwave

Tsunami

Heavy rain

Violent wind

Conflict

Volcano

27

Annex 3: Additional guidance for the analysis of disease threats
Table

1.

Typic

al

effect

s of
the
main

crisis-

emer

gent
risk

factor

s on

repro

ductiv

e,

mater

nal
and

neon

atal

health

outco

mes.

Risk factor Effects

Impact of

risk

Timing (once risk

factor is occurring)

Specific mechanism (s)

Increasing acute

malnutrition

+++ Immediate Poor maternal nutrition leading to low birth

weight, obstetric and neonatal

complications.

Worsening

feeding and care

practices

+++ Immediate Reduced breastfeeding (due to stress and

mental health problems, lack of privacy,

increased workload, inappropriate donations of

breast milk substitutes) leading to increased risk

of neonatal and infant mortality.

Worsening mental

health

+ A few weeks Obstetric complications.

Increased risk of neonatal and infant mortality

due to compromised care.

Overcrowding + Immediate Increased transmission of neonatal infections.

Inadequate

shelter

+ A few weeks Increased risk of malaria during pregnancy,

resulting in worse birth outcomes.

Increased severity of neonatal pneumonia.

Increased risk of neonatal dehydration or

hypothermia.

Inadequate

WASH services

++ Immediate Increased risk of peri-natal and neonatal

infections (especially when exclusive

breastfeeding prevalence is low).

Poor menstrual hygiene.

Increased SGBV

frequency

++ Immediate Increased unwanted pregnancies and unsafe

abortions.

Disability due to SGBV physical trauma.

Reduced access

to health services

+++ Immediate Untreated obstetric and neonatal

complications.

Missed antenatal preventive care.

Increased unsafe abortions, lack of post-

abortion care.

Untreated sexually transmitted infections.

28

Table 2. Main risk factors causing increases in the severity of infectious diseases, and

their timing.

Table 3. Main crisis-emergent risk factors causing an increase in transmission of infectious diseases, and

their timing.

Infections

disease

(epidemic

prone)

Risk factors: Impact and timing of risk

Increasing

acute
malnutrition

Overcrowdin

g

Insufficient vaccination coverage Poor WASH

conditions

Airborne-droplet transmission

Pneumococcal

disease

++

+

Immediate

+

++

Immediate

+++

Immediate if already present in

country.
+
Immediate

Hib disease ++

Immediate
++
Immediate
+

Immediate

Other bacterial

respiratory

pathogens

+++
Immediate
+++
Immediate

– ++

Immediate

Risk factor Risk impact and timing

Airborne-droplet

transmitted diseases

Faecal-oral transmitted

diseases

Vector-borne

diseases

Increasing acute malnutrition +++

Immediate
+++
Immediate
++
Immediate

Disrupted curative services +++

Immediate
+++
Immediate
+++
Immediate

High HIV burden with extensive

HIV treatment interruptions

++

3-6mo

++
3-6mo
+
3-6mo

Inadequate shelter (exposure to

cold)

++
Immediate

– –

Inhalation of indoor smoke

(inappropriate cooking or heating

fuels)

+
Immediate

Smoke inhalation from volcanic

eruption

+
Immediate
– –

NCD treatment interruptions +

3-6mo
– –

29

Measles +++

Immediate
+++
Immediate
+++
Immediate if already present in
country.
++
Immediate

Pertussis ++

Immediate
+++
Immediate
+
Immediate

Meningococcal

meningitis

– +++

Immediate
+++
Immediate if already present in
country.

Influenza ? +++

Seasonal

– ?

Faecal-oral transmission

Cholera ++

Immediate
+++
Immediate

+++ +++

Immediate

Shigellosis4 +++

Immediate
+++
Immediate
– +++
Immediate

Typhoid fever +++

Immediate

++

Immediate
– +++
Immediate

Rotavirus ++

Immediate
++
Immediate
+++
Immediate if already present in
country.

Polio – +++

Immediate
+++
Immediate

E. coli, other

common

enteric

pathogens
+++
Immediate
+++
Immediate
– +++
Immediate

Hepatitis A and

E

? – – +++

Immediate

Helminths,

schistosomiasis

++
Immediate
++
Immediate
– +++
Immediate

Vector-borne transmission

Malaria ++

Immediate

– – +

(2mo)

Other mosquito-

borne diseases

? – ++

Immediate if already present in

country.

++

(2mo)

Annex 4: Scoring the magnitude of health threats /needs

Note that this is applicable to both the short and long-form PHSA.

Answers to questions in the Crisis-emergent Health Status and Threats section should be scored in terms

of the extent to which the health problem or group of diseases could result in health impacts, i.e. the

magnitude of crisis-attributable excess mortality and/or excess mental health

problems.

Such a scoring is essential to establish health sector priorities, but is objectively difficult to do, as it

requires putting together information from all sections of the Key Questions, and considering various

causal pathways and interactions among risk factors and even disease groups.

In order to undertake the scoring, the following parameters should be considered together:

4 All else being equal, transmission risk is highest during the dry season.

30

The baseline burden of disease (think of how many DALYs lost this disease or group of diseases was

responsible for before the crisis). The baseline disease burden is however irrelevant for crisis-

emergent health problems, including trauma injuries or combatant – perpetrated SGBV. It is also

relatively unimportant for epidemic-prone diseases.

The extent to which crisis-emergent risk factors could increase this burden of disease. To what extent

could different risk factors occur? What is their risk impact, i.e. relevance to this particular disease or

group of diseases (see e.g. Annex 3)? Note that the combination of different risk factors has a

multiplicative effect;

What is known or can be assumed now about access to curative and preventive health services

relevant to this disease or group of diseases;

What further disruptions to the health system could occur, and the effect they would have on this

disease or group of diseases, in addition to the above.

Table 1 provides guidance on how to attribute scores.

Table 1. Guidance for scoring the magnitude of health threat or need for different groups of health

problems.

Magnitude of threat /

need

Meaning Notes

High Could result in high levels of excess

mortality and/or mental health

problems.

Could be one of the top driv ers of worsened

health status, and single-handedly result in a

substantial increase in all-cause mortality, or

substantial worsening of mental health and

functioning.

Think of a very severe epidemic; a large

proportion of cases of life-threatening disease

going without treatment; huge increases in

infectious disease burden due to combinations

of important risk factors (ov ercrowding,

malnutrition, poor WASH). Intermediate Could result in considerable levels

of excess mortality and/or mental

health problems.

Could single-handedly result in a moderate

increase in all-cause mortality, or moderate

worsening of mental health and functioning. Low Could make a minor contribution

to excess mortality and/or mental

health problems.

Small but non-negligible increase.

None Will very probably not result in any

excess mortality or mental health

problems.

Whatever the baseline, no crisis-emergent

risk factors could occur that the pre-crisis health

system wouldn’t be able to cope with.

Alternatively, the number of trauma injuries

or combatant-perpetrated SGBV cases is very

likely to be zero or extremely low.

Unclear No plausible assessment can be

made at this time.

Either the baseline is unknown, or it is

impossible to say at this stage how the crisis

could affect it, if at all.

Alternatively, it is impossible to know whether

there have been any trauma injuries or

combatant-perpetrated SGBV cases.
Four important points to remember while scoring are:

31

The magnitude of threat / need is time-dependent. It may increase as new crisis risk factors emerge, or

vice versa. This should be reflected, particularly in the long-form PHSA (i.e. different magnitudes of

threat should be reported, corresponding to different times).

For the vast majority of questions, one should be able to at least make a plausible assumption

about what could happen as a result of the crisis. Only a few questions should be scored as

‘Unclear’.

One should resist the temptation to score every question as ‘High’, unless this is truly warranted.

Remember that scoring all or most questions as ‘High’ would imply catastrophic levels of excess

mortality: is this really a plausible development? Differentiating between different magnitudes of

threat

/ need, on the other hand, helps to identify relative priorities for the humanitarian health response.

One should provide a score without thinking about the mitigating impact of the humanitarian

health response. At this stage, one analysing needs for the health sector and pointing out what

could happen in the absence of an adequate response.

Annex 5: Table 1a and 1b: Expected evolution of crisis emergent

health threats over time
Note that this is only applicable to the long-form PHSA

Below is an example of the expanded Tables 1a and 1b of the long-form PHSA. It builds on the short-form

PHSA by providing a longer time horizon. Where there are predicted changes in risk, the box should be

used to indicate the justification for the prediction.

Timing is primarily based either on predictable seasonality (such as rainy season and malaria, or lean

season and malnutrition) or on predictable evolution from onset. An example of the latter would be

trauma injuries after a sudden-onset natural disaster: the timing of need would be immediate, and

indeed would dramatically decrease after one week, since the window for treatment (though not

32

rehabilitation) is very short for most life-threatening injuries. Another example would be for NCDs, TB and

HIV, where initial impact may be low, but may increase over time as the morbidity associated with

disruption of treatment increases (as does the transmission of TB and HIV as a consequence of treatment

disruption). Occasionally, timing may be based on some known upcoming event, e.g., the risk of

violence associated with an upcoming election.

If no plausible prediction can be made about the course of a given threat (e.g., an outbreak with a rare

pathogen), it is better to leave it grey than make unfounded predictions.

To understand the key health threats, it is important to understand the pre-crisis burden of disease for the

main groups of disease, expressed as Disability Adjusted Life Years (DALYs) lost. These can be found here.

Table 3a. Magnitude1 of expected somatic health threats and their expected evolution over time 2.

Health problem
Month(s), starting now

1 2 3-6 6-12
Worse WASH
situation

Dry season may

exacerbate WASH

situation where

lack of fresh water

for

drinking/washing

Rainy season may

exacerbate

WASH situation

where flooding

occurs

Worse sexual and
reproductive health
outcomes

No major changes

expected

Worse malnutrition

and child health

Low crop yields

threaten already

bad nutritional

situation

Lean season from

May to August

Most SAM cases

last year in

September-

November

Increased burden

of endemic
infectious diseases

Malaria is the chief

threat

Rainy season to

exacerbate
malaria

Risk of epidemics Meningitis is

biggest threat;

others measles,

cholera, yellow

fever, hepatitis E

Cholera in rainy

season

Increased HIV and
TB burden

Interruption in

treatment may

cause increased

transmission

Increased NCD
burden
Interruption in
treatment may
cause increased

morbidity

Trauma Violent trauma

likely to continue

Modest decrease

in violence during

rainy season

1 Red: Could result in high levels of excess mortality/morbidity. Orange: Could result in considerable levels of excess
mortality/morbidity. Yellow: Could make a minor contribution to excess mortality/morbidity. Green: Will very
probably not result in any excess mortality/morbidity. Grey: No plausible assessment can be made at this time.
2Changes in risk over time shows the expected progression after an acute onset emergency, or predicable
seasonality of morbidity.

For each of the above domains, it is useful to include a brief narrative about the health and WASH

problem prior to the crisis, in order to provide context and aid in operational engagement with the

existing system. Questions to address are included below under “pre-crisis” (note: not all answers may fit

http://www.who.int/healthinfo/global_burden_disease/estimates/en/index1.html

33

neatly within the stated category). Use the questions below to guide your narrative; they need not all be

answered

explicitly.

The narratives below should be consistent with, and expand upon, the table above.
WASH situation

Pre-crisis

 What is the WASH situation at present?

Crisis-emergent

 To what extent could the rainy season (e.g. flooding), or the dry season (e.g. lack of fresh water)

lead to a worsening WASH situation?

 To what extent could other crisis risk factors lead to a worsening WASH situation,

and

when?

Sexual and reproductive health outcomes

Pre-crisis

 What was the crude birth rate?

 What was the maternal mortality ratio?

 What was the prevalence of contraceptive use?

Crisis-emergent

 To what extent could crisis risk factors worsen reproductive, maternal and neonatal health outcomes,

and when?

For a proper understanding of sexual and reproductive health needs, in-depth assessment is

recommended to refine initial needs analysis.

Malnutrition and child health
Pre-crisis

 What was the prevalence of acute malnutrition (severe, moderate and global) among children 6-50

months old?

 What was the proportion of women aged 15-49 years with low body mass index (<18.5kg/m2)?

 What was the proportion of children exclusively breastfeed until 6mo of age?

 What was the under 5y (child) mortality ratio?

Crisis-emergent

 To what extent could any worsening food insecurity have an effect on nutritional status, and

when?

 To what extent could worsening feeding and care practices have an effect on nutritional status,

and when?

 To what extent could nutritional status deteriorate in different age groups (infants, other children,

pregnant and lactating women, people living with HIV, general population) and when?

Burden of endemic infectious diseases

Pre-crisis

http://www.who.int/reproductivehealth/publications/emergencies/field_manual_rh_humanitarian_settings

34

 What were the top three infectious cause of outpatient consultation, in order of proportional

morbidity?

Crisis-emergent

 To what extent could crisis risk factors increase the burden of the main endemic infectious diseases?

Risk of epidemics

Pre-crisis

 What, if any, confirmed epidemics have occurred in the affected area (in the case of displaced

people, both the area of origin and the host community) over the last 10 years?

 What was the severity of any epidemics (total known cases and deaths)?

Crisis-emergent

 Which epidemic-prone diseases could cause outbreaks, with what attack rate, severity, and

when? Are any happening now?

 Which local infectious disease eradication/elimination programmes could be at risk of setbacks,

and when?

HIV and TB burden

Pre-crisis

 What was the HIV prevalence in the general population, and how many people were in need of

antiretroviral treatment?

 What was the annual incidence of active TB (total number and rate)?

Crisis-emergent

 How many people’s HIV/TB treatment has been or may soon be interrupted, and when could

their health outcomes start to deteriorate?

NCD burden

Pre-crisis

 What were the most important groups of NCDs?

 What was the prevalence of diabetes?

 What was the prevalence of hypertension?

Crisis-emergent

 How many people’s type 1 (insulin-dependent) and type 2 diabetes treatment has been or may

soon be interrupted, and when

could their health outcomes start to deteriorate?

 How many people’s hypertension treatment has been or may soon be interrupted, and when

could their health outcomes start to deteriorate?

 To what extent could other crisis risk factors increase NCD burden, and when?

Trauma
Pre-crisis

35

 What is known about the incidence of SGBV, including during any crises that may have occurred

in the same population previously?

Crisis-emergent

 How many people are known or projected to have sustained life-threatening trauma injuries, and

could substantial numbers of trauma injuries continue to occur over the foreseeable future?

 What is the observed or expected typology o trauma injuries?

 Is there evidence of combatants perpetrating SGBV on the affected population?

 To what extent could other crisis risk factors increase SGBV frequency, and when?

Table 4b. Magnitude1 of expected mental health and psychosocial support threats and their

expected evolution over time.
Mental Health and
psychosocial
support problem
Month(s), starting now
1 2 3-6 6-12
Worse mental
health problems

Post-traumatic

stress, untreated

chronic mental

health disorders

Worse psychosocial
support problems

1Red: Could result in high levels of excess mental health/psychosocial support problems. Orange: Could result in
considerable levels of excess mental health/psychosocial support problems. Yellow: Could make a minor
contribution to excess mental health/psychosocial support problems. Green: Will very probably not result in any

excess mental health/psychosocial support problems. Grey: No plausible assessment can be made at this time.

The narratives below should be consistent with, and expand upon, the table above.

Mental health problems

Pre-crisis

 If possible, include a discussion of the essential concerns, beliefs, and cultural issues that aid

providers should be aware of when providing psychosocial support.

Crisis-emergent

 To what extent could the prevalence and severity of mental health problems increase and when?

 To what extend could substance addictions become more frequent, and when?

 What is known about the safety and ongoing care of patients in mental health care institutions?

Psychosocial support problems

Pre-crisis
 If possible, include a discussion of the essential concerns, beliefs, and cultural issues that aid
providers should be aware of when providing psychosocial support.
Crisis-emergent

 To what extent could other crisis risk factors increase the frequency of psychosocial support

problems, and when?

36

Understanding of mental health and psychosocial support threats requires in-depth assessment, typically

conducted by the IASC Mental Health and Psychosocial Support Working Group, an inter-cluster entity

set up in many crises, to which the Health Cluster should refer.

Annex 6: Table 2 of the long form PHSA: Scoring the magnitude of

disruption to key health system components

Note that this section is only applicable to the long-form PHSA.

Answers to questions in the Crisis-emergent Health Resources and Availability and Health System

Performance sections should be scored in terms of the extent to which the health system

component or parameter the question relates to (parameter, e.g. quality of health services, or

health system component, e.g. the existing epidemic alert and response system) is known or may

be assumed to undergo crisis-attributable disruptions. Alternatively, the extent to w h i c h people

are without feasible access to certain health services, or to which health system performance may

be declining, should be scored. Table 4 provides guidance for this scoring.

Table 2 . Guidance for scoring the extent of disruption or lack of access to a given health

system feature or service.

Extent of disruption Meaning

High The majority of the health system feature / health service has been or could be

rendered non-functional.

Most people / patients do not have access to healthcare.

A major reduction in health service coverage or quality could occur.

Intermediate A substantial minority of the health system feature / health service has been or

could be rendered non-functional.

A substantial minority of people / patients do not have access to healthcare.

A moderate reduction in health service coverage or quality could occur.

Low A small minority of the health system feature / health service has been or could be

rendered non-functional.

A small minority of people / patients do not have access to healthcare.

A small reduction in health service coverage or quality could occur.

None The vast majority or entirety of the health system feature / service is very probably

still as functional as before the crisis.

No risk factors for reduction in health service coverage or quality have been

identified.

Unclear No plausible assessment can be made at this time.

It is important, while scoring, to remember that:

1. For the vast majority of questions, one should be able to at least make a plausible
assumption about what could happen as a result of the crisis. Only a few questions should

be scored as ‘Unclear’.

2. All scores should express the effect of the crisis, not the baseline situation, however

challenging the latter may have been. In other words, a health system feature (e.g.

pharmaceutical supply) that is weak at baseline should not automatically be scored

‘High’, unless the crisis has severely disrupted it.

3. One should provide a score without thinking about the mitigating impact of the
humanitarian health response. At this stage, one analysing needs for the health sector and

pointing out what could happen in the absence of ( o r s c a l i n g b a c k o f , i n t h e c a se

o f a P H S A u n d e r t a k e n m i d – c r i s i s ) an adequate response.

https://interagencystandingcommittee.org/system/files/iasc_rg_mhpss_assessment_guide_

http://mhpss.net/

37

Annex 7: Table 2 of the long form PHSA: Expected evolution of

disruptions to key health system components over time
Note that this section is only applicable to the long-form PHSA.

Below is an example of the expanded Table 4 of the long-form PHSA. It builds on the short-form PHSA by

providing a longer time horizon. Where there are predicted changes in disruptions, the box should be

used to indicate the justification for the prediction. Timing of changes in disruption is more

difficult to

predict than timing of changes to disease threats, however there are situations where prediction can be

made. For example, certain health system components are predictably less functional

during rainy

seasons when roads become impassable. Another example is that financing shortfalls can sometimes be

predicted several months in advance (in the absence of mitigating measures).

Table 2. Overview of disruptions to key health system components.
Disruption
Month(s), starting now
1 2 3-6 6-12
Disrupted
management
Inadequate

referral services in

remote areas

Reduction in
financing

CERF expires

Inability of non-
state providers to
maintain services

Many existing

facilities

destroyed

(see below)

Lack of funding

may cause NGOs

to shut down

services

Disruption to supply
chain (including
pharmaceuticals)

Supply chain

coordinated by

Central Medical

Store, functioning

but still gaps

Arrival of rainy

season will

hamper transport

of supplies

Return to dry

season
Degraded alert
and response

Security challenges

prevent complete

coverage of

surveillance and

response

Rainy season will

make it more

difficult to

receive

surveillance data

and mount

responses to

outbreaks

Return to dry
season
Migration of human
resources for health

Some health staff

reluctant to work in

conflict areas

Damage to health
facilities

50% of health

facilities are

destroyed

Fewer attacks

typically occur

during rainy
season

Attacks rise again

during dry season

Attacks against
health

There have been

50 reports of

attacks against

health workers

Fewer attacks
typically occur
during rainy
season
Attacks rise again
during dry season
Access to
healthcare

Access may be

harder during the

rainy season

1Red: The majority of the health system feature / health service has been or could be rendered non-functional. Most
people / patients do not have access to healthcare. A major reduction in health service coverage or quality could
occur. Orange: A substantial minority of the health system feature / health service has been or could be rendered
non-functional. A substantial minority of people / patients do not have access to healthcare. A moderate reduction
in health service coverage or quality could occur. Yellow: A small minority of the health system feature / health
service has been or could be rendered non-functional. A small minority of people / patients do not have access to

38

healthcare. A small reduction in health service coverage or quality could occur. Green: The vast majority or entirety
of the health system feature / health service is very probably still as functional as before the crisis. No risk factors for
reduction in health service coverage or quality have been identified. Grey: No plausible assessment can be made
at this time.

For each of the above domains, it is useful to include a brief narrative about the health system status

prior to the crisis, in order to provide context and aid in operational engagement with the existing system.

Questions to address are included below under “pre-crisis” (note: not all answers may fit neatly within the

stated category). Use the questions below to guide your narrative; they need not all be answered

explicitly.

Once initial needs are established, in-depth analysis of the disrupted health system is recommended,

especially in the context of early recovery planning.

The narratives below should be consistent with, and expand upon, the table above.

Management

structure

Pre-crisis

 Who is in charge of the health system at different hierarchical levels?

 How decentralised are health policy and resource allocation?

 What health services are meant to be provided at community level/secondary/tertiary levels?

Crisis-emergent

 Are health authorities still in place and/or able to take, transmit and execute decisions?

Financing

Pre-crisis

 What is the usual financing model (e.g., are some services free? Where do facilities receive their

funding?)?

Crisis-emergent

 To what extent could financial resources for health services, at any level, be reduced, and when?

 To what extent could people’s ability to afford either the direct (user fees, drug costs) or indirect

(e.g. travel, sustenance of patients) costs of healthcare be curtailed, and when?

Role of non-state providers

Pre-crisis

 What proportion of health facilities is public versus private? What proportion relies on non-state

actor support (which actors?)?

Crisis-emergent

 To what extent do existing non-state providers, if any, seem able to maintain service provision?

Supply chain
Pre-crisis

http://www.who.int/hac/techguidance/tools/disrupted_sectors/en/

39

 How are pharmaceuticals/medical supplies procured, stored and supplied to public health

facilities? Is there a national medical store?

 How dependent is the health system on locally produced pharmaceuticals? Are there issues with

pharmaceutical quality?

Crisis-emergent

 What disruptions to the medical supply chain are occurring or likely to occur, and when?

Alert and response

Pre-crisis

 What is the name of any epidemic surveillance system, and what was its actual functionality in

the affected area?

 How prompt and effective was the health system’s response to past epidemics?

Crisis-emergent

 To what extent has the health system’s epidemic surveillance, alert and response capability

been compromised?

Human resources for health

Pre-crisis

 How many doctors/nurses/etc., including specialists, were working in the affected area? (inc.

ratios of staff to population)

Crisis-emergent

 To what extent is or could displacement / migration of human resources for health away from the

affected population occur?

Functionality of health services

Pre-crisis

 How many health facilities, by level (primary, EmOC [basic or comprehensive emergency

obstetric care], secondary, tertiary) were functional in the affected area, and where were they?

 Were there existing areas without access to functioning facilities?

Crisis-emergent

 How many health facilities, where, and at which level (primary, EmOC, secondary, tertiary) are

known or projected to have been damaged as a result of the crisis?

 How many people are known or projected to be without realistic access to functional health

services (primary, secondary, tertiary, EmOC, mental health, etc., as available)

Resilience of the health system to damage

Pre-crisis

 In the event of mass casualty events, what specialised trauma surgery and rehabilitation facilities

can injury cases realistically access? What is their approximate capacity?

40

 What evidence, if any, is there of emergency preparedness and resilience in the health system

(e.g. emergency supply stocks; contingency plans; safe hospitals)?

Crisis-emergent

 To what extent have any components of health services (staff, infrastructure, assets, or patients

themselves) been attacked or looted, and what is the pattern of attacks to date?

Access to healthcare
Pre-crisis

 What is the current situation in relation to healthcare access?

Crisis-emergent

 To what extent could crisis-emergent factors affect access to healthcare?

Humanitarian health system performance

Humanitarian health system performance is omitted from the short-form PHSA because no information in

this domain is typically available at the onset of a new crisis. It is typically also not available within the first

14 days of a crisis, but it is included in the long-form PHSA because it may be added as information

becomes available, and it is a crucial component of accountability of the humanitarian response.

Utilization of services

Pre-crisis

Describe the existing and crisis-emergent utilisation of preventive and curative health services, including:

 outpatient utilisation rate (consultations per person per year)

 Number of procedures (c-sections, births attended by skilled attendants, trauma surgeries)

performed

Crisis-emergent

 To what extent could crisis risk factors reduce utilisation of preventive and curative services, and

when
Quality of humanitarian health services

 What has been the coverage of humanitarian vaccination campaigns?

 Case fatality rates from known conditions compared with benchmarks (e.g., <1% for cholera, <10%

for complicated SAM)

 Anything else known about quality of health service delivery, and competency of human

resources for health
Crisis-emergent

 To what extent could crisis risk factors reduce the quality of health services, and when?

41

A nnex 8: A ppropriate methods for the collection of primary data
Table 6. Appropriate methods for collection of statistics and data, by type of information. From

Checchi et al., Lancet

Type of information
Prospective

surveillance

Population sample

survey

Analysis of

programme data
Other methods

Affected population
size and composition

Community-

based

demographic

surveillance

Residential structure

tally plus structure

occupancy

estimation

Vaccination or

nutritional screening

data combined w ith

expected age

structure

Area estimation plus

population density

estimation

Various qualitative or
convenience methods

Exposure to armed
attacks

Facility-based
surveillance of injuries
and attacks against
health

Retrospective survey
of individual
exposure to injury

Conflict analysis
(tracking of media and
other informant reports)

Sexual and gender
based violence

Facility-based
surveillance of SGBV
cases

Retrospective survey
of individual
exposure to SGBV

Conflict analysis
(tracking of media and
other informant reports)

Food security and

feeding practices

Household
livelihoods, resilience

and coping, food

access, food

consumption and

feeding practices
survey

Agricultural production
monitoring

M arket analysis

Household focus

groups

Desk-based food

security risk assessment

Nutritional status Repeated

anthropometric

sampling from sentinel
communities

Anthropometric
survey

Trend analysis from
community- or facility-

based
anthropometric

screening, and
CM AM admissions

Desk-based nutritional
risk assessment

Physical health Early Warning Alert
and Response

Netw ork system
(EWARS) for epidemic
alert and response

Survey to measure
point prevalence of

chronic diseases or

retrospective

incidence of acute

disease syndromes

Analysis of facility-
based morbidity and

mortality data

Desk-based disease risk
assessment and

situation analysis

Tracing and tracking of

people in need of

treatment continuation

Mental health Collecting data

covering serious

mental health

symptoms as part of

general facility-based

health surveillance.

Adding questions

covering serious
mental health

symptoms to general

health surveys

Analysis of HM IS
morbidity data

Literature (desk) review

Services mapping

Participatory

assessment

Service availability
and functionality

HeRAM S (w ith

updated

geographical

database of facilities)

Who What Where
When (4W)

Service coverage

Coverage survey

(vaccination, health

services, nutritional

programme, etc.)

Comparison of actual

programme outputs

vs. target

beneficiaries

Focus groups, other

qualitative methods for

exploring service

utilisation and barriers

Service effectiveness

Analysis of HM IS data
(e.g. on cure rates)

Facility audits and spot
checks, patient ex it
interviews

Population mortality Community-based
demographic

surveillance

Passive “body count”
surveillance

Retrospective
mortality survey

(verbal autopsies as

add-on to explore

causes of death)

Census (post-w ar) and
demographic

modelling

Capture-recapture
analysis

Indirect (model-based)

estimation

History and political structure

Sri Lanka is a multi-party democracy with a semi-presidential system in which the President serves as the head of state and government. The President exercises executive power on the recommendation of the Prime Minister and the Cabinet of Ministers.1 Major Political party in Sri Lanka includes All Ceylon Islamic United Front, All Ceylon Makkal Congress, All Ceylon Malay Political Union, All Ceylon Tamil Congress, and Aziz Democratic Workers Congress.2

The two main ethnic groups on the island, the Sinhalese and the Tamils, and its two main religions, Buddhism and Hinduism, all immigrated to the island from India. Indian culture is also strongly present in a variety of fields, including astronomy, art, architecture, literature, and music.3

Overview of Sri Lanka demographic information

The population of Sri Lanka is projected to grow to 21.41 million people by the end of 2020.4 According to current estimates; the population will peak at 22.19 million people in 2037, which will start to decline. The population is projected to decrease to 15.46 million people by 2100.4Since 2000, Sri Lanka’s population growth has been less than 1%. The population increased by 0.42 percent, or around 89,000 individuals, between 2019 and 2020. Although Sri Lanka has a considerable negative net migration that slows population growth, the fertility rate of 2.21 children per woman is higher than the population replacement rate of 2.1 children per woman. In the following decades, as the fertility rate continues to fall.4

Main characteristics of Sri Lanka humanitarian crisis

Time is running out for Sri Lanka on many fronts. With 6.7 million people urgently needing humanitarian aid, Sri Lanka’s economic crisis is quickly becoming one of the greatest humanitarian disasters in decades. The Ministry of Health is collaborating closely to supply hospitals with critical medications currently in limited supply.5 Over 20,000 people, including protesters and security personnel, have received emergency medical care from first responders and Red Cross ambulances throughout the most recent protests. In addition, over a thousand people received ambulance services from SLRCS. They were taken to hospitals for additional care.5As the humanitarian effects of the economic crisis continue to grow, millions of people are experiencing shortages of food, gasoline, cooking gas, vital supplies, and medicines.5 Sri Lanka’s health workforce’s capacity deal with the probably heightened demand for medical .personnel.

As the humanitarian effects of the economic crisis continue to grow, millions of people are experiencing shortages of vital supplies and medicines.6 The current crisis, with increasing shortages of medicines and other essentials, has a profound impact on

maternal and child health

, social determinants of health, and the threat of another wave of COVID-19 cannot be ruled out. The current medicine shortage has made day-to-day service provision of healthcare difficult for government and private hospitals. Thus, in the instance of increased demand for medicines – be it the pandemic, a natural disaster, or any other crisis – Sri Lanka looks at severe consequences, including loss of lives.3

SRI LANKA- HUMANITARIAN CRISIS

Country Facts9

Sri Lanka has roughly 65,

61

0 square kilometers. Its coastline stretches for 1,340 kilometers. This country has an average population density of about 319 people per square kilometer when the amount of land available is compared to the number of residents. Columbo capital city, is the oldest, most significant, and most populated city, with a population of 648 034 people.

Events responsible for crisis

Bombing (2019)

Reduce taxes

Banned on import of chemical fertilizer

Population Rank

61

Growth Rate

0.30% (174th)

World Percentage

0.28%

Density

348/km² (38th)

Land Area

62,710 km²

References

1. Roberts M. Exploring confrontation: Sri Lanka: politics, culture, and history. Routledge; 2021 September 1.

2.”The Devastating Health Consequences of Sri Lanka’s Economic Collapse.” The BMJ. Last modified June 29, 2022.

https://doi.org/10.1136/bmj.o1543

.

3.” Sri Lanka’s Public Health System Crippled by the Economic Crisis is Calling out for Help — Perspectives on Global Health.” Perspectives on Global Health. Last modified April 23, 2022.

https://www.perspectivesmcgill.com/opinion/medicineshortage

4. “Demographics of Sri Lanka.” Wikipedia, the Free Encyclopedia. Last modified February 25, 2002. https://en.wikipedia.org/wiki/Demographics_of_Sri_Lanka.

Bibliography 

5Vaidyanathan, Rajini. “Sri Lanka Healthcare on the verge of Collapse in Economic Crisis.” BBC News. Last modified April 17, 2022.

https://www.bbc.com/news/world-asia-61111405

.

6. WHO | World Health Organization. Accessed July 27, 2022.

https://www.who.int/docs/default-source/health-workforce/health-labour-market-analysis-in-sri-lanka

7.”The Devastating Health Consequences of Sri Lanka’s Economic Collapse.” The BMJ. Last modified June 29, 2022. https://doi.org/10.1136/bmj.o1543.

Webpage

8.” Exploring Confrontation | Sri Lanka: Politics, Culture and History | M.” Taylor & Francis. Accessed July 27, 2022. https://www.taylorfrancis.com/books/mono/10.4324/9781315077277/exploring-confrontation-michael-roberts.

Webpage

9.” Sri Lanka Population 2022 (Demographics, Maps, Graphs).” 2022 World Population by Country. Accessed July 27, 2022. https://worldpopulationreview.com/countries/sri-lanka-population.

“Sri Lanka on the brink of Humanitarian Crisis.” IFRC. Accessed July 27, 2022.

https://www.ifrc.org/press-release/sri-lanka-brink-humanitarian-crisis

.

9.Peiris, G. Hubert and Arasaratnam, . Sinnappah. “Sri Lanka.” Encyclopedia Britannica, July 24, 2022. https://www.britannica.com/place/Sri-Lanka.

Economic status

A few years ago, Sri Lanka’s economy expanded quickly enough to give most people jobs and financial security. Its officials are feverishly attempting to negotiate a bailout with the International Monetary Fund. Still, the country is now in a condition of collapse and depends on handouts from India and other nations.6 The 22-million-person South Asian Island nation is experiencing a complete economic breakdown that is worse than the typical financial crises in developing countries. It has resulted in political unrest and violence and made it difficult for the average person to afford food, fuel, and other necessities. Sri Lanka’s sudden economic collapse has broken its healthcare system. Sri Lanka’s economic crisis caused by years of excessive borrowing and poor policies of the current administration has plunged the country into an unprecedented crisis. Sri Lankan Rupee has become the worst performing currency in the world; the country faces an increasing scarcity of essentials.6 The public is continuously protesting, calling for the resignations of the President, prime minister, and the administration, highlighting the government’s mismanagement, apathy, and corruption.

The Office of the United Nations Commissioner for Human Rights publicly condemns the government’s efforts to curb the protest. In 2019, the government cut taxes and incurred large debts, depleting the treasury just before COVID-19 arrived. Due to the sharp decline in its foreign exchange reserves, Sri Lanka could not cover import costs or protect its battered currency.5

Sri Lanka map9

‘s rupee.8

SRI LANKA

SRI LANKA- HUMANITARIAN CRISIS

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