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Revised UN Humanitarian Appeal - Global Health Cluster Plan

Needs Analysis

Short-term needs (until May):

The January 2010 earthquake in Haiti caused massive mortality and countless injured who require surgery and trauma care. Many of the victims became disabled and will need specialized care. Homeless people gathered under improvised shelters or public spaces leading to overcrowding that, combined with poor living conditions, facilitates the spread of air-, water- and vector-borne diseases as well as the potential for epidemic diseases. The population has been strongly emotionally-affected and will require mental health and psycho-social support. The whole health system has been deeply affected in its infrastructure and organization affecting the capacity of the system to respond to the pressing health needs of the population. Livelihoods were lost, availability of food decreased, with particularly adverse effect on vulnerable groups including children. People with chronic diseases and HIV have been faced with the interruption of their treatment. SGBV is a looming risk. The rainy and hurricane seasons will start in the coming months, thus further complicating an already disastrous situation. The immediate risks include diarrhoea and waterborne diseases. Priority actions until May will focus on primary health care and mobile clinics to reduce morbidity and mortality among homeless people living in overcrowded conditions with poor sanitation. Specific preventive measures aiming at reducing the incidence of diarrhoea include the provision of adequate sanitation and in particular latrine building.

Overall needs

Coordination, needs assessment, monitoring and evaluation

Health services are being provided by all functional health centres in Port-au-Prince, other affected areas and areas hosting displaced populations. More than 246 teams, including local organizations and teams from different countries and INGOs, are supporting government efforts to treat the injured and ill. This tremendous influx of human resources and supplies has generated a substantially increased need for coordination, with health partners as well as with local authorities. Good decisionmaking depends on the availability of information on needs, trends, risks, local and external resources.

It is essential that the support and assistance for the relief phase be linked to sustenance of essential health services. The revitalization and recovery of the health system needs to take place in a coordinated, coherent and comprehensive manner, so that no critical gaps are left during the transition from relief to early recovery.

In order to harmonize the reactivation of services and efforts to better rebuilding the health system, it is key to work in coordination with and under the leadership of the NHA. Indeed, the vision and leadership of the NHA with regard to the post-disaster needs assessment (PDNA) exercise must help to align efforts of key players in order to make the best possible use of the resources available to rebuild a more efficient and equitable health system.

Outbreak Control and Disease Surveillance

Population displacement results in spontaneous, overcrowded resettlement areas, raising the risk of transmission of certain communicable diseases, such as vaccines preventable diseases, in particular measles and diphtheria, but also meningitis, HIV, TB, acute respiratory infections and diarrhoeal diseases. Un vaccinated children against measles have accumulated since last catch up campaign, because of low routine vaccine coverage’, so that reintroduction of measles is a concern which would take a heavy death toll given the poor nutritional status and low accessibility of curative care. A vaccination campaign in response to a diphtheria epidemic’s which took place from august to November 2009 with concentration of cases in metropolitan was interrupted by the earth quake. Tuberculosis (TB) and AIDS are among the leading causes of morbidity and mortality in Haiti. The country has the highest HIV and TB incidence in the Americas. In the acute phase of this emergency, the potential interruption to anti-TB and HIV treatment services and loss of patient follow-up is likely to be a significant problem.

Patients who have been injured during the earthquake or who will get injured as a consequence of the environmental hazards resulting from destruction are at risk of tetanus, which is already highly endemic in Haiti, both in its neonatal and post-neonatal forms. In addition, displaced populations may be at an increased risk of malaria and dengue due to an increased exposure to vectors. Epidemiologic surveillance, outbreak prevention, disease control measures and immunization are therefore essential.

Water supply and environmental health

More than a million people are living roofless and many will remain poorly sheltered at the arrival of the rainy season in an environment of poor sanitation related to poor waste and excreta management and risk of water contamination.

The structural damage to the already weak water, sanitation and electricity systems, the interruption in service that occurred in water provision and solid waste collection and the increase in the number of patients and therefore the quantity of medical waste, solid waste and excreta in health care facilities have resulted in an increased environmental risk to health through inadequate quantity and quality of water, inadequate sanitation and the disruption in the cold chain systems (morgues, storage of medicines and food). Providing safe water is all the more essential for medical use, for hygiene and for human consumption. Diarrhoea is already a major contributor to the high rates of under-five mortality; PAHO/WHO estimates that diarrhoea accounted for 16% of under-five deaths in Haiti before the earthquake of the 12 January 2010.

Damage to water infrastructure of health services, poor management of waste, including health care waste, can potentially expose health care workers, waste handlers, patients and the community at large to infection, toxic effects and injuries as well as increasing the risk of polluting the environment. The collection of solid waste and medical waste is essential to control the spread of vectors, and the collection of sewage limits the spread of infectious and water-borne diseases.

The current situation promotes the proliferation of vectors and therefore vector-borne diseases (mosquitoes, rodents and flies).

Basic health care services

The destruction of health infrastructure and the displacements of population following the earthquake have increased the need of support with regard to the delivery of basic health care services in all health facilities, not only those directly affected by the earthquake. The capacity of the national health institutions must be repaired and strengthened, health facilities need to be re-equipped. It is necessary to ensure that comprehensive secondary and tertiary health services (system and structures) are available nationwide. Services must be reactivated as soon as possible in a new health system based on primary health care.

People affected by the earthquake currently living in overcrowded conditions and in a poor environment have a higher risk of airborne and waterborne diseases and particular attention should be paid on reducing avoidable excess mortality associated with this displacement situation. The capacity for diagnosis and treatment is an essential component of the provision of health services. It is important to have functional laboratories with the capacity for clinical testing and epidemiological surveillance. In the same aspect the accessibility of blood for those patients who are in need should be strengthened by reinforcing the national capacity in blood collection, testing and adequate use of blood.

Key reproductive health interventions should prioritize safe delivery, acute care of the newborn, family planning and clinical management of rape. These interventions are critical components of the Minimal Initial Service Package (MISP) for reproductive health, an international standard which identifies lifesaving interventions which must be implemented even in the acute phase of an emergency and sustained beyond this phase.

Non-communicable diseases (NCDs) are recognized as an important health concern in Haiti. Chronic conditions, including cancer, cardiovascular diseases, diabetes, chronic respiratory disease and neuro-psychiatric disorders, account for an increasing proportion of the disease burden. The priorities during the acute phase of this emergency are to minimize treatment interruptions.

Psycho-social support is essential for people who have lost their families and their property. It is important to ensure that mental health patients continue to receive assistance and that culturally sensitive psycho-social support is available at community level. Mental health and psycho-social needs are expected to increase significantly not only in the short term but also in the long term. Particular attention should be given to vulnerable groups such as children, women, those who suffered amputations, health care workers, and others.

Mobile clinics will be of increased importance, particularly as the rainy and hurricane season are rapidly approaching. Homes and shelters established after the earthquake are at risk to be flooded, just as much as the PHC clinics.

Development, retention and scaling-up of human resources are areas that need to be addressed as a key element to ensure quality health care provision.

Treatment and rehabilitation of injured patients

The UN Convention on the Rights of People with Disabilities, which was ratified by Haiti on 23 July 2009 requires the provision of specific health services needed by people with disabilities, including early identification and intervention as appropriate, and services designed to minimize and prevent further disabilities.

It is imperative for a country like Haiti that is facing such catastrophic effects resulting from the earthquake to count on a specialized institute on medical rehabilitation. Indeed institute-based rehabilitation (IBR) – or medical rehabilitation – will play a role not only in the immediate but also in the mid- and long-run response. Rehabilitation capacity needs to be strengthened within the health sector at all levels: hospital / rehabilitation centres, primary care and community levels. Referral mechanisms and linkages between these levels need to be developed to ensure optimal outcomes. Medical rehabilitation is focused on restoring abilities, and should begin as soon as possible after emergency trauma care has been provided and continue until the person return to his/her community.

The functional recovery of people with injuries often involves complex rehabilitative measures, including not only coordinated input from a team of rehabilitation professionals (physiatrists, physiotherapists, occupational therapists, prosthetists, and orthotists) but also the involvement of orthopedic surgical teams that often needs to re-op cases that were treated during the emergency. In Haiti, there is no such rehabilitation medical institute, so, special efforts might be deployed to put in place one as soon as possible. Such a national institute for rehabilitation will contribute to reinforce the health system in order to better cope with the mid and long-run needs of the thousands who have been handicapped by the aftermath of the earthquake.

Beside institutional rehabilitation services, development of some community-based rehabilitation (CBR) services for early identification, referral and support will be essential. The essential psychosocial support that is to be offered to patients in the process of rehabilitation must to go hand in hand with the reactivation of the basic health services.

Essential drugs and medical supplies

A large number of hospitals and other health facilities lost their stock of medicines and medical supplies during the earthquake. The loss of these stocks as well as the need for additional essential drugs and medical supplies due to the number of wounded after the earthquake needs to be addressed. In addition, a large number of the response agencies that arrived in Haiti did not come prepared to face the scale of the disaster and are obtaining their medicines and medical supplies from the PAHO/WHO Essential Medicine Programme (PROMESS). Furthermore, as the central medical store PROMESS is also receiving donations from different bilateral donors that provide supplies to PROMESS that are to be further distributed, there is a need to increase the operational capacity of PROMESS to be able to respond to this new challenge. In addition, during the emergency period, it is very important for PROMESS to get an estimate of the needs not only in Port-au-Prince, but throughout the country. PROMESS is strengthening its relationship with partners in health involved in the supply chain management, and will try to bring all partners on board, in close collaboration with MoH. The development of a strategy to push deliveries to the field must be accompanied by rapid assessment of institutions and organizations beneficiaries of the aid.

Objectives and activities

The overall objective of the intervention is to save lives and prevent further deterioration of public health conditions in the earthquake-affected areas. The Health Cluster will work with the NHAs to ensure a coordinated response to mitigate the avoidable morbidity, mortality and disability of the Haitian population related to the earthquake and subsequent population displacement. In line with the other priority clusters, the Health Cluster has identified the priority short-term objective as follows.

The specific objectives and related activities include the following:

1) Effective coordination of the Health Cluster response, needs and disaster risk assessment, monitoring & evaluation, under the authority of the NHA

Activities

• Coordination of international health assistance within the Health Cluster.
• Support the Disaster Response Commission set up by the national Government.
• Promote the establishment of an Emergency Operation Centre within the MoH.
• Carry out rapid health assessments.
• Conduct health assessments on needs, damage, impact and gaps in the assistance including monitoring and evaluation.
• Monitor mortality and morbidity trends, set up early warning systems.
• Map local resources available as well as external support including the foreseen length of that support.
• Assess risks and initiate disaster risk reduction activities.

Indicators

• Information available for decision-making: disaggregated information on institutional assessment, trends, service provision, mapping and state of local health structures, activities and location of international cooperation, and early warning system.
• Percentage of steering role functions reaching “good capacity”, as measured by established guidelines, by the MoH&P (baseline n/a, target 20%).

2) Ensure outbreak control and disease surveillance

Activities

• Re-establish the capacity of prevention and control of communicable diseases through the establishment of an emergency communicable disease surveillance system (Early Warning Alert and Response Network) and strengthen the routine disease reporting system.
• Strengthen the HSIS.
• Ensure immunization including mass vaccination campaign against measles, diphtheria, and tetanus and prepare response to outbreaks of communicable diseases.
• Ensure vector-borne and zoonotic disease control activities.

Indicators

• Sentinel sites reporting rate on communicable diseases occurrence (baseline n/a, target 60%).
• Vaccines coverage (MR, DPT, DT) (baseline n/a, 90% of targeted populations).
• Percentage of targeted families (in temporary settlements) provided with a mosquito net (baseline 0, target 95%)

3) Ensure adequate water supply and environmental health

Activities

• Re-establish the capacity of prevention and control of communicable diseases through the establishment of an emergency communicable disease surveillance system (Early Warning Alert and Response Network) and strengthen the routine disease reporting system.
• Strengthen the HSIS.
• Ensure immunization including mass vaccination campaign against measles, diphtheria, and tetanus and prepare response to outbreaks of communicable diseases.
• Ensure vector-borne and zoonotic disease control activities.

Indicators

• Percentage of public hospitals with water quality test results that reach guidelines values 80% of the time (baseline n/a, target 60%).
• Percentage of public hospitals where hygiene education training activities are carried out monthly (baseline 0, target 60%).
• Percentage of public hospitals with a sanitation strategy (baseline 0, target 50%).
• Percentage of public hospitals with a comprehensive health care waste management strategy defined (baseline 0 target 60%).
• Percentage of hospitals where integrated vector control management training is carried out (baseline 0, target 80%).
• Number of departments in which a human rabies surveillance system is established (baseline 0, target 5).

4) Re-activation of basic health care services for a more integrated health system base in primary health care

Activities

• Proper and timely management of communicable diseases, particularly water and air-borne.
• Emergency basic repairs to health facilities/temporary health facilities.
• Strengthening non-affected health facilities to serve the affected population.
• Ensure continuity of primary health care services, including reproductive health (including emergency obstetric and neonatal care; maternal and child health, and prevention and management of sexual violence) and including treatment against tuberculosis and HIV/AIDS.
• Support the management of chronic diseases.
• Support the provision of mental health and psycho-social support according to internationally agreed guidelines (Inter-agency Standing Committee [IASC]).
• Establish and strengthen mobile clinics for primary health care.
• Support human resources to ensure health delivery and re-equipping affected health facilities.
• Support diagnosis and treatment services (blood bank, laboratory, X-Ray, imagery).
• Prevention, screening and treatment of acute malnutrition.

Indicators

• Percentage of public network hospitals providing basic health services, as recommended by WHO (baseline 16, target 60).
• Number of mobile clinics activated and distributing PHC packages (baseline 0, target 80).
• Proportion of institutional deliveries (baseline 24%, target 30%).
• Percentage of biomedical investigation lists that are undertaken by national public health laboratory (baseline, target 80%).
• Percentage of biomedical investigation lists that are undertaken by the departmental public health laboratories (baseline, target 50%).
• Quantity of blood collected from voluntary donors (baseline 75%, target 90%).

5) Effective treatment and rehabilitation of injured patients

Activities

• Support the treatment of injuries and emergency services including referrals of patients.
• Ensure the access to a free orthopaedic unit (follow-up of patients).
• Ensure the proper functioning of at least one specialized institute on medical rehabilitation (IBR).
• Set up community-based rehabilitation services (CBR).
• Ensure the availability of assistive devices and technologies such as wheelchairs, and prostheses.
• Support mid- and long-term training for human resources rehabilitation specialists (physiatrists, physiotherapists, occupational therapists, prosthetics, and orthotists) as well as orthopaedic surgeons and nurses.

Indicators

• Percentage of people with physical impairment that have had access to rehabilitation services (baseline 0, target 60%).

6) Ensure availability of essential drugs and medical supplies

Activities

• Provide essential medicines, surgical and trauma kits, essential medicines and health supplies based on assessments.
• Ensure the proper functioning and development of the PAHO managed Haiti's central procurement agency for drugs and pharmaceutical supplies (PROMESS).

Indicators

• Number of hospitals with most critical drugs and medical supplies on hand (based on established list) based on on-site assessments (measured quarterly) (baseline = n/a, target = 100).
• Value of medicines and medical supplies distributed.
• Percentage of hospitals and departmental depots that meet international standards of good drug management.

Throughout health interventions, it is important to ensure that gender equality and other cross-cutting issues are addressed including by: ensuring needs assessments include gender analysis and collection and analysis of sex and age disaggregate data as well as data on those with specific priority needs (including physical and mental disability); ensure gender balanced assessment teams; ensure response design takes into account the different needs, potential barriers, and ensure equal access to health services; ensure women and adolescent girls and boys are included in planning and implementation of health sector activities; implement MISP for RH in crises including providing nonstigmatizing care for survivors of sexual violence; ensure that communication strategies are developed and implemented to highlight the specific health risks affecting women, men, boys and girls including specifically targeting adolescent girls and boys; ensure coordination with other sectors and incorporation of cross cutting issues, ensure health services are accessible to women and children (girls especially) (e.g. setting up private consultations rooms for women and girls, recruiting female staff were possible). Ensure that communities (women, men, boys and girls) are aware of how and where to access needed health services.

Table of coverage per site

A link to the list of health sites and coverage per site is available from the Health Cluster page on

• OneResponse

Sectoral monitoring plan

Health Cluster meetings are taking place on a daily basis, the sub-groups of the Health Cluster (basic health services and clinics, hospitals, information management) meet twice a week. Several working groups are established in order to address special health topics, also organized by regions. A situation report and Health Cluster Bulletin which provide information about the health situation and progress made is regularly issued. Assessments and field visits are ongoing.

Contact Information

Dr. Henriette Chamouillet, PWR Haiti
E-mail: chamouihen@hai.ops-oms.org