Humanitarian Health Action

Purpose statements for panels and sessions

WHO Conference on the Health Aspects of the Tsunami Disaster in Asia

Session 1.4: Health services delivery: a critical review of experience


Delivering health services both during and after disasters is crucial to preventing excess morbidity and mortality. Trauma and exacerbated medical conditions demand attention in the immediate phase of emergencies. In the longer term, mass displacement raises the risk of communicable diseases. Psychosocial and reproductive health issues also need to be addressed, as does physical rehabilitation from injuries. All of these health needs and many others came to the fore following the December 26th tsunami. Paradoxically, disasters themselves challenge the ability of health professionals to provide services at the time they are most necessary. The tsunami stole the lives of doctors, nurses and other health workers. It also swept away clinics, damaged hospitals, and cut critical supply lines. While accessing health care became more difficult, in many areas the demand for health services increased.

After the tsunami, as is commonly the case with disasters, a combination of ad hoc and formal health efforts, both national and international, were made. Responders provided care in health facilities that ranged from undamaged to damaged, rehabilitated, or newly-built. Materials and supplies came from national stores and international donations, with varying degree of appropriateness. They were delivered by road, boat, and air, and in civilian and military vehicles. At certain times and places, health service was provided for free. At others it came for a fee. National and international providers, civilian and military, NGO and IGO, sometimes worked cooperatively, and at other times set up parallel structures or differed on health care priorities and the nature of services to be provided.

Many aspects of health services delivery lend themselves to quantitative analysis, including number and type of clinic visits, lengths of hospital stays, and amounts of various medicines dispensed. The outcome of service provision may be estimated by dint of the mortality and morbidity of the population served. This panel will offer a quantitative and qualitative review of health services provision in diverse tsunami-affected regions. The goal is to identify ways to build on and improve health service delivery in future disaster responses.

Key questions

Needs assessment: How did service providers and others assess the health status and existing and potential needs of the population? To what extent were shortfalls in supplies, medications and human resources measured before designing and implementing a response? How were supply line integrity and warehousing needs assessed? In what ways was assessment information shared between various agencies and donors? Did stakeholders participate in shaping health service delivery responses? Were the qualifications and numbers of responding service providers appropriate to the assessed needs?

Coordination: How did community, national and international service providers work together? To what extent did they work apart? How was information shared? What points of contention arose? In what ways did donor, UN and WHO actions support service provision, and how could that support be improved? When multiple agencies wished to contribute health services in areas that did not require all of their support, what was the result, and how could such overlap be resolved in the future?

Gap-filling: What were the most and least successful models of health service delivery? What obstacles prevented patients from accessing health services? Conversely, what obstacles stood in the way of health professionals providing care? What logistical efforts were most successful and in what ways could logistics be improved? How was donated aid managed and distibuted? In what ways did or could technology play a role in improving service delivery? What were the results when national and international, civilian and military actors worked in parallel versus together? To what extent were psychosocial and pre-existing public and primary health services (e.g. regular vaccinations, TB therapy, chronic disease treatment) supported?

Capacity: What were some examples of pre-existing national disaster preparedness plans that succeeded? What is being done to strengthen that capacity? What additional preparations have been made to deliver effective health services in the unfortunate event of future earthquakes, tsunamis or other disasters? What factors and capacities allowed certain agencies or military units to respond more quickly?