Main Health Issues Post Tsunami

1
Main Health Issues Post Tsunami WHO Action in
Aceh
Presented by Faisar J.WHO Banda Aceh, 7
October 2005, Medan
2
General Issues

• Tsunami highlights the vulnerability of health
  services in Aceh
• Health emergency preparedness system is not in
  place
• High dependency on external sources aid in
  implementing coordination, planning and
  implementation.
• Access to health service for the poor is not
  sufficiently established.
• Referral health system is not well established.

3
Priority Health Issues Brought Up by Community

• Maternal Child Health
• Nutrition Status
• Malaria
• TB
• Diarrhoea
• Acute Respiratory Infection
• Dengue
• Leprosy
• Skin Infection
• Mental Health
• (Based on DTPS Meeting on October 1st)

4
Problematic Areas Raised by Health Service
Providers

• Policy Strategy
• Health Human Resources
• Health Facility Logistic
• Health Planning Financing
• Community Health Service
• (Based on Aceh Health Strategic Planning
  Workshop, September 19th, Brastagi)

5
1. Problems Identified Within Policy
Strategy Area

• Pre tsunami financial law does not reflect
  current planning needs.
• Even post tsunami, release of fund is still at
  the end of budget year.
• WHO Response
• Supporting the reestablishment of Aceh Health
  System ( Technical support, RENSTRA 2006-2010,
  DTPS, health sector coordination support).

6

• B. Too many coordinating bodies claiming rights
  to control the situation
• WHO Response
• Work closely with BRR and PHO in coordinating
  health emergency response activities, avoid
  project duplication and evaluating proposed
  concept notes from aid agencies.
• Work closely with PPMK in operating HEIOU in
  identifying who doing what where.
• Supporting PHO, DHO's, and Hospital in preparing
  long term coordination planning (RENSTRA)

7

• C. Unclear policies regulating access for poverty
  affected population due to tsunami and conflict,
  to basic health services
• WHO Response
• Supporting the reestablishment of Aceh Health
  System ( Technical support, RENSTRA 2006-2010,
  DTPS).
• Initiate the establishment of Hospital
  Redevelopment Steering Community.

8

• D. Not equal distribution of qualified health
  personnel between urban and rural areas.
• WHO Response
• Supporting PHO, DHO's and Hospitals in preparing
  Health Sector RENSTRA.
• CPDMS training, target all health service
  provider in Aceh.

9
2. Problems Identified In Relation to Human
Resources Management

• A. Not enough skills to collect and use
  effectively health data for decision making.
• WHO Response
• DTPS for 21 districts management team.
• Hospital Management Training (1 Week Comparative
  Study Training) in Penang
• Workshop on Health Information System for 21
  Districts
• Workshop on Hospital Information System for all
  hospital in Aceh.

10

• Logistic skills not sufficient to support
  effective distribution.
• Open access for various drugs and medicine.
• WHO Response
• Provided funding for the destruction of damaged
  drugs and medicine in Meulaboh and Banda Aceh
• Training of Trainers (TOT) in Pharmaceutical
  Waste Management for 21 DHO's in Aceh
• Training of pharmacists (in collaboration with
  PSF-CI) on good warehousing practices
• Training of Trainers (TOT) in Pharmaceutical
  Waste Management for 21 DHO's in Aceh.

11
3. Problems With Damaged
Infrastructure Logistic

• A. Limited local resources
• Construction of Calang Pharmaceutical Warehouse
  (co-funding with AusAID)
• Donated equipment to the laboratory of Balai POM
  di Banda Aceh
• Equipped the hospital Laboratory and trained 3
  lab technicians and the lab Director in Meulaboh
  Hospital

12

• A. Limited local resources
• Provided emergency health kits, essential
  medicines, diagnostic kits, and medical supplies
  to public health facilities and NGOs
• Distribution of cars to DHO, PHO and hospitals,
  especially in district who receive significant
  impact of the tsunami and earthquake.
• Equipped the hospital Laboratory and trained 3
  lab technicians and the lab Director in Meulaboh.

13

• Resources use does not take into consideration
  changes and distribution of post tsunami
  population.
• WHO Response
• Supporting the reestablishment of Aceh Health
  System ( through RENSTRA 2006-2010 planning),
• Hospital revitalization workshop, inviting DHO,
  PHO and hospitals, especially in the tsunami
  affected area.

14

• C. Lack of special civil engineering standards
  for disaster prone area.
• WHO Response
• Training on Mitigation Damage of Health Facility
  (MDHF) due to Disaster.
• Encouraging a National Policy on MDHF due to
  Disaster.

15
4. Problems With Planning Financing

• Limited government fund to meet demand for
  emergency health services.
• Release of fund at the end of budget year.
• WHO Response
• Supporting health sector lng term redevelopment
  planning (RENSTRA)
• Working with MOH's Crisis Centre in opearting
  Health Emergency Information Operation Unit.
• Technical Financial support PHO and DHO.

16
5. Problems with Service Delivery

• Supervision monitoring insufficient for quality
  assurance.
• WHO Response
• Installation of computers, internet, tables and
  chair, photocopy machines, etc in the PHO.
• Supporting PHO's and Provincial Hospital Health
  Sector Coordination Role.

17
5. Problems with Service Delivery

• B. Curative service more important than
  preventive efforts.
• WHO Response
• Disease surveillance, including surveillance
  training.
• Measles Campaign and NID
• Health Care Waste Management
• Supporting PHO DHO in vector control program
• Mental health training for PHO, 21 DHO's and
  Psychiatric Hospital.
• To balance long term curative service plan and
  preventive efforts plan in RENSTRA Planning.

18
Curative service more important than preventive
efforts.

• Training on Management of Severe Malnutrition in
  Pidie, Aceh Besar, A.Barat, A.Timur, A.Utara,
  Kota Lhokseumawe and PHO.
• IMCI socialization, training and facilitators
  workshop in 11 districts
• Support PHO and DHOs for School Health Program
  revitalization in 7 districts

19
Recommendation

• Decentralization give local decision maker more
  authority to make change. District Government
  should allocate more budget for health sector,
  especially to ensure the quality of health
  services for the poor.
• PHO and DHO need to revitalize it's
  organization's structure, task and function to
  deal with the increasing need on coordination of
  health services and recovery acceleration need.
• Health sector in Aceh must put priority to the
  development of health information system to
  support health planning, monitoring and
  supervision needs.
• PHO and DHO need to take a lessons learnt that
  Aceh is located in disaster prone area and must
  have a good health emergency preparedness system.

20

• THANK YOU