Post-Nargis Joint Assessment (PONJA

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coordination hubs in townships to support the coordination and management of health activities and ensure liaison with local health authorities

A Summary of Health-Related Issues

Website:www. whomyanmar.org Email: whommrnargis@searo.who.int, searnargis@searo.who.int

The Post-Nargis Joint Assessment (PONJA) is a comprehensive multisectoral assessment of the situation in the areas of Myanmar affected by Cyclone Nargis. It has been coordinated jointly by the Government of Myanmar, ASEAN and the United Nations. This is a summary of salient health issues from the PONJA report.

Key Health Findings
Impact on Health facilities
• Two-thirds of health facilities suffered some damage. One out of five was totally destroyed. Most of them were small, rural primary care centres. About half of the remaining damaged health centres have received some repair. • • The estimated cost for rebuilding health facilities is 12.8 billion Kyats (US$2 billion). Before the cyclone 80% of people lived within an hour of a health facility. Disrupted supply and destroyed facilities have decreased access, especially to preventive health serv ices. More than half the people surveyed (56%) reported inadequate access to health care. In comparison, about a third (36%) reported inadequate access to food. • After the cyclone, the proportion of health centres with limited supplies of medicines rose from 10% to 21%. Most of these facilities are staffed only by community health workers and midwives. • The nearest health facility for 11% of people was a private doctor's office. Only 5% of the people surveyed reported having access to mobile clin ics, many of which are run by NGOs.

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Health institutions offering antenatal services declined by 5%, those with delivery care declined by 9%, and those offering immunizations declined by 16% since the cyclone.

Water and Sanitation
• Poor sanitation due to cyclone-related destruction is a major problem. The proportion of people with latrines decreased from 77% to 60% after the cyclone while those without any kind of sanitary waste disposal doubled from 8% to 16%. • • This increases the potential risk of disease outbreaks. 60% of people report that access to clean water is inadequate, and are depending on rainwater because ponds, the traditional sources of water in villages, have become contaminated with seawater.

Impact on Health of the People
• The most common current health problems reported are diarrhoea (34%), fever (37%), cold (39%) and respiratory problems (22%). Trauma and injury accounted for 8% of complaints. About 65% of people reported a health problem in the 15 days before the Village Tract Assessment (VTA) of PONJA began in June. About a quarter of all respondents listed more than one condition.

Mental Health and Psychosocial Issues
• A reported 7% of families suffered a death in the family since the cyclone. The average reported number of deaths per household was 2.2. With an average family size of 5, this represented 3% of all members of surveyed households. Health workers reported deaths in 36% of all villages. • • Women were much more likely than men to have died; 3% of adult men and 6% of adult women died in the affected areas surveyed. Following so much destruction and death, the biggest current health need is for psychological support: 23% of people reported 2

psychological problems since the cyclone, while only 11% reported receiving any care.

Recommendations from PoNJA
Short-Term Recovery Needs
• Ensuring basic health services with the provision of services and referrals; medical services for the injured, disabled and those suffering from mental disorders; and other groups made vulnerable as a consequence of the cyclone. • • Ensuring adequate epidemiological surveillance of the population and preparedness to identify and respond to disease outbreaks. Carrying out temporary repairs and preparation for the restoration phase.

Medium-Term Restoration Needs
• Preparation of integrated township plans. • Revitalization and restoration of regular health services, including housing for health workers, equipment, supply and vehicles. o Continued selective support for temporary services. This would include funds for: (i) temporary facility rent and other associated expenses pending completion of the restoration programme; and (ii) costs for preventive and public health services including through mobile teams, as agreed in the township plans. o Support for human resource development (including training) and deployment. o • • Support for management and coordination of health services, especially at the township levels. Enhancement of Emergency and Disaster Management Abilities. Identification of Capacity and Implementation Constraints.

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The Health Response to Date
• • The Government of Myanmar and the international community have rallied assistance. ”Build Back Better” is the guiding principle. The Ministry of Health has posted thousands of medical and public health specialists to the affected areas and several hundred NGO workers are also providing care. • The Health Cluster in close collaboration with Ministry of Health has developed a joint plan of action. Health needs identified by PONJA assessment will be incorporated into this plan. • The four priorities of the Joint Plan are: 1. Coordination among partners to ensure the most efficient use of all resources; 2. Continuous assessment and monitoring of health needs and ways to meet those needs; 3. Response to existing gaps; and 4. Strengthening and revitalizing health systems. Coordination • Health Cluster partners are working in townships with local health authorities to make recovery and reconstruction plans with improved services and more resilient health facilities. • Health Cluster leads have been appointed at township level from among the Health Cluster partners active in the respective townships. They will facilitate coordination of health activities at the township level. They will lia ise with local health authorities as well as NGOs working in health, water and sanitation, nutrition and other health-related issues, compiling and sharing information on health activities on a regular basis to facilitate joint planning, identification of gaps and avoidance of overlap. Revitalization of Health Services • Health services similar to those that were in place prior to the cyclone are already being established in temporary settings such as 4

community buildings, private homes and pagodas. By 12 months after the cyclone, facilities, services, equipment, supplies, and training should already be better than they were prior to the storm. The presence of a large and engaged health cluster working throughout the affected regions in coordination with health authorities will help make this happen. • Damaged medical equipment of affected health facilities will be replaced, including, for example, cold chain and waste-disposal equipment. • • Training and community health promotion activities are being planned to reactivate the primary health care system. Support to revitalization and expansion of existing programmes such as EPI, HIV and TB is being provided. Assessment and Monitoring of Health Needs • • The findings from PONJA will guide the health cluster response. Disease surveillance systems have been strengthened. A weekly bulletin reports the findings of the Early Warning, Alert and Response System (EWARS), which now integrates data from NGOs and the government. • In addition, specific joint assessments and public health intervention missions in the affected areas are being undertaken. For example, a survey of psychosocial needs in six affected towns is being undertaken by the Ministry of Health with support from the Health Cluster. • A logistics monitoring system is being developed to track drugs, medical supplies and equipment. This will support the development of a preparedness plan for disease outbreak. Response to Existing Gaps • NGOs and the Ministry of Health are focusing on immunization activities in collective shelters while midwives and community health workers provide this service in remote areas. 5

Sexual and reproductive health services are being strengthened and expanded and NGOs and UN organizations are contributing to the provision of antenatal care and safe delivery services. Equipment and supplies to attend deliveries are now being upgraded.

Latrine building programmes have begun in collaboration with the Water and Sanitation Cluster. Most families have received hygiene kits to assist in recovery, but health education and promotion should be a major priority.

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