Table 1. The outcomes of placing emergency district support officers in districts most affected by the April 2015 Nepal earthquake.
| Task | Situation pre-intervention (December 2015) | Inputs from emergency district support officersa | Situation post-intervention (December 2016) |
|---|---|---|---|
| Coordinating recovery activities in the health sector | District health authorities faced many competing health-sector priorities, e.g. preparing health-facility reconstruction plans, solving issues related to the border closure. The UN Office for the Coordination of Humanitarian Affairs was withdrawing. |
Assisted district health authorities to prepare and conduct meetings of the health cluster. Completed the 4Ws matrix (Who is doing What, Where and When). Monitored recovery activities of health-sector partners (nongovernmental agencies, UN agencies working in health). |
Health-cluster partners were mapped using the 4Ws approach. Partners were mobilized during responses to disease outbreaks and local disasters. Duplication of reconstruction plans and activities were avoided. |
| Strengthening disease surveillance and response | Few districts (5/14) were regularly reporting data to the Epidemiology and Control Division of the health ministry. Mean timeliness and completeness scores of districts were 41.7% and 66.7% respectively. | Coached medical reporters and statistic recorders. Assisted them in preparing statistical reports. Helped them solve logistic issues, e.g. with computers, electricity supplies or internet access. |
Almost all health districts (13/14) were able to report data to the Epidemiology and Control Division. |
| Rapid response teams were in place in all districts, with various levels of training, but without full capacity for outbreak investigations. | Participated in event-based surveillance and verification of rumours. Recorded 44 clusters of diseases over the year 2016. Technically and logistically assisted and trained rapid response teams during 33 outbreak investigations over the year 2016. Coordinated efforts with surveillance medical officers for the surveillance of vaccine-preventable diseases. |
44 clusters of diseases affecting > 947 individuals were reported to district health authorities, investigated and contained. Rapid response teams were empowered. Information related to these outbreaks was shared with the Epidemiology and Control Division. |
|
| Monitoring the recovery of health facilities | Affected areas had 793 health facilities (723 health posts, 44 primary health-care centres, and 26 hospitals).12 The earthquake damaged 662 (83.5%) health facilities, including 363 (45.8%) destroyed.12 Due to logistic constraints, field supervision by district health authorities was rarely done, except for immunization activities. Availability and quality of health services was not known after the initial post-disaster needs assessment (May–June 2015). Most health facilities (36/41, 87.8%) were reporting medicine stock-outs. |
Conducted 822 field visits in 451 different health facilities, using a standardized checklist developed from national health-facility surveys. Median number of visits per month to health facilities was 55.5 (interquartile range: 43.0–92.5). Of 302 health facilities visited from March–December 2016, 61 (20.1%) were using buildings declared unsafe by the health ministry. Looked for local solutions to decrease the risks for health teams and patients, e.g. the use of tents or relocation to public buildings. Provided real-time and accurate feedback to district health authorities regarding availability and quality of health-service provision, and daily challenges faced by health teams. Worked to improve inventory management of medicines and communication between health facilities. |
Field visits showed that 375 health facilities were renovated or rebuilt (56.6% of all 662 damaged health facilities; 6 district hospitals, 10 primary health-care centres, 359 health posts). Availability of services was recorded and had recovered to pre-disaster levels. Most health posts monitored from June 2016 (75/85; 89.7%) had paediatric services and could manage respiratory tract infections; 75/87 (86.2%) had adolescent services available. and could follow-up tuberculosis patients; and 77/85 (88.5%) could perform first aid. However, sexually transmitted infections management and human immunodeficiency virus disease follow-up were available in only 31/87 (35.6%) and 7/87 (8.1%) health posts, respectively. Numbers of health facilities reporting medicine stock-outs decreased over the year from 36/41 (87.8%) in January 2016 to 48/58 (82.8%) in December 2016. |
UN: United Nations.
a Emergency district support officers were 12 Nepalese medical doctors posted by the World Health Organization (WHO) to the 14 districts most affected by the earthquake. They provided technical assistance to the district health authorities during the recovery phase.
Notes: Pre-intervention data mainly came from the post-disaster needs assessment conducted in May–June 2015 and led by the National Planning Commission with the assistance of national experts and institutions, Nepal’s neighbouring countries and development partners (UN agencies, international and national nongovernment agencies). Post-intervention data were collected by the WHO emergency district support officers during their monitoring visits to health facilities.