HRIM 365: Disaster Management for

health records managers

BY OKARI GEOFFREY MASEME

gokarimaseme2@gmail.com
Tel No: 0728431936
 Unit purpose and learning outcomes
Unit purpose;
• To equip the student with knowledge and skills in disaster management
and response.
Learning outcomes;
✓ Describe theories in disaster management
✓ Discuss classification of disasters
✓ Describe the process for comprehensive emergency management
✓ Discuss the management of humanitarian assistance
✓ Discuss medico-legal work in disasters
 Course outline
1. Introduction to disaster management concepts
2. Theories of disaster and disaster management
3. Disaster management approaches; comprehensive emergency
management; Risk accumulation model; Prevention
research/causal/logic model
4. Epidemiologic surveillance & disease control in disasters.
5. Structuring disaster preparedness framework
6. Implementing a national disaster mitigation programme for hospitals
7. Preparedness for mass casualty and fatality management
8. Humanitarian law and ethics
9. Management of humanitarian assistance: humanitarian relief and SUMA
10. Medico-legal work in disasters.
Lecture 1: Introduction to disaster management
• Disaster: Any occurrence that causes damage, ecological
disruption, loss of human life, deterioration of health and health
services on scale sufficient to warrant an extraordinary response
from outside the affected area.
• It is a phenomenon that causes damage to life, property and
destroys the economic, social and cultural life of people.
• Its an occurrence (natural or manmade) causes human suffering and
creates human needs that victims cannot alleviate without assistance.
• Disasters occur when hazardous events meet a vulnerable society
• Hazard: Probability that a potential disastrous event will occur
during a given time period in a given place e.g. electric energy, etc.
 Introduction to disaster management
• Risk: Combination or product of likelihood of an occurrence of
a hazardous event and severity of injury or ill health that may be
caused by the event or exposure
• Risk=Likelihood X Severity
• Vulnerability: Refers to a set of conditions and processes that
increases susceptibility of communities to the impact of hazards
• Risk analysis: Involves looking for the potential impacts and the
capability of populations or organizations to cope with.
• Disaster risk management: Measures aiming at reducing the
vulnerability to which people are exposed to or reduce the
intensity of the hazardous event
 Reasons for disaster risk management
a) Poverty reduction – Poor populations are hit hard
whenever a disaster occurs since they are more vulnerable
b) Save lives –Prevent loss of lives
c) Sustainable development – Prevent damage to property
or mitigate the impacts of natural disasters
d) Save resources – Save funds used for intervention and relief
foods
e) Crisis prevention – Wars and conflicts due to migration
and conflicts over distribution of resources after disaster
occurrence
f) Adaptation to climate change – Adopt strategies to curb
effects of climate change
 Disaster risk management embraces on:
a) Risk analysis
✓ Enables the risks and possible solutions to be precisely identified
✓ Provides information to determine the probability of events occurring
and put measures in place to deal with them
✓ Disasters occur when natural event coincides with a vulnerable society
Hazard + Vulnerability Disaster risk Disaster
b) Disaster prevention and mitigation
✓ Involves planning and implementation of emergency aid, transitional aid
and reconstruction
c) Disaster preparedness
✓ Putting systems and resources in place to deal with disasters whenever
they arise
✓ Effective response in an emergency and its impacts
 Vulnerability analysis
• Refers to finding susceptible elements in the environment to a given
disaster.
• Enables planners to assess the possible and economic impacts of natural
events and identify corresponding preventive measures
• It captures the potential impacts at household levels and existing
capacities of the population and organizations to deal with the extreme
natural events.
• It analyses the interactions between susceptible elements and hazardous
environments PV EV
• The vulnerability matrix:
EV SV
 Components of a Vulnerability Matrix
a) Physical/structural vulnerability factors
✓ They include buildings at risk, basic infrastructure, population
growth/density, rapid urbanization, technical construction, unsafe critical
facilities (hospitals)
b) Environmental vulnerability factors
✓ Gives rise to disasters that develop slowly e.g. pollution, climate change,
drought, heavy rainfalls, loss of biodiversity etc.
c) Economic vulnerability factors
✓ Sufficient or insufficient socio-economic status e.g. poverty, nutrition,
income, resources, land use etc.
d) Social vulnerability factors
✓ Human and institutional vulnerability which determines the level of an
organization e.g. risk perception, corruption, politics, legal frameworks,
access to information etc.
 Vulnerability and capacity analysis
• It involves looking at the availability of resources to resit the impact
of a hazardous event and/or recover quickly from them among
individuals, institutions, households, communities, institutions etc.
• It is a tool for mainstreaming disaster risk reduction
• It performs the following functions:
i. Identify vulnerable groups
ii. Identify vulnerability factors and how vulnerable groups are
affected
iii. Assess their needs and capacities
iv. Ensure projects, policies and programs address these needs
through interventions and mitigations of protecting adverse
impacts.
 Steps in vulnerability analysis
a) Select a framework for analysis – Establish a clear and shared
understanding of what is to be analysed and role of VCA; use a
conceptual and analytic frameworks
b) Select a unit/level of analysis – To facilitate planning the scope
and focus of theVCA and methodology selection
c) Identify stakeholders – To provide expert knowledge and ensure
ownership of findings by relevant stakeholders
d) Selection of data collection and analysis approach – It should
be appropriate to the scale, scope and purpose ofVCA.
e) Collection of data – Use appropriate data gathering methods to
build evidence.
f) Data analysis – link vulnerability and reveal the cause-effect linkages
g) Decision making and action – Use findings to design and make
appropriate modifications
 Vulnerability Chain
• It refers to a situation in which vulnerability generates new
vulnerability (multiple vulnerabilities)
• Risk refers to expected level of destruction or loss that will take
place given the probability of hazards events taking place and the
level of vulnerability of the elements exposed to these hazards

R=HxVxE
Where R-Risk,V-Vulnerability, E-Exposure
• Impact refers to the effect of a disaster on the vulnerable element
I=PxV
Where; I-Impact, P-Phenomena,V-Vulnerability
 Disaster management
• It is a continuous and integrated process of planning,
organizing, coordinating and implementing measures which
are necessary for:
✓Prevention of danger or threat of a disaster
✓Reduction of risk of any disaster or its severity
✓Capacity building
✓Preparedness to deal with any disaster
✓Prompt response to any threatening disaster condition
✓Assessing the severity of effects of any disaster
✓Evacuation, rescue and relief
✓Rehabilitation and re-construction.
 Types of disasters
a) Natural disasters - Naturally occurring physical phenomena
✓Geological/topographical origin e.g. Volcanoes,
Earthquakes, Landslides, Tsunamis
✓Meteorological origin e.g. tropical storms, hurricanes,
tornados, floods etc.
b) Human made/anthropogenic disasters
• They occur as a result of transformation of nature by human
beings e.g.
✓Industrial e.g. radioactive spills
✓Technological disasters e.g. transport failure
✓Nuclear plants
✓Security related e.g. wars, terrorism etc.
 Principles of disaster management
a) It is the responsibility of all spheres of government
b) Disaster management should use resources that exist on a
day-to-day purpose
c) Organizations should function as an extension of their core
business
d) Individuals are responsible for their own safety
e) Disaster management planning should focus on large scale
events
f) DM planning must recognize the involvement and potential
role of non-government agencies
g) DM planning must take account of the type of physical
environment and structure of the population
 Characteristics of disasters
a) Kill most people at one go – especially earth quakes
b) Disrupts water supply, sewage systems (needed for safe water and
sanitation).
c) Cause damage to health systems and other infrastructure.
d) Large scope and intensity of impact
e) Duration of impact
f) Predictability
g) Length of forewarning
h) Controllability
 Health effects of disasters

a) Breakdown/damage of publicly supported health system

b) Communicable diseases through expanding the geographic range of
certain diseases e.g. malaria, cholera,
c) Population displacement resulting to pressure on water and food
d) Food shortages and malnutrition due to food shortages
e) Water contamination and sanitation as they disrupts sewerage systems
and water supply
f) Mental health due to anxiety and depression
g) Climate change due to greenhouse effects
h) Deaths and mortalities
Lecture 2: Theories of disasters causation and
disaster management
• A theory is a set of interrelated propositions that allow for the
systematization of knowledge, explanation and prediction of social
life and the generation of new research hypotheses.
• Theories provides a basis for thinking systematically about complex
problems.
• It enables us describe what is going on, explain it, predict the future
events under given circumstances.
• The early theories referred disasters as occurrences to unfavorable
or negative events, usually of a personal nature, resulting from
unfavorable alignment of the stars and planets.
• Disasters are often caused by nature or may have human origins and
there are four fundamental theories of disaster occurrence.
 Fundamental Theories of disasters causation
a) Acts of Fate/Acts of God
✓ Disasters arise from impersonal and uncontrollable forces beyond
human understanding which are predetermined and beyond a victim’s
control.
✓ They are cosmic or divine retribution for human failings e.g. personal
disasters for personal failings & collective disasters for societal failings.
b) Acts of Nature
✓ Increase in scientific knowledge leads many people to substitute natural
causes for supernatural ones.
✓ Floods occur due to a large amount of rainfall from a severe storm
exceeding the soil’s capacity to absorb it.
✓ Rapid runoff exceeds the river basin’s capacity, excess spills over river
banks, flood buildings, and drown people and animals.
 Fundamental Theories of disasters
c) Interactive effects of nature and society
✓ Hazards arise from interaction of a physical event system and a
human use system.
✓ It takes both a hazardous physical event system and vulnerable human
use system produce disasters (occur when both items are present).
✓ Human societies adapt to prevailing environmental conditions (e.g.,
temperature, wind, rainfall, seismic activity) at a given location.
✓ Failure to anticipate variation in environmental conditions results to
inadequate adaptation to extreme events e.g. heat waves, floods etc.
✓ People can avoid disasters by staying out of active seismic locations
or build structures that resist extreme environmental events.
 Fundamental Theories of disasters
d) Social construction
✓ Disasters are systematic in the types of people they harm and types
of geographic locations and human use systems they strike.
✓ The theory calls attention to the social vulnerability of specific
population segments.
✓ Socially vulnerable population segments emerge due to
psychological, demographic, economic, and political processes that
produce them.
✓ There are many ways in which institutions can reduce the hazard
vulnerability of those who have the least psychological resilience,
social support, political power, and are poorest economically.
 Theories of disaster management
• Crisis management is directed at populations and communities in urgent
need of resources due to a disaster or public tragedy.
• Crisis management ensures securing the scene and engage in rescue and
recovery (by first responders) and provide relief programs to populations in
urgent need and reconstruct communities in the disaster aftermath.
• People use methods of policy, advocacy, community, and management
practice to respond to disasters and public tragedies.
• Managers of different organizations administer emergency service
organizations and co-ordinate relief services; resources must be sustained
and maintained overtime.
• Communities plan for disasters and respond in a timely manner to unfolding
events; material goods and human resources deployed in crisis aftermath;
communities need to be rebuilt and populace supported.
 Theories of Disaster Management
• Several theories inform models of disaster management:
1. Historical Perspective
2. Prevention Model (Public Health)
3. Problem-Solving (Task Model)
4. Conservation of Resources (COR)
5. Organizational Readiness (Structure-Functional theory)
6. Traumatogenic Forces
 Historical Perspective
• Initially, disasters were regarded as rare events of nature
(outside forces).
• They were perceived fatalistically; neither predictable nor
preventable.
• Overtime it was recognized that human actions contributed
to disaster occurrence either through;
✓ Preventable causes (i.e. poor building construction, poor
farming practices)
✓ deliberate acts of intentional harm (i.e. terrorism, toxic
waste, genocide).
• This led to the recognition that human action might prevent
or mitigate the effects of disasters.
 Prevention Model
• The concept of prevention has its origins in public health and
community psychiatry.
• Prevention is conceptualized as primary (prevention-
preparedness), secondary (early intervention), and tertiary
(recovery in the disaster aftermath).
• Macro methods are needed to implement the three phases of
this prevention model
 Primary Prevention (Preparedness)
• Primary prevention identifies risks and hazards in the
environment in an effort to eradicate them and prevent
disasters.
• Comprehensive disaster preparedness plans help communities
mitigate the effects of the disasters that occur unexpectedly
and that unfold rapidly.
• Public education, rehearsal, and training prepare citizens to
respond to a disaster in a manner that promotes resiliency and
minimizes risk.
• A corps of first responders (police, fire, and medics) are
trained to perform rescue & recovery.
 Secondary Prevention (Early Intervention)
• Secondary prevention or early intervention consists of rescue
and recovery.
• During the rescue phase, first responders are responsible for
gaining control of the event or scene, preserving life and treating
the wounded.
• During the recovery phase, responders locate the dead and
process the remains.
 Tertiary Prevention (Recovery Phase)
• It involves helping reconstruct communities and make repairs
to the land and infrastructure.
• A variety of interventions should be considered that lie along
the macro-micro continuum.
• There is provision of direct face-to-face concrete resources
and counseling both on-site and in the crisis aftermath.
• Policy, advocacy, management and community practitioners
establish policies and programs, fund, staff, and manage
disaster relief programs and organizations.
 Problem-Solving (Task Model)
• This model has nine tasks.
1) Gain control of the event, scene
2) Preserve life and treat the wounded (rescue)
3) Locate and recover the dead (recovery).
4) Manage risks on the scene and establish safe zones where
victims can be relocated
5) Deploy and manage resources- water, food, shelter, sanitation,
safety, clothing
6) Provide security; protect person & property; prevent looting
7) Provide official information on the disaster and the course of
recovery; restore communication between survivors and their
loved ones
8) Control rumors and maintain calm and cooperation
9) Assess secondary social problems such as health epidemics or
displaced persons.
 Conservation of Resources
• Material and social resources are key determinants in communal
efficacy in responding to disasters.
• The theory conceptualizes resources in the context of stress.
• It focuses on community infrastructure and resource depletion.
• In a disaster, communities attempt to obtain, retain, protect and foster
resources.
• Where resources are scarce, a military or police presence is needed to
regulate access and deter looting.
• This theory recognizes that local communities or governments may
not be able to absorb the impact of a disaster with their own
resources.
• There often is a need for directed invitations for outside help.
 Conservation of Resources
Resource overload
 Directed invitations for outside support may lead to resource
overload.
 Whether material or human, resources need to be coordinated.
Human resources need to be housed and fed.
 Like the disaster itself, the arrival of resources can overtax a
community.
Resource loss
 In a disaster, the loss of one resource can quickly cascade into a series
of losses.
 The loss of a resource or the failure to regain resources after a disaster
is a significant predictor of community stress.
 Depletion of material and human resources may lead to significant
out-migration of the populace from the affected area and significant
migratory influx to nearby areas.
 Organizational Readiness
• Structure-functional theory informs organizational practice
during a disaster.
• Two layers of organizations are affected:
a) The local area impacted by the disaster responds first.
b) External emergency relief organizations may be invited
to assist the affected local community.
 Local Organizations
• Communities have a local office of emergency preparedness.
• This office is responsible for preparing a local emergency
plan, initiating early warning systems, issuing evacuation
orders and activating first responders.
• This office has a command structure composed of experts in
communication, transportation, law enforcement,
emergency medical care and emergency mental health
counselors.
Directed Invitations from External Organizations
• Depending on the location of the disaster, getting resources
to it may be very difficult.
• The disaster may make the landscape unrecognizable; roads
and signage may be gone.
• Supplies (material and human), though available, may not be
able to get where needed. Military and private sector airlifts
may be required.
 Traumatogenic Forces
• What initially appears to be an isolated or unpredictable
event may, upon closer analysis, reveal societal patterns that
lead to the disaster.
• Capitalism (profit motive) may be a traumatogenic force in
that it can lead to soil erosion, toxic waste, poor building
construction, cost-saving tactics, and lax standards and
enforcement.
• Immigration policies that endanger individuals or separate
families or fail to respond to the plight of others may lead to
humanitarian disasters.
Other theories related to disaster management
paradigm

Paradigm

Weberian
Marxist Economic Perspectives
Theory Management
Interpretation of Theory Integration
on Disaster emergency
management
 Marxist Interpretation on Disaster

Marxist Interpretation
on Disaster

Development (Links
Marxist Interpretation Economic Theory
between development,
on Disaster(Economic & (Capacity to recover
vulnerability and
political condition) disaster)
disaster)
 Marxist Interpretation on Disaster
(Integration of Theories)
Theories Cause (in Disaster Effect of the approach
Vulnerability) of the
approach
1. Marxist Interpretation on Economic conditions and Poor, minorities and other
Disaster (Economic & political powerlessness are marginalized people are
political condition) related to DV most likely to live in
dangerous areas and affected
by disasters
2. Economic Theory Economic prosperity and Quickly recover, capacity to
(Capacity to recover ability to economically manage disaster, assistance
disaster) recovery to face disaster that hits in
society, nations and country
3. Development (Links Wellplanned or haphazardly Disaster result may be
between development, development cause less or increased or reduced
vulnerability and more vulnerability
disaster)
 Economic Theory (Capacity)
Economic Theory
(Capacity)

Development
Economic Theory (Links between Sustainability Technology (Use of
(Capacity to recover development, ( Environmental modern and nuclear
disaster) vulnerability and degradation) technology)
disaster)
 Economic Theory (Capacity)
Theories Cause (in Disaster Effect of the approach
Vulnerability) of the
approach
1. Economic Theory(Capacity to Economic prosperity and ability Quickly recover, capacity to
recover disaster) to economically recovery manage disaster, assistance to
face disaster that hits in society,
nations and country
2. Development (Links between Well–planned or haphazardly Disaster result may be increased
development, vulnerability development cause less or more or reduced
and disaster) vulnerability
3. Sustainability ( Available or unavailable of Positively or negatively impact
Environmental degradation) natural resource and activities of for level of disaster
population
4. Technology (Use of modern 1.Positive cause: capabilities to May build capacity to face
and nuclear technology) prevent, prepare for and response disaster or may make
to disaster complicated and cascading
2. Negative cause: complexity of disaster
modern infrastructure
 Weberian Perspectives of emergency management
Weberian Perspectives
Cultural values, attitudes
of emergency
& practices
management

Social Constructionist Social construction

views viewpoints

Organizational Organizational
Weberian Perspectives behavior interest

Emergent behavior Lack of well trained

Risk perception and Apathetic or pathetic

communication about disaster
 Weberian Perspectives of emergency management
Theories Cause (in Disaster Effect of the approach
Vulnerability) of the
approach
1.Weberian Perspectives of Cultural values, attitudes & practices may … may greater losses;
emergency management raise disaster vulnerability Lack of professionalization among emergency
(Cultural values, attitudes managers and weak disaster institutions make
& practices) vulnerable to disaster.
2.Social Constructionist views Role of human in disaster Several hazards may arise because of social
(Social construction construction
viewpoints)
3.Organizational behavior 1. Organization’s own interest and do not Organizational behavior may translate into a disaster
(Organizational interest) understand how their actions or inactions where hundreds of employees may lost their lives in
affects others agencies. 2. Cultural barriers the line of duty
across units discourage joint planning,
training and exercising.
4. Emergent behavior (Lack of Untrained volunteers behavior may create Well-intentioned individuals may injure or kill victims
well trained) serious problems for first responders. when performing search and rescue operations;
spontaneous organizations often do better than the
capability of emergency managers to effectively
utilize them.

5.Risk perception and Such attitude may produce or reduce the EMs may be trying to reduce. If risk can be conveyed
communication vulnerability in an accurate and convincing manner, the public will
(Apathetic or pathetic about be more likely to take steps to reduce vulnerability
disaster)
Management Theory
(Political and organizational activities)

Systems
Theory

Decision Management
Theory Theory

Management
Theory
Chaos Policy
Theory Making

Compliance
Paper Plan
Model of
Syndrome
Evacuation
 Management Theory
Theories Cause (in Disaster Vulnerability)of the approach Effect of the approach
1. Management Theory Effective or ineffective leadership and strategic planning The ability of emergency managers to sway
may be reducing or increasing vulnerability public opinion and actively pursue objectives
(Political & organizational
will likely increase steps taken for mitigation
actions) and enhance the preparedness level of the
jurisdiction
2. Decision Theory Lack of information may make responders and citizens Incorrect perceptions, bureaucratic politics and
vulnerable to injury, death, disruption and other adverse factors consequently have a bearing on the
(Availability of information)
effects of disasters. creation of risk, susceptibility, resistance and
resilience
3. Systems Theory Natural, built, technological, social, political, economic, The location and construction of our buildings
cultural, organizational and psychological systems have may be due to policy enforcement, cultural
(Socio-economic and
direct impact on level of vulnerability. Diverse systems preferences, income levels, risk perception,
organizational system) interact in complicated ways. urbanization, education of the population etc.
4. Chaos Theory Many variables that interact to produce vulnerability. Vulnerability may be reduced by addressing
multiple variables simultaneously.
(Systems theory’s many
variables)
5. Paper Plan Syndrome Paper plan syndrome without developing capabilities to Vulnerability can only be addressed through
implement the plan does nothing to ensure adequate risk assessments, land-use planning, improved
(Emergency operations
response and recovery operations. engineering;
plan)
6.Compliance Model of These variables would help responders predict who is Compliance model influences whether or not a
not likely to leave and determine what can be done to person evacuates during an impending
Evacuation
encourage them to evacuate. disaster.
(A number of variables)
7. Policy Making Political processes allocate both knowing and Through policy, citizens become more
unknowing values in society that distribute vulnerability concerned about common forms of
(Political processes)
among the population. vulnerability; if our policy only takes into
account expert advice, our society may
become more vulnerable to civil hazards.
Integration (National, international & local)

Networking
and
Collaboration
Preparedness
Integration and
Improvisation

Integration
 Integration (National, international & local)
Theories Cause (in Disaster Effect of the approach
Vulnerability) of the
approach
1. Integration Emergency managers may not be The delegation of additional
(National, international & local able to meet all the assignments homeland security tasks to the
integration) and responsibilities. local level without the provision
of sufficient human resources
may not be able to meet all the
jurisdiction to disasters
2. Networking and Getting public, private and non- Networking and collaboration
Collaboration profit agencies to work together increases contact and
(Multi-organizational response) before, during and after disasters cooperation among disaster
is likely to reduce liabilities and response organizations that
raise capabilities. builds capabilities.
3. Preparedness and Planning, training and exercising As part of preparedness,
Improvisation (Ties are developing capabilities of the improvisation may either make
between vulnerability & community for managing people susceptible or may
emergency management) disaster. increase opportunities for
resilience.
Lecture 3: Disaster management approaches
• Disaster management is the organization and management of
resources and responsibilities for dealing with all humanitarian
aspects of emergencies in order to lessen the impact of disasters.
• It aims to reduce or avoid potential losses from hazards, assure
prompt and appropriate assistance to victims of disaster, and
achieve rapid and effective recovery.
• The DM cycle illustrates ongoing process by which governments,
businesses, and civil society plan for and reduce the impact of
disasters, react during and immediately following a disaster, and
take steps to recover after a disaster has occurred.
• Appropriate actions are required at all points in the cycle lead to
greater preparedness, better warnings, reduced vulnerability or the
prevention of disasters during the next cycle.
 Disaster management approaches
• The complete DM cycle includes shaping public policies and plans
to either modify causes of disasters or mitigate their effects on
people, property, and infrastructure.
• As a disaster occurs, disaster management actors, in particular
humanitarian organizations, become involved in the immediate
response and long-term recovery phases.
• Disaster management aims at promoting sustainable livelihoods and
their protection and recovery during disasters and emergencies.
• Different models can be applied for disaster management.
a) Comprehensive emergency management (CEM) model
b) Risk accumulation model
c) Prevention research/causal model
Disaster management cycle
 Disaster management cycle
• There are four disaster management phases which do not always
or generally, occur in isolation or in this precise order.
1. Mitigation - Minimizing the effects of disaster e.g. building
codes and zoning; vulnerability analyses; public education.
2. Preparedness - Planning how to respond e.g. preparedness
plans, emergency exercises/training; warning systems
3. Response - Efforts to minimize the hazards created by a
disaster e.g. search and rescue; emergency relief .
4. Recovery - Returning the community to normal e.g.
temporary housing; grants; medical care.
Comprehensive emergency management (CEM) model
• The model is used in disaster risk reduction following the DM cycle.
• This is by reducing disaster risks through systematic initiatives,
strategies or policies to analyze and manage the causal factors of
disasters e.g. lessening vulnerability, reduced hazard exposure etc.
Phases of the comprehensive emergency management
(CEM) model
1. Mitigation
✓ Measures to minimize effects of a disaster by supporting protection
and prevention activities, easing response, and speeding recovery
to create better prepared and more resilient communities e.g.
building codes & zoning; vulnerability analyses; public education
✓ This requires adoption of norms and standards to ensure resisting
potential hazards
✓ They include structural measures which involves construction
projects to reduce economic and social impacts e.g. strengthening
roofs, flood barriers, dams, windbreaks, building codes
✓ Non-structural measures are policies and practices which raise
awareness of hazards or encourage developments to reduce the
impact of disasters e.g. public health awareness campaigns,
insurance schemes, training, vaccination, public health campaigns.
Phases of the comprehensive emergency management
(CEM) model
2. Preparedness
✓ Involves planning how to respond by activities and measures taken
before hazardous events occur to forecast and warn against them,
evacuate people and property e.g. preparedness plans, emergency
exercises/training, drills, warning systems, action plans.
✓ Ensure disaster plans are in place and up to date.
✓ These measures are taken to reduce the minimum level possible,
of loss in human life and other damage, through the organization
of prompt and efficient actions of response and rehabilitation.
✓ They also involve planning, organizing, training, interaction with
other organizations and related agencies, resource inventory,
allocation and placement, and plan testing.
Phases of the comprehensive emergency management
(CEM) model
3. Response
✓ Include solutions or coping strategies when a disaster strikes
✓ They are efforts to minimize the hazards created by a disaster e.g.
search and rescue; emergency relief, evacuating people,
communicating risks.
✓ Includes mobilization of necessary emergency services and first
responders in the disaster area e.g. first wave of core emergency
services, such as fire-fighters, police and ambulance crews.
✓ They are non-structural policies, laws, regulations,
procedures/processes used during a disastrous occurrence
✓ The disaster management program coordinates all health
sector activities to reduce loss of life and property and protect
the integrity of health services.
• Healthcare intervention response starts here
• The focus in the response phase is on meeting the basic
needs of the victims until sustainable community
has been achieved.
• It also may involve initial repairs to damaged infrastructure.
• Response activities are post activities geared towards:
✓ Providing emergency assistance
✓ Speeding recovery operations
✓ Returning systems to normal level
✓ Reducing probability of additional injuries or damage
Phases of the comprehensive emergency management
(CEM) model
4. Rehabilitation
✓ Returning the community to normal e.g. temporary housing;
grants; medical care.
✓ The aim of the recovery phase is to restore the affected area to
its previous state.
✓ It is the beginning of the repair of physical, social and economic
damage.
✓ It involves treatment of patients, counselling, financial aid, and
renovation of structures e.g. lifelines, health and communication
facilities, as well as utility systems.
Phases of the comprehensive emergency management
(CEM) model
5. Reconstruction
✓ Refers to building new structures to replace those that were
destroyed by disasters e.g. houses and health facilities
✓ Involves development and application of risk reduction strategies
with the affected structures to ensure they wont undergo such
effects again.
 Uses of the CEM model in DRR

• The recovery phase of a CEM affords an opportunity to develop

and apply risk reduction through rehabilitation and reconstruction
of the affected structures
• Plans of action to guide disaster management wherever it occurs
• The response phase strengthens the coping strategies to build
disaster resilience
• The preparedness and mitigation provides decisions and actions to
improve the pre-disaster conditions of the stricken community e.g.
early warning systems, building codes, sharing information etc.
 Importance of information and communication in DM

i. Efficient communication ensures dealing with disasters to

satisfaction at all levels.
ii. It ensures all possible causes of disasters and ways of mitigating
them are studied and communicated.
iii. Efficient communication can prevent occurrence of a disaster or
reduce its impact and play decisive role in the success of DM.
iv. The structural and non structural mitigations are communicated
to the public in general so as to adopt necessary measures.
v. It highlights risks and vulnerabilities.
vi. It provides timely warning in mitigation to avoid negative impact
due to underestimation through information technology
vii. It ensures hazards does not become a disaster.
viii. Disaster Mitigation efforts are supported by communication
 Strengthening Capacity for Reducing Risk

 The various types of capacity development for reducing risks are as

follows:
1. Soliciting active participation from all stakeholders.
2. An assessment of the current capacity.
3. Formulation of capacity development strategies
4. Implementation of capacity development
5. Evaluation of capacity development
 Risk accumulation model
Environment
Inadequate management
Hazards are every E.g. poor management,
day risks that exists lack of policies and
in the environment mitigation measures
e.g. urbanization,
deforestation etc.
Risk accumulation
processes
No/limited coping • E.g. Continued
strategies deforestation leads to
E.g. limited accumulation of risks
finances for
reforestation

Major disaster Minor disaster

E.g. global E.g. drying springs,
warming and erosion, crop damage
climate change
Disaster effects
• Population/health effects e.g.
malnutrition
Disasters e.g. • Economic effects e.g. reduced
Drought, floods income from agriculture,
dependency
• Environmental effects e.g.
environmental degradation
The preventive research/causal model
 The preventive research/causal model
• This model looks at the vulnerability and underlying causes/aetiology
of a given disaster (ill-health)
• It involves direct and immediate application of effective public health
strategies through basic research and hypothesis testing.
1. Vulnerability
✓ The first step looks at the social, environmental characteristics of
population at risk e.g. vulnerable groups, low socio-economic
status, physical and ecological environment, road users etc.
2. Causes/aetiology
✓ Analyzes cause of ill-health
3. Natural/anthropogenic causes
✓ It categorizes causes either to natural or man-made causes
✓ Sometimes its difficult to differentiate the two because ill-health or
disaster can result from the association of natural and anthropogenic
factors.
 The preventive research/causal model

4. Solutions/tackles causes or etiology

✓ The community brings solutions or responses such as disease
surveillance, public education and training awareness
5. Legal and institutional frameworks
✓ It looks the legal and institutional frameworks for implementing the
solutions or responses
✓ It needs good governance and accountability
6. Impacts
✓ It looks at the impacts after the implementation of solutions or
responses e.g. medical costs, social costs, economic costs, vulnerability
reduction, administration costs etc.
7. Outcomes
✓ It analyses the results following the implementation of interventions
(preventive research and DRR strategy and treatment linkage)
 Linking preventive research and DRR

• The spread of ill-health is a disaster for a community e.g. the HIV and
COVID-19 pandemics
• Preventive research looks at the aetiology while DRR strategy focuses on
the vulnerability and risk reduction; vulnerability creates conditions of ill-
health ad disasters
• People face threats in their lives and livelihood and societies are
confronted with various risks in their pursuit of development
• The threats arise from many sources e.g. natural hazards, development
policy failure breakdown and social order and armed conflict.
• The effects of these threats are harmful to health, livelihood and
ecological resilience but disasters are special because there are often
devastating and widespread.
• Preventive research and disaster reduction are two different approaches
but have an objective to improve the public’s health.
 Linking preventive/causal research and DRR

Preventive DRR
research • Focuses on
• Focuses on Public health vulnerability
causes or and risk
etiology reduction

Importance of preventive research

✓ Its development and implementation leads to well designed interventions
and selection of appropriate health indicators e.g. number of cases treated
✓ It examines fundamental causes of catastrophic events which have
negative impacts on publics health.
 Lecture 4: Structuring disaster preparedness
framework
• The general disaster preparedness framework ensures that there
are appropriate systems, procedures and resources in place to
provide prompt and effective assistance to disaster victims thus
facilitate relief measures and rehabilitation of services.
• Disaster preparedness is an ongoing multisectoral approach of
activities forming an integral part of the national system
responsible for developing plans and programs for disaster
management.
• This involves developing a plan to facilitate the disaster
management cycle (mitigation, preparation, response and
recovery).
• The disaster preparedness framework consists of ten steps;
 Disaster preparedness framework
1. Mapping of the risk area
✓ It involves the evaluation of the risk of the country or particular region
prone to disasters
✓ It also involves identification and estimation /quantification of disasters
e.g. earthquakes, floods, drought , fire outbreaks etc.
2. Adoption of standards
✓ They are structural (barriers) and non-structural (policies) standards
✓ They are chosen according to types of disasters anticipated e.g. building
codes and design to reduce the impact of earthquakes, smoke detectors
to sense fire outbreaks and raise public awareness through alarms
3. Health legislation and policies on disasters
✓ Enforcement of regulations aimed at reducing risks to a particular area.
✓ They may include policies, laws, regulations and action plans
formulated and implemented to counter the risks of disaster
occurrence e.g. road traffic regulations.
 Disaster preparedness framework
4. Organization of communication and information systems
✓ Ensure there are working/accessible transport and evacuation systems
✓ Ensure communication networking i.e. identify who should coordinate
the channels of communication following a given chain of command of
the affected institution/element/community etc.
✓ Establish a good relationship with the media; who speaks with the
media, and lay a platform on how to engage the media in airing their
coverage of the scene.
5. Warning systems
✓ Maintain an early warning system e.g. observing the level of water in
the rivers to issue warning of a possible floods to populations at risk
✓ Meteorological data can also be used in issuing warning of possible
climate change conditions that might be harmful to the people at risk.
✓ Ensure frequent surveillance to monitor the occurrence of a possible
disaster.
 Early warning system

Station (monitoring &

reporting e.g. water level )

No

Does the forecast

indicate a disaster

Yes

Warn the community at

risk and relaunch the
evacuation plan
 Disaster preparedness framework
6. Coordination and response mechanisms
✓ Integration of all stakeholders from different sectors since a disaster
management is a multi-disciplinary and multisectoral activity to ensure
that the plan is owned by all stakeholders
✓ Plan for multisectoral activities that should be done and give each
stakeholder their specific functions that they need to perform
✓ Identify all actors and ensure there is collaboration between them
7. Ensure availability of resources
✓ Emergency funds/finances set aside for the response
✓ Emergency relief items such food, water, beddings etc.
✓ Essential drugs to treat those who have been affected
8. Develop a public education program and create awareness
✓ Enhance awareness to the population about possible disasters
✓ Curricula development in disaster management e.g. teaching in schools
✓ Ensure community participation thus owning the preparedness plan.
 Disaster preparedness framework
9. Coordinate information section with media/mass media
✓ Communicate new information with media
✓ Have workshops and seminars to train people on issues to deal with
disasters
10. Organize simulation exercises to test response mechanisms
✓ It involves modelling and testing simulations e.g. drills to test how the
occupants respond to disasters, rehearse and practice the plans.
✓ Have networked simulations by inducting simulation exercises
involving the health sectors and other areas on a regular basis.
 Contribution of disaster preparedness to DRR
a) It improves effectiveness of contingency planning through regular
rehearsal, effective EWS, logistic and financial support
b) Timely and comprehensive recovery reducing vulnerability and promote
development thro’ transitioning after a disaster is effectively managed
c) Transforms disaster assistance management practice towards the disaster
risk reduction approach.
d) Contributes to sustainability when external relief support starts being
phased out through local coping strategies
e) Develop resilience to disasters facilitated by innovative approaches to
emergency response aimed at long-term recovery.
f) Strengthen potential emergency management to address prospective
risks by transforming recovery activities to mitigation functions
g) The recovery phase ensures review of the existing development to
minimize risk accumulation from future development activities.
Lecture 5: Implementing a national disaster mitigation
program for hospitals
• It is established to reduce hospital vulnerability to disasters
• This encompasses the entire health sector to promote and
coordinate mitigation (prevention), preparedness, response and
early rehabilitation activities.
• The national health disaster management/mitigation program is
coordinated by the health disaster coordinator.
• The objectives of the national disaster mitigation program for
hospitals includes;
✓ Reduce vulnerability
✓ Implement the disaster preparedness plan at a reasonable cost
✓ Ensure continuity of service
Process of implementing a national disaster mitigation
program for hospitals
1. Assemble a team of experts
✓ Assemble experts from multi-disciplinary sectors e.g. engineers,
architects, seismologists.
✓ They are responsible for considering the structure, architectural
elements, lifelines, equipment, organization, area characteristics.
2. Describe the health system
✓ Analyze the overall health system in terms of its past and current
organization (public and private hospitals)
✓ Map all facilities and evaluate their readiness for a disaster
✓ Describe their vulnerability and capacity to cope with disasters
3. Estimate the hazard
✓ Perform a risk analysis and rate the level of risk acceptance
✓ Determine the structural viability of the facilities e.g. buildings
✓ Describe useful life of a hospital (structures & functional characteristics)
Process of Implementing a national disaster mitigation
program for hospitals
4. Conduct a preliminary vulnerability analysis
✓ Prioritize the hospitals to be analyzed and select the most
appropriate strategy
✓ Train people on vulnerability analysis and quantify vulnerability in
terms of structural, non-structural and organizational elements
5. Select a building for analysis
✓ Give priority to highly vulnerable structures in high risk zones e.g.
hospitals in Budalangi are vulnerable to floods
6. Make a quantitative evaluation of the structures
✓ Make a detailed analysis and recommend solutions based on
standards e.g. building codes based on original plan.
✓ Compare the structures in relation to construction plans
✓ Analyze the cost-effectiveness of retrofitting
Process of Implementing a national disaster mitigation
program for hospitals
7. Prioritize the investment in the projects
✓ Give priority to hospitals that are more vulnerable but performs a
greater service delivery
✓ Prioritize projects for investment using political, technical and
financial criteria.
✓ If inadequate resources to implement measures in all hospitals,
program the work in phases
8. Retrofitting and arrange for financing
✓ Produce a detailed retrofitting plan and arrange for financing
ideally from national sources.
✓ Ensure hospitals remain operational while construction is ongoing.
9. Execute the mitigation project
✓ Implement the project to ensure disaster risks are reduced thus
build resilience of the hospitals.
Role of a national health disaster management program
a) Promotion
✓ Provision of public education through media and health educators.
✓ Include disaster reduction into development activities of the program
b) Establishment of standards
✓ Building and maintenance standards for facilities in disaster prone areas
✓ List of essential drugs and supplies for emergencies
c) Training
✓ Inservice training of personnel and inclusion of health-related topics on
disaster management in curricula of other sectors.
d) Collaboration with other institutions
✓ Coordinate disaster management with multisectoral responsibility.
✓ Relief organization at the national and international level
e) Coordinating response during disasters
✓ Mobilization of health response
✓ Provide advise and coordinate operations of behalf of the ministry of health
 Evaluating the health disaster management program
• The health disaster management programs are evaluated based on the
objectives and functions that have been specifically assigned to it.
• It is based on;
i. Evaluation of the preparedness program
✓ Review of the national and regional disaster plans of the MOH
✓ Simulation and testing of the disaster plan
ii. Evaluation of mitigation measures
✓ Identify structures that have undergone vulnerability and those that will
remain functional after a disaster.
✓ Review policies, legislation, EWS and simulations
iii. Evaluation of the training program
✓ Identify the number of people with specialized training on disaster
management
✓ Compare existing plans and training with current trends
 Lecture 6: Disaster epidemiology
• Refers to the use of epidemiology to measure short and long term
health effects of disasters and predict consequences of future disasters.
• Disaster surveillance is a public health practice for assessing health
effects, monitor effectiveness of relief efforts, respond to public
concerns and media inquiries and facilitate future disasters planning.
• As human populations grow and societies become increasingly
interconnected and complex, damages from natural and human-
induced disasters have become more and more extensive.
• Societal vulnerabilities continue to deepen due to the effects that
disasters have on human health.
• As a health records personnel, you may be involved in responding to
disasters thus need to understand the different types of disasters, the
immediate and longer term effects on public health and factors that
magnify adverse health outcomes.
 Goals of disaster epidemiology

i. To prevent or reduce the morbidity and mortality resulting

from a disaster.
ii. Assess the needs of affected populations and provide timely
and accurate health information to decision makers
iii. Identify risk factors and improve prevention and mitigation
strategies for future disasters
iv. Inform the design of early warning systems and the
development of targeted training and education programs
v. Inform resource allocation plans for the response phase of a
disaster cycle.
Factors that determine the public health
effects of a disaster
• Several factors determine the public health effects of a
disaster, including the;
a. Nature and extent of the disaster itself,
b. Population density,
c. Underlying health and nutritional conditions of the
affected population,
d. Level of preparedness,
e. Preexisting health infrastructure.
 Disaster related health effects

i. Direct health effects

✓ They are caused by the disaster’s actual, physical forces and these
health effects typically occur during the event e.g. drowning during
a tsunami, injury caused by flying debris during a hurricane or
tornado and suffocation, motor crashes, electrocution.
✓ Others include damage to water systems, sanitation facilities, food
supply systems, health infrastructure, and other basic infrastructures
ii. Indirect health effects
✓ They are caused by unsafe/unhealthy conditions that develop due to
disaster effects or events that occur from anticipating the disaster.
✓ Some may not appear until several weeks following a disaster while
others occur immediately after, or even prior to, the disaster e.g.
vector-borne diseases, waterborne diseases, disease outbreak, mental
health conditions, worsening of chronic conditions.
Disaster related health effects
 Public health implications
• Increased mortalities and morbidities due to injuries resulting
from disasters including cleanup efforts and worsening chronic
diseases e.g. diabetes, asthma, HBP.
• Mental health and wellness issues due to absence of mental
health services and lack of coping strategies with a disaster.
• Exposure to cold weather and a lack of shelter could result in
hypothermia.
• Exposure to radioactive material could also result in short- and
long-term health issues.
• Risk of an outbreak or illness due to damage or disruption to
water systems, sanitation facilities, food supply systems, health
infrastructure, and other basic infrastructure.
• Increased opportunities for communicable disease transmission
due to congestion in camps or within shelters
Role of epidemiology in disaster preparedness and
response
• Traditional epidemiologic methods and tools apply to disaster
mitigation, preparedness, response, and recovery efforts.
• The complex nature of disaster preparedness and response efforts, and
multiple players and stakeholders involved, its critical to understand the
unique role and responsibilities of an epidemiologist.
• In general these are the roles of epidemiologist in disaster management;
a) Identify major health problems
b) Determine the extent of diseases/injuries
c) Prioritize health interventions
d) Identify causes of disease and risk factors
e) Monitor health trends
f) Evaluate impact of health programmes
g) Conduct rapid needs assessment
 Role of epidemiology in disaster management cycle
a) Mitigation
✓ Surveillance and monitoring activities, conduct epidemiologic studies of
populations likely to be affected.
✓ Evaluating safety of building codes and interventions
b) Preparedness
✓ Conduct activities e.g. hazard mapping, translating data into policy,
vulnerability analysis, educating local community, and provision of guidelines
for CNA and disaster-related morbidity and mortality surveillance.
✓ Providing training and building partnerships with other stakeholders.
✓ Use surveillance systems to detect disaster-related health effects.
c) Response
✓ Employs scientific data collection and analysis methods to conduct a rapid
assessment of health and medical needs through surveillance and investigations.
✓ Recommendations the distribution of health resources to affected populations.
d) Recovery
✓ Surveillance and monitoring activities of health problems, conduct research on
causes-effect relationships, evaluate interventions, and develop follow-up
studies of populations affected by the disaster.
 Challenges faced by epidemiologists during a
disaster
a) Absence of baseline data e.g. prevalence of health
conditions
b) The population under surveillance may change frequently
and be unpredictable.
c) Damage or disruption to the local public healthcare
infrastructure e.g. sanitation, waste water treatment, fear
d) Logistical constraints due to lack of enough resources
requiring international response
e) Coordination of data collection efforts
f) Working in a potentially hostile political environment
g) Lack of time for organizing epidemiologic investigation
h) Limited infrastructure for data collection
 Disaster Response Rapid Needs Assessment M
• A rapid needs assessment (RNA) is a collection of techniques
designed to provide information about a community’s needs
following a disaster.
• It uses local resources and specific methods to conduct a relatively
quick, effective, and representative community snapshot to assess
needs and guide relief efforts.
• RNA is conducted at any phase of the disaster cycle but the
affected community’s need change at different points in the cycle.
• RNA gathers information about the health and other basic needs
of a community affected by a disaster.
• RNA determines extent of disaster damage human health and
health infrastructure, identify the needs of a community, and
recommend interventions to reduce morbidity or mortality.
 Type of information collected during RNA
a. Magnitude of the disaster’s effect on the community;
b. Number of households affected,
c. Basic characteristics of the households affected (e.g., are there
more vulnerable groups with increased risk for disease or
death?),
d. Current health priorities and potential public health problems,
e. Availability of basic needs such as food and water,
f. Need for external support or intervention.
 Purpose of Disaster Response RNA
• The primary purpose of an RNA is to rapidly obtain vital
information about the needs of a community and monitor
changes in those needs during the recovery period to;
a. Describe the effects of the disaster on health;
b. Determine the critical health needs and assess the impact of the
disaster;
c. Characterize the population residing in the affected area;
d. Produce household-based information and estimates for
decision-makers;
e. Evaluate the effectiveness of relief efforts through a follow-up
assessment; and
f. Prevent adverse health effects.
 Phases of RNA
a. Prepare/planning
✓ Determines the purpose and scope of the assessment and data tools
✓ Creating a management plan by identifying tasks and responsible persons
while working with partners
✓ Determine needs assessment method (sampling) based on preliminary data
b. Conduct the assessment
✓ Conducting face to face interviews either using papers or electronic options
✓ Collecting existing and new information about the assessment
✓ Develop criteria for action, based on high priority needs identified.
c. Data entry and analysis
✓ Entering and analyzing data using appropriate methods/softwares
✓ Synthesizing and interpreting data descriptive and inferential statistics
d. Write the report
✓ Delivering information collected and communicate results
✓ Provide a preliminary (draft) and final report to stakeholders
 Sources of primary and secondary data for RNA

• The sources of primary data will include;

a) Morbidity/mortality data
b) Risk factor/behavior data
c) Epidemiological studies/scientific literature
d) Public/institutional records e.g. hospital records, housing records, policies
e) Social indicators
• The sources of secondary data will include;
a) Surveys
b) Individual or group inquiry e.g. focus groups, community forums or
listening sessions, interviews
c) Observations e.g. general field notes, windshield surveys (systematic
observation from a moving vehicle), videotapes, photographs, photo-voice.
 Challenges during Disaster Response RNA

i. Limited access due to inability or difficulty in reaching people to interview.

ii. Limited coordination due to poorly coordinated efforts between various
Non-Governmental Organizations (NGOs) and excludes the host
government and the affected community.
iii. Lacking expertise since the assessment team lacks the expertise needed.
iv. Incomplete data since the number of competed surveys are often fewer than
expected (e.g., poor access or refusal).
v. Unreliable population size since the estimated size of the target population –
the denominator – is unreliable.
vi. Failure to consider needs since the assessment report does not consider the
affected population’s perceived needs.
vii. Poor information sharing since information is not shared with government,
NGOs, or other agencies.
 Disaster Surveillance

• Surveillance is the ongoing, systematic collection, analysis, and

interpretation of injuries, illnesses, and deaths for planning,
implementation, and evaluation of public health practice.
• Surveillance enables public health to track and identify any adverse health
effects in the community following a disaster.
• Disaster surveillance is an epidemiology tool that assesses health effects,
monitors the effectiveness of relief efforts, responds to public concerns
and media inquiries, and assists in planning for future disasters.
• During a disaster, consider surveillance to understand a disaster’s impact
on affected populations and the surveillance activities in place.
• Disaster surveillance systems provide information and feedback which
provides the basis on which interventions are planned as well as insights
into future disasters.
 Importance/purpose of Disaster Surveillance

a) Follow disease trends for early detection and control

b) Estimate the magnitude of a health problem
c) Monitor a population’s health and identifying priority, immediate, and
long-term health needs
d) Ensure resources are targeted to the most vulnerable groups
e) Evaluate the coverage and effectiveness of program interventions
f) Identify research needs and evaluating control strategies
g) It is an early warning to disease problems guiding immediate control
measures
h) Provides a link to public health action by investigating and controlling
diseases through searching for causes/evidence
 Elements of Surveillance
a) Collection
✓ Involves gathering data for all notifiable diseases needing surveillance
✓ Each state has a morbidity reporting system based on state laws and
regulations e.g. CDC requires a disease register for some diseases
b) Analysis
✓ Analyzed in place, time and person as well as the associated risk
✓ Describe disease occurrence patterns using changes in diseases and
disease potential
c) Interpretation
✓ Interpret data to spark public health action
✓ Determine amount of excess necessary action based on priorities to
various diseases, interests, capabilities and resources
d) Dissemination
✓ Provide reports to medical and public health communities to inform
and motivate them
✓ Feed the information provided to public health systems for action
102
 Designing and conducting disaster surveillance system
a) Establish objectives
✓ Set clear objectives and describe how to use the surveillance information to
inform public health action.
b) Determine variables (case definition)
✓ A case definition is a set of standard criteria for classifying whether a person
has a particular disease, syndrome, or other health condition
c) Determine data sources and collect data
✓ Consider using traditional sources such as vital statistics, registries and
nontraditional sources for information such as humanitarian aid agencies,
civil defense organizations, religious officials, or police.
d) Analyze data
✓ Analyze those data by person, place, and time to determine the attack rate
or incidence proportion.
e) Disseminate data
✓ Provide reports to decision-makers, stakeholders, and partners at all levels
103 to inform and motivate them
 Types of public health surveillance
 There are two many types public health surveillance.
a) Passive surveillance
✓ A system in which a health jurisdiction regularly receives reports from
hospitals, clinics, public health units, or other sources.
✓ Collection of data by health facilities as part of their routine work of diagnosis
and treatment (relies on HC providers to report on their own initiative).
✓ It is called ‘passive’ because the data is obtained only from the people who
seek help from the health services – the health workers make no additional
effort to contact other individuals.
✓ It is based on either available data on reportable diseases are used or
reporting is mandated or requested with the responsibility for the
reporting often falling on health care provider or district health officer.
✓ In Many counties of Sub-Saharan Africa there is a passive surveillance system
based on monthly activity reports and weekly reporting of notifiable diseases,
i.e. diseases that must be reported to health authorities (most communicable).
 Passive Surveillance
Advantages
 Less costly
 Easier to design and carry out.
 Useful for monitoring trends over time.
Disadvantages
 Low sensitivity.
 Amount of data available is limited.
 May not be representative.
 Types of public health surveillance

b) Active surveillance
✓ Employs staff members to regularly contact heath care providers or the
population to seek information about health conditions for a limited time
period (usually weeks or months).
✓ Health professionals actively seek to collect data from all possible cases in
their area, under instruction to do so from a higher level authority
✓ Project staff make periodic field visits to health care facilities such as clinics
and hospitals to identify new cases of a disease/s or deaths from the disease
that have occurred (case finding).
✓ It is usually conducted in relation to a specific disease or disorder, or it
seeks to assess take up of a particular health service (e.g. FP or
immunization).
✓ Active surveillance data are collected since higher health authorities request
a specific surveillance report, instead of waiting for health posts or other
health facilities to send them routine reports.
 Types of public health surveillance
✓ Involves interviewing physicians and patients, reviewing medical
records and in developing countries and rural areas, surveying
villages and towns to detect cases either on a routine basis or after an
index case has been reported
✓ It an event-based surveillance, which refers to unstructured data
gathered from sources such as media reports, community concerns
and rumors.
✓ For example, if there is a rumour about a measles outbreak in your
community, the Health Centre will ask you to report if there are any
new cases of measles during a defined period of time.
✓ You will then have to actively collect data about new cases of measles
by making house-to-house visits in your catchment area and reporting
back to the Health Centre.
 Active Surveillance

Advantages
 Can be very sensitive.
 Can collect more detailed information.
 May be more representative.
Disadvantages
 Costly
 Labor intensive.
 Difficult to sustain over time.
 Types of Public Health Surveillance
Passive Surveillance Active Surveillance

• Diseases are reported • Health agencies contact

by health care providers health providers seeking
reports
• Simple and inexpensive
• Ensures more complete
• Limited by incompleteness reporting of conditions
of reporting and variability
of quality • Used in conjunction
with specific epidemiologic
investigation
 Active Surveillance

Advantages
 Can be very sensitive.
 Can collect more detailed information.
 May be more representative.
Disadvantages
 Costly
 Labor intensive.
 Difficult to sustain over time.
 Other Types of Public Health Surveillance

✓ Reporting of health events by health professionals selected to represent a

geographic area or a specific reporting group (either passive or active)
✓ Sentinel surveillance occurs when data are gathered from a limited
number of sites and is an alternative to population-based surveillance and
national surveillance.
✓ It is used when high-quality data are needed about a particular disease that
cannot be obtained through a passive system.
✓ Selected reporting units, with a high probability of seeing cases of the
disease in question, good laboratory facilities and experienced well-
qualified staff, identify and notify on certain diseases.
✓ Most passive surveillance systems receive data from many health workers
or health facilities while a sentinel system deliberately involves only a
limited network of carefully selected reporting sites e.g. facilities
reporting on influenza, pneumococcus, meningitis etc.
 Other Types of Public Health Surveillance

✓ The systematic process of data collection and analysis for the purposes of
detecting and characterizing outbreaks of disease in humans and animals in a
timely manner“ (WHO, 2014).
✓ Focuses on one or more signs and symptoms rather than a physician-
diagnosed or laboratory-confirmed disease.
✓ Attempts to bring together a variety of data - largely from the clinical setting,
but from other sources in the community as well - to support decision
making in the event of a disaster or emergency.
✓ Involves use of data to identify and predict trends as they are occurring, often
taking the form of analyzing patient chief complaints as they present for care
in hospital emergency rooms and other acute care settings.
✓ Its quick and efficient in transmission of critical data from clinical systems to
the appropriate local, County, and National public health agencies.
Lecture 7: Preparedness for mass casualty and fatality
management