for Bhopal 5th to 7th September draft

1. Day 1 Session: 1.6 Overview of DRR and Health 75min
15.45 – 17.00 hrs
Session objectives:
By the end of this session participants will be able to explain
• The components of health services with respect to DRR.
• The causes of morbidity (disease or injury) and mortality (deaths) pre-disaster,
during and post disaster.
• The transmission of infectious diseases
• The various barriers that could be introduced to reduce public health risks in
disasters.
Key learning points of the session:
• Definition of Health - Health is a state of complete physical, mental, social and
spiritual well being- it is not the mere absence of disease
• DRR related components of health services include health system, infrastructure,
control of communicable diseases and non-communicable diseases.
• Understanding of the structure of health services and systems in Madhya Pradesh is
essential.
• Feco-oral disease transmission route and the interventions that can act as barriers
in the disease transmission route which eventually mitigate the public health risks
Handout for the session:
What is Health?
WHO defines health as “a state of complete physical, mental, social and spiritual well
being - it is not the mere absence of disease”.
DRR related components of Health Services

2. Fig 1. Components of health services (based on SPHERE Guidelines)
Structure of Health Services in MP
Sub-centres provide for 5000 population in plains and for 3000 population in hills/ tribal
areas. There is one ANM in every centre and a male health worker in many centres.
Above this is a health supervisor (or LHV). The Medical Officer In Charge (MO IC/
Prabhari) looks after this team. In many blocks there is also a Block Sanitary Inspector
(BSI). Primary Health centres – (A) PHCs (usually non-bedded) exist at 30,000
population level with a doctor and support staff. The Primary Health Centres - PHC/
Referral Hospital has 16 to 30 beds. There are usually 2 to 3 doctors other than the
BMOH. Deliveries should take place at all Referral Hospitals. First Referral Units (FRUs)
are supposed to have specialists and be able to do Caesarean Sections and difficult
deliveries.
The primary goals of disaster risk reduction are to:
1) Prevent and reduce excess mortality and morbidity,
2) Promote a capacity to return to normalcy in case a disaster strikes

3. Fig. 2. Health risks in disasters
Different types of disasters are associated with differing scales and patterns of mortality
and morbidity (see table), and the public health and medical needs of an affected
community will therefore vary according to the type and extent of disaster expected.
Prioritization of health services requires a clear understanding of the affected
community’s normal health status, needs, health risks, resources and capacities. Prior to
disaster, information needs to be complete and all of the relevant data available and
analyzed so that important public health decisions can be made. A multi sectoral
assessment that includes community representatives should therefore be conducted
routinely to determine the priority public health needs, the availability of local resources
and the requirements for external assistance and the public health impact of any
expected disaster
Almost 55.8% of the entire state is susceptible to floods.
Aila affected more than 6.3 million people and nearly half a million homes.
Health effects of Aila:
Out of a total population of 13, 50, 000 affected in 24 Parganas:
• 53,840 suffered from diarrhoea out of which 11 died.
• 61 were victims of snake-bite and 2 people died.
• 6,17,000 people were injured.
• 22,400 people suffered from malaria, dengue and cholera
Some Health Statistics in MP –

4. Table 1. Demographic Indicators in MP
Minor ailments – cough, cold, fever, diarrhoea, worms, pain, cuts, injuries,
red eye, allergies which are treated by ANM-s and field level health workers.
Skin diseases commonly seen include– fungal infections, scabies, impetigo
Chronic Diseases
Table 2. Chronic Diseases in MP and India (NFHS 3 2005-06).
Prevalence Madhya Pradesh CG India West Bengal
Diabetes (Males) 5.55/ 1000 9.32 10.51 23.23
(Females) 5.58 6.59 8.81 16.41
Asthma (Males) 11.02/ 1000 8.58 16.27 43.65
(Females) 12.83 7.46 16.96 34.04
Thyroid (Males) 4.24/ 1000 3.58 3.83 6.67
(Females) 5.99 5.63 9.41 16.26
Table 3. Health Indicators in MP and India

5. NFHS 3 MP Bihar Bengal
Deaths IMR 70 62 48
Child too thin for age 60 58 44

6. Table 4. Maternal Health Indicators in MP and India

7. Table 5 Health Service Indicators MP

8. Transmission of Infectious Diseases
Diseases are spread basically due to inadequate or poor quality of drinking water, poor
sanitation and bad hygienic practices. Specifically, communicable diseases are caused
due to faeco-oral transmission routes as shown in (Fig.3) F-diagram or commonly called
as 5 F diagram. In this diagram the 5 F-s refer to Finger, Flies, Fields, Fluids and Food.
Diarrhea and cholera are some of the commonly observed diseases post disaster.
Faeco–oral disease transmission plays a vital role in the outbreak of diarrhea and
cholera epidemics in emergencies. Even in normal situations also, such communicable
diseases are spread from one person to another through the transmission routes as
shown in the 5 F diagram.
The transmission can be through making contact with any of these 5 F-s. Pathogens in
the faecal matter reach the host directly through unwashed fingers, flies, field (soil or
land), fluids (water) and food. This is the primary transmission. Pathogens can also get
transmitted at the secondary level. For example, from fluids to food or finger to food.
These are clearly mentioned in the F diagram.
Fig.3 F- diagram

9. The diagram also shows vertical lines breaking the transmission routes. They are the
barriers which help prevent transmission. Specific WASH interventions can act as
barriers in the transmission route. They are classified as primary barriers and secondary
barriers. Primary barriers are the ones that prevent the pathogens in the faecal matter
from reaching finger, flies, field, fluids and food. Secondary barriers are the
interventions that help in checking the secondary level of transmission. It can be noted
that primary barriers are basically water and sanitation interventions and the secondary
barriers are part of hygiene promotion.
Five Barriers that reduce risk of disease
1. Mother and Child Health.
This is now called Reproductive and Child Health. It includes antenatal care ANC,
Institutional Delivery and Immunization
2. WASH or water, sanitation, hygiene.
It includes Safe Water (which has undergone both filtration, and disinfection), Sanitary
Latrines to dispose urine and faeces, Hand Washing (before eating and after going to
the toilet). Hand Washing should preferably be done using soap.
3. Food.
Early initiation of breastfeeding (within half an hour of birth) with exclusive
breastfeeding for initial 6 months of the infants life, Timely initiation of complementary
feeding after 6 months and continuation of breastfeeding at least till completion of 2
years of age of the baby – as per Infant and Young Child Feeding Practices (IYCF),
ICDS for pre-school children (3-6 year) and Mid Day Meals for school going children (>
6 years) are the various nutrition interventions for children
4. The fourth barrier is for non-infectious causes.
• Anti Snake Venom or ASV is to be made available in all PHCs and is the best way
of saving lives in July and August
• Good Life Jackets can be made at low cost and provide protection from drowning
• Safe Housing can prevent deaths such as those in the tornado in U Dinajpur in
April 2010 or lightning deaths
5. The fifth barrier is against chronic diseases. Screening at Sub Centres helps detect
diabetes, high BP or other chronic diseases
Since 53% of the villages of West Bengal are flood-prone, so recovery including
rehabilitation and reconstruction is difficult in these areas. Both government and NGOs
must work together to face and manage these kinds of disasters. SAMBIT suggested
forming a group in every block comprising of one government official and a doctor and
that their contact numbers must be provided to everybody in the respective block. Pre-
disaster and post disaster plans are required.

10. Session plan:
Running Description of specific activities of the session
time
First 5 Facilitator starts the session with explaining objectives of the session and the
mins significance of the session for the entire training programme.
This needs approximately 2 minutes followed by “Quick Brainstorming”
The facilitator asks the question “What is Health?” to the participants and
helps them come up with few answers that help determine the concept of
health. The facilitator should list down the points from the brainstorming on
the white board. At the end of the brainstorming please emphasize on
following points:
• Health is not the mere absence of disease
• Explain elements with following specific examples
o Physical: Able to do work and earn a living
o Mental: Free from Tensions eg Joblessness/ Violence
o Social well being: Freely able to Voice Opinion
6-10 For understanding the various health services in DRR the visuals are used.
mins
Visual 1 Health Services:
• Explain three components of Health services: Health Infrastructure-
example sub-centre,
• Control of Communicable Diseases- TB control or treatment of
diarrhoea, Control of Non-Communicable Diseases- high BP/ injury/
RCH
11-15 The facilitator emphasizes on the various structures of health services in West
mins Bengal. Here the focus should be on various systems of health mainly, ANMs,
ASHA and AWWs. The structures details are given namely, about PHCs, sub-
centres etc.

11. 16-30 Explanation of visuals
Visual 2 shows the fig 2. Printed on flex
banners.
It explains about the common diseases
caused during disasters: Injuries,
Drowning, Diarrhoea, Malaria, Measles,
Pneumonia, Newborn Deaths, Pregnancy
related
The facilitator shows Fig 2 to the
participants and gives an overview of the above diseases.
31-45 Statistics of disease in Madhya Pradesh: Display the charts (Table 1 to
5) indicating various diseases prevalent in MP.
Deaths/ Mortality – Compare state rates with local IMR U5MR Death Rates
from Block MO or CMO
Nutrition (Growth monitoring) – Compare state rates with local nutrition
status from CDPO or DPO.
46-60
Visual – 4: F diagram:
The facilitator begins by asking “How diseases are caused?”
Then shows the visual (printed on a flex banner) to participants and requests
them to identify the name of the disease and the causes for the disease.
Please list participants’ responses on flip chart.
Explain F diagram to the participants. Please emphasize on how all the
elements in diagram are interrelated.
Show the transmission route from faecal matter to ultimately the host by
referring to the flex banner. Explain how the transmission happens through
fingers, food, field, fluids and flies.

12. 61-75 Participatory discussion
Explain the barriers in the transmission route. Ask the participants if the
transmission route can be broken or can we introduce some barriers in the
route. Welcome their ideas and ask them to explain how that can be barriers.
Then introduce other barriers as shown in the F-diagram. The emphasis
should be on the 5 Barriers that reduce risk of disease
1. Mother and Child Health
2. WASH
3. Food
4. Prevent non-infectious causes (-Anti Snake Venom -Life Jackets against
drowning -Safe Housing)
5. Screening for chronic diseases.
Conclude the session by assuring the participants that more and detailed
information on public health risks will be dealt with in the subsequent
sessions.
Methods:
Brain storming. Use of visual aids on SPHERE and F diagram.
Participatory discussion on Minimum Standards for each of 5 Barriers and using
questions
Material required:
1 White board,
4 white board markers differently coloured,
8 flip charts,
pre-designed visual aids – posters; pics of Mosquito, Dirty Water, Open Defaecation,
Fly; flex banners, flip charts. Local Data on IMR, U5MR, Nutrition if available.