HEALTH CLUSTERS AND THE HEALTH EMERGENCY OPERATION CENTER (HEOC)
C. Action Plan (Problem Identification, Strategic Policy, Sub-Cluster Activities, and Budget Requirements)
3) How to Develop Policies and Strategies
Identifying problems is the main step for developing policies and strategies for handling emergency response according to scenarios and impact assumptions. Problems can be identified from predicted impacts, for example problems on the population aspect, problems on the health aspect, problems on the aspects of facilities, governance, and the environment that impact on health or the health system, including coordination problems, lack of resource capacity, and crisis problems other health. The following is an example of problem identification from the scenario developed in the previous chapter:
Table 2.5 Problem identification example based on a scenario
Scenario List of Problems
On Friday, September 28, 20xx, at 18.02. WITA, there has been an earthquake with a scale of 7.4 on the Richter scale. The epicenter of the earthquake was 26 km north of Donggala and 80 km northwest of Palu City with a depth of 10 km which was followed by a tsunami that hit the west coast of Sulawesi Island, Indonesia, and liquefaction.
The earthquake shock was felt in Donggala District, Palu City, Parimo District, Sigi District, Poso District,
-
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Scenario List of Problems
Toli Toli District, Mamuju District, and even to Samarinda City, Balikpapan City, and Makassar. The earthquake triggered a tsunami up to a height of 5m in Palu City, and caused liquefaction at several locations, namely in the villages of Balaroa, Petob, and Jono Oge.
The earthquake caused thousands of people to panic and try to save themselves. The impact of the earthquake, tsunami and liquefaction resulted in a total of 4,402 fatalities, 2,665 deaths, 701 missing.
Furthermore, a total of 172,999 IDPs were spread over more than 100 evacuation points.
- Numerous individuals lost their lives, went missing, and suffered various degrees of injury.
- … - … - … The earthquake also had an impact on health and government facilities, in which 9 community health centers were heavily damaged from 4 districts, 1 hospital was heavily damaged and 17 auxilliary community health centers were heavily damaged.
- Health facilities were directly impacted by the disaster, leaving many victims in need of assistance.
- … - … - …
Health workers were also affected by the disaster. - A large number of health workers were also affected by the disaster.
- … - … - … Infrastructure and facilities not functioning properly, i.e. power outages, disconnected communications, and transportation equipment that cannot function properly.
- Critical facilities and infrastructure were
inaccessible for
approximately four days due to power outages, communication disruptions, lack of clean water supply, and limited fuel for transportation equipment.
- Road access was cut off, particularly in remote and affected areas.
- … - … During the emergency response period, many disaster victims contracted diarrheal disease at the evacuation points.
- Diarrheal disease appeared at several evacuation sites.
- … - … In response, Central Sulawesi's governor declared an Emergency Response Status for 14 days from September 28.
- In the initial week of the disaster, coordination efforts were not effective.
- Volunteer management was not well-coordinated in the first week, with some
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Scenario List of Problems
volunteers failing to report their arrivals and departures to the Health Cluster.
- …
Source: Central Sulawesi Provincial Health Office Disaster Plan document revision 1 of 2020.
The list of problems helps the drafting team to determine policies and strategies to address them. This is done by taking into account their capacity, timeliness, and operationality. The list can then be transferred to the policies and strategies table, as shown in the example below.
Table. 2.6 Policies and Strategies example No. Identification of
Problems
Policy Strategy
1 Numerous individuals lost their lives, went missing, and suffered various degrees of injury.
All deceased victims and those who suffered serious injuries are to receive appropriate medical treatment in accordance with established procedures.
- Collaborate with the DVI team for victim identification.
- Establish a referral hospital to handle critical cases.
- Deploy both mobile and fixed Emergency Medical Teams (EMTs) to affected areas.
2 Health facilities were directly impacted by the disaster, leaving many victims in need of assistance.
Ensuring the continuity of health facility operations.
- Create health posts and field hospitals at strategic locations to provide triage and initial medical care.
- Establish another referral hospital.
- Construct a health post at the evacuation site.
- Deploy health volunteers/ EMTs to affected health facilities to support the
continuation of health services.
3 A large number of health workers were also affected by the disaster.
Ensuring the continuity of the roles and
responsibilities of affected health workers.
- Assess the number of health workers required.
- Request additional health workers, volunteers, or release health workers to help from other areas.
- Deploy health volunteers/EMTs to
36 No. Identification of
Problems
Policy Strategy
affected health facilities to replace the functions of affected health workers.
4 Critical facilities and infrastructure were inaccessible for approximately four days due to power outages,
communication disruptions, lack of clean water supply, and limited fuel for transportation equipment.
Ensuring that health services are delivered using alternative means, such as generators, when necessary.
- Coordinate with PLN to repair damaged power lines.
- Coordinate with the Office of Informatics to fix the damaged communication network.
- Coordinate the supply of clean water in the evacuation sites.
- Collaborate with Pertamina to procure fuel stock.
5 Road access was cut off, particularly in remote and affected areas.
Providing immediate access to health services for affected communities in isolated areas.
- Coordinate with PU to improve access to affected areas.
- Coordinate with the Indonesian Air Force to provide air
transportation services to isolated areas for health services.
- Identify the nearest referral hospital.
- Deploy both mobile and fixed EMTs to affected areas.
6 Diarrheal disease appeared at several evacuation sites.
Ensuring that individuals suffering from diarrheal disease receive proper treatment.
- The sub-cluster responsible for health services must provide assistance to evacuation points based on its function.
7 In the initial week of the disaster,
coordination efforts were not effective.
Establishing a clear command structure for effective disaster response and management.
- Activate the predefined health disaster team command system or health cluster team.
- Activate the health cluster to coordinate health-related relief efforts.
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At the stage of determining the emergency response for the health crisis contingency plan, the drafting team must continue to brainstorm, discuss and correct, including consulting with decision makers at the field and section level.
Discussions with the cross-sectors involved and experts are also important to be carried out so that the problems, policies and strategies determined are in more detail close to the actual situation that will occur and predict all the worst uncertainties that might occur.
CONTINGENCY PLAN OUTLINE
Title Foreword Glossary
Table of Contents Section I Introduction A. Background B. Purpose C. Legal Basis
Section II Health Capacity
A. General Overview of the Area 1. Geography
2. Demography
B. Health Department Organizational Structure
C. All Available Capacities (Government and Non-Governmental Resources) D. Capacity Gap Compared to Minimum Service Standards
Section III Risk Analysis A. Disaster Potential B. Risk Analysis Calculation C. Priorities
Section IV Contingency Plan A. Scenario Development B. Impact Assumptions
C. Action Plan (problem identification, policy strategy, sub-cluster activities, and budget needs)
Section V HEOC/Health Cluster Activation A. Organization
B. Duties and Responsibilities C. Standard Operating Procedures D. Facilities
Section VI Follow-Up Plan Section VII Conclusion Attachment