Building Health Systems Resilience in the Eastern Mediterranean Region th World 7 th d Health s h summit R Regiona nal M Meet eting ng Tehr ehran Uni Universi sity o of Medi edical S Scienc ences Kish I h Island, nd, I I.R. I Iran, n, A April 29 29-30 30 Rana Hajjeh, M.D. Director of Programme Management WHO Regional Office for the Eastern Mediterranean
Presentatio ion h highlig lights ts • Definition and elements of health systems resilience • Importance of health systems resilience in the Eastern Mediterranean Region • Eastern Mediterranean regional framework for building resilient health systems • Measurement of health systems resilience • EMRO initiatives on building health systems resilience • Opportunities, challenges and way forward
Health Sys ystems ms Resi silien ence e Elements Definition The ability of a health system exposed to a shock to resist, absorb, accommodate and recover from the effects of the shock in a timely and efficient manner, including through the preservation and restoration of its essential basic structures and functions through risk management.” Source: Adapted form “ Terminology on disaster risk reduction”. UNISDR. Available: Source: Olu O (2017) Resilient Health System As Conceptual Framework for Strengthening Public Health Disaster Risk https://www.unisdr.org/we/inform/terminology#letter-e. Accessed: 17 April 2019. Management: An African Viewpoint. Front. Public Health 5:263. doi: 10.3389/fpubh.2017.00263
Do we e need r need res esilience f e for the hea he health system ems of the E Easter ern M n Mediterranea ean R n Region ? n ? Hea Health th em emer ergenci cies i in the E EMR • At risk of natural and man-made emergencies as well as epidemic prone diseases • Unprecedented scale of violent conflicts • 11 graded events and 8 graded countries • 58 million people in need of emergency healthcare • 30 million displaced people, i.e., half of all displaced persons globally
Exam amples o of H Haz azar ards in the E e Easter ern M Mediter erran anean ean R Region on Severe weather storm Egypt, Jordan, Palestine, Syria, and Lebanon The world Bank, Dec, 2015 Cyclone in Oman, British Expats, May, 2018 Drought in Somalia, BBC News, Feb, 2017 Chlorine release, Iraq Conflict in Yemen, International crises group, Nov, 2017 Cholera epidemic fears in Hiran as severe flooding forces families to flee their homes HORSEED EED STAFF, M May, 2018 2018 Earthquake and floods in Iran
Number er o of E Even ents 0 1 2 3 4 5 6 7 Armed C Conflict, F Forced Almost Certain movem ement, CBRN Risk level Risk Di Chole lera, m measle les, dust s storms k Distribution in the Very low Low Very Likely Diphtheria & & Moderate Pertussis is, ME MERS-CoV oV Polio io High e Easter Likelihood Very high ern M Earthquake ood Likely Mediter Flood, d drought, Dengue, Impact RVF, F, CCH CCHF, F, X XDR T TB erran anean Severe Tsunami, i, i industria ial l ean R accident Unlikely Region Moderate He Heat w waves, cold ld waves, n noel l on, 2018 influ luenza v virus, y yello llow fever Minor 018 Very Unlikely Ma Mass m movements including l landslides
Hazards ds Per C Country, 201 2016-201 2018 Country Hazards Country Hazards Afghanistan Natural disasters, disease outbreak, armed conflict, Oman Disease outbreak, natural disasters, hosting displaced population, labor displaced population migration Bahrain Disease outbreak, labor migration Pakistan Natural disasters, disease outbreak, displaced population, mass gatherings Djibouti Disease outbreak Palestine Armed conflict, disease outbreaks Egypt Disease outbreak, hosting displaced population Qatar Disease outbreak, labor migration, mass gatherings Jordan Disease outbreak, hosting displaced population Saudi Arabia Natural disasters, disease outbreak, labor migration, mass gatherings Iran Natural disasters, disease outbreak Somalia Natural disaster, armed conflict, disease outbreaks Iraq Natural disaster, armed conflict, disease outbreak, mass Sudan Natural disaster, armed conflict, disease outbreaks gatherings Kuwait Disease outbreak, labor migration Syria armed conflict, disease outbreaks, displaced population Lebanon Disease outbreak, hosting displaced population, mass Tunisia Natural disasters, disease outbreak, mass gatherings gatherings Libya Disease outbreak, armed conflict UAE Disease outbreak, labor migration, mass gatherings Morocco Disease outbreak, labor migration Yemen Armed conflict, disease outbreaks Risk varied between countries and between hazards for each country
EMR R Regi egional Fr Framework f for Bui uilding R Res esilient Hea Health S System ems Global F Gl Fram ameworks Adopted in 2015, to scale up implementation of DRR strategies as means to improve resilience to disasters Priority 1 . Understanding disaster risk Priority 2 . Strengthening disaster risk governance to manage disaster risk WHA 64.10: Strengthening Priority 3. Investing in disaster risk reduction national health emergency and for resilience Priority 4 . Enhancing disaster preparedness disaster management capacities for effective response and recovery, and resilience of health systems rehabilitation and reconstruction
Hea Health th System em S Stren engthen ening, R Resilien ence, e, U UHC and S SDGs “UHC and health emergencies are cousins – two sides of the same coin. Strengthening health systems is the best way to safeguard against health crises” Dr Tedros Adhanom Ghebreyesus, WHO Director General SDG 1: No poverty SDG 3: Equitable health outcomes SDG 4: Quality Education and wellbeing; Global public health SDG 5: Gender Equality SGD 8: Inclusive economic security and resilient societies SDG 16: Inclusive societies growth and decent jobs Achieve Universal Health Coverage All people and communities receive the quality health services they need, without financial hardship Health system strengthening along with preparedness for emergency response and recovery Source: Adapted from “The standard PowerPoint presentation of the Health System Development Department”. The Eastern Mediterranean Region of World Health Organization. a nd Kieny MP, Bekedam H, Dovlo D, et al. Strengthening health systems for universal health coverage and sustainable development. Bull World Health Organ 2017;95:537–539| doi: http://dx.doi.org/10.2471/BLT.16.187476
Reg egional F Framework: k: Elem ements o of Building Res esilient H Hea ealth Sy Systems Universal Health Essential Public Health Information Governance Resources Coverage Health Functions System Integrated multi-hazard Access to comprehensive National Legislation Surveillance early warning function quality, health services Workforce Development Polices and plans for health Collection and analysis of Essential package of emergency preparedness data form official and helath services Strengthening stewardship and response unofficial sources. and governance Reporting of Disaster and other risk Risk communication Support financing system data/information to reduction strategies support risk assessment Improving financing Coordination structure and Health facility safety Forecasting and modelling mechanisms Logistics and supply Intersectoral action to system address the social System and operational Organizational structure Risk assessment research determinants of health
Mea easu suring R Res esilience o e of Hea Health Sys yste tems in the E Easter ern M n Mediterranea nean R n Region, n, 201 2016-2018 018 R.1.1 : Multi-hazard national public health Monitoring and Evaluation Preparedness emergency plan Framework (MEF) R.1.2 : Priority public health risks mapped 1. Annual reporting R.2.1 : Activate emergency operations 2. After Action Review (AAR) R2.2 : Emergency operations center Response 3. Simulation Exercise (SimEx) R.2.3 : Emergency operations Program R.2.4 : Case management procedures 4. Joint External Evaluation (JEE) P.1.1 : Functional Mechanisms for Coordination coordination R.5.4 : Functional Mechanisms for Community coordination
JEE EE a and Annua nual Report orting d data of of the EM EMR R co countries, 201 2016 ─ 20 2018 18 Preparedness Response Coordination Community Capacity score Afghanistan No Bahrain Limited Djibouti Egypt Developed Jordan Demonstrated I.R.Iran Sustainable Iraq Kuwait Lebanon Libya Morocco
JEE and Annual Reporting data of the EMR countries, 2016 ─ 2018 Preparedness Response Coordination Community Oman Capacity score Pakistan No OPT Limited Qatar Developed Saudi Arabia Demonstrated Somalia Sustainable Sudan Syria Tunisia UAE Yemen
EMRO RO I Initiatives for or B Build ldin ing H Hea ealt lth S Systems R Res esilie ilience
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