The following discussion illustrates the impact of violence and injuries (in LAMICs), the guidelines for providing health services in disaster emergency response and the framework of health policy development for emergency preparedness.
“Just under a third of injuries worldwide (32.8%) are recognizably intentional; half of these are self-inflicted and half result from interpersonal violence and war” (Murray 2006) Violence kills more than 1.6 million people worldwide each year, accounting for 14% of male deaths and 7% of female. (WHO, 2002). Furthermore, “the mortality burden from all types of injuries in high-income countries is 10% of that in low/middle-income countries” (Hofman, 2005). In addition to the gaps in having an organized and skilled healthcare workforce within an emergency response system, low-and-middle-income countries experience significant post-conflict, non-communicable diseases (mainly psychological) that affect productivity and overall well-being of families and communities (Hofman, 2005).
The public health approach to violence is based on four key steps (Dahlberg 2002): 1) understanding the magnitude and scope of violence at the local, national and international levels 2) determining the etiology of violence and factors that increase susceptibility to committing or being victims of violence 3) formulating and implementing effective interventions 4) and dissemination of effective programs.
While the nature of violent acts, can be physical, sexual, psychological or an act of neglect, the difficulty of properly addressing the specific health needs incurred by violence remains in the measurement of violence and its actual impact (Dahlberg, 2002). Data on fatalities and war-related deaths can indicate the extent of violence in a particular country. These data can also be used for identifying groups at high risk for violence and monitoring their health. Potential sources of the various types of information include: individuals; agency or institutional records; government records; and population-based and other surveys. However, calculating rates from these sources is not always possible because population data are often unavailable or unreliable—especially among migrant/refugee populations whereby the objective of proper record and consensus tracking is challenging. Lastly, data on violence generally come from a variety of independent organizations and with lack of uniformity between and within countries (especially LAMICs),
The Sphere Project (2004) outlines the minimal standards for health service delivery during disaster response. It lists 6 essential standards: prioritizing health services; supporting national and local health systems; coordination; primary health care; clinical services; and health information systems.
In prioritizing health services: the major causes of morbidity and mortality should be properly identified and monitored; health authorities at all government levels should be involved in the design and implementation of health interventions; and, collaboration with multi-sector agencies to ensure proper health service delivery implementation in coordination with water, shelter, and food securities.
In supporting national and local health systems, there should namely be an immediate identification of a lead health authority to serve as a supervisory role during multi-agency and/or multi-national collaborations to address conflict-affected areas (the MOH is the primary lead, if present and capable). Secondly, there should be an emphasis on supporting existing resources (hospitals, workforce, etc.) rather than deploying a foreign field hospital and place further strains on the country’s limited resources.
In the coordination standard, the main action to ensure is the establishment of proper duties and responsibilities of local and national health authorities to develop a streamlined and effective operating mechanism. In providing the standards of primary health care, there should be an emphasis in disseminating health education information in addition to establishing proper referral systems among the various health centers and personnel. Most notably, these services must be carefully adapted to cultural and social norms to ensure compliance and adherence to treatments.
In providing the standards of clinical services, there should be proper monitoring and evaluation by adequate clinical health staff in regard to drug management (due to the scarcity of drugs and its susceptibility to being misused and even mismanaged in procurement). Lastly, with providing health information systems, a standardized health information system (HIS) is implemented by all health agencies to routinely collect relevant data on demographics, mortality, and morbidity and health services
Developing a policy response to violence and injuries may consist of three phases (Schopper, 2006).
Phase 1: Initiate the policy development process. This can be accomplished by various steps; initiating with an Assessment step. An epidemiological assessment may provide policy makers with the proper morbidity and mortality data relating to violence and injury (challenges: the reliability of data collection methods). An intervention assessment may be conducted whereby an evaluation of the country’s existing resources and programs devoted to prevention is methods are analyzed. An assessment of the existing policy development is essential to determine the direction of future legislation as well as the knowledge gaps to address. A stakeholder analysis will provide insight as to who may be proponents or opponents of injury prevention policies. Stakeholders may include: elected officials, commissions, regional/local governments (at state/govt. level); universities and researchers (academia level); advocacy groups and sponsors (NGO level). The second step would entail raising awareness of violence and injury. Examples include: World Refugee Day, UN International Day in Support of Victims of Torture, and Human Rights Day. The third step involves identifying the proper leadership and affirming political commitment—namely to serve as a coordinating role to ensure the involvement of the various stakeholders is properly incorporated into the policy development process.
Phase 2 involves the actual policy development. This phase essentially focuses on setting the priorities, defining responsibilities for implementation, identifying necessary resources for implementation, and developing a monitoring mechanism to ensure the timely policy development.
Phase 3 involves the approval of stakeholders, government and state entities. The stakeholder’s approval would be most advantageous—in light of political ambiguity—as they are most likely to be the advocates for the intended policy development.
In closing, how are we to address the various logistical/operational challenges faced in international disaster response? (IFRC, 2005) With regard to human resources, how can we expedite the processes in ensuring timely arrival of relief workers without the various international legal red tape surrounding the recognition and protection of relief workers? With regard to financial resources, how can we expedite the processes involving the transfers of funds between international communities to conflict-affected regions? With regard to equipment, how can we ensure safety in delivery of the necessary goods to our target regions? And lastly, how can we incorporate effective coordination (information and resources) among humanitarian agencies to maximize use of scarce resources?
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Dahlberg L.L., Krug E.G. Violence: a global public health problem. WHO report on Violence and Health, 2002
Hofman K., Primack A., Keusch G., Hrynkow S. Addressing the Growing Burden of Trauma and Injury in Low-and-Middle-Income Countries. AMJPH January 2005, v.95 (1): 13-17
International Federation of Red Cross (IFRC). International disaster response laws, rules and principles (IDRL). Jan 2005
Murray, S. Public Health. Editorial. CMAJ Feb 28, 2006 v.174(5): 620-21
Schopper D, Lormand JD,Waxweiler R (eds). Developing policies to prevent injuries and violence: guidelines for policy-makers and planners. Geneva,World Health Organization, 2006.
Sphere Project: Humanitarian Charter and Minimum Standards in Disaster Response. pp249-310 (2004)
World Health Organization (WHO). World report on violence and health. Geneva: WHO; 2002. Available: www.who.int/violence_injury_prevention/en (accessed March 14, 2009)
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It is sad to learn that, most of injuries around the world is caused intentionally, why am I not surprised, in the northern region of Ghana, a group of people could just start a conflict because of a fowl which in tend causes casualty just a simple misunderstanding. In a developing country such as Ghana, it is very rare to hear that someone has been shot down but in the US, it is scarce to not hear that someone has been killed from a gun shot in the daily news. People in the Military are those who have access to guns in Ghana. The Ghanaians culture does not encourage people to sell or own gun, there is not a single gun store in Ghana. People who sell guns sell it illegally at the black market to arm robbers and gang members. As much as it was bad for President John Rawlings regime to put armed robbers under firing squad in Ghana, it helped reduce the number of violence as compared to present day Ghana. People in Ghana die way more from communicable disease, non-communicable disease and road accidents. This is because there of the limited assess to health care and the rough roads in Ghana to the villages were food crops are grown and brought to the cities and market for sales. The cars used for carrying goods are old with different problem as unchecked brake and emission checks for a long period of time, altogether causing road accidents that kill pedestrians along the roads.
ReplyDeleteDue to the lack of health care facilities and insufficient healthcare provides there is indeed a huge problem once there is a health related issue such especially in low income countries. Wars have a great impact on human and health. When there is war the demands for healthcare practice and medicine rises due to lack of resources for example.
Armed conflict causes an enormous amount of death and disability worldwide through wars and is able to affect low and middle class countries profoundly because of the same problem as they lack of resources on healthcare facilities already. It destroys families, communities, and cultures. Wars also forces people to leave their homes which causes them to become internally displaced persons, refugees to other countries who might not also have enough resources with health care facilities. Wars violate human right because they are not able to live freely and to do as they please. There is indeed an enormous gap about war and health. To better understand some of the arising problems in war areas, countries needing emergency health services, health professionals can start especially in developing countries to recorded information, political problems associated with health, and all other relevant problem that can help further research to make the world a better one. We can use these information and data to start educate generation and better ourselves on issue that would yield a better tomorrow for us all even by taking baby steps.