Centre for Research on Health Care in Disasters

Background and problem formulation:

Natural disasters increase and affect more people globally. Due to vulnerability low-income countries are more often affected and the lack of resources limits the capacity to prepare and respond. International humanitarian assistance has increased dramatically during the last 30 years and more money is available for relief to disaster-affected countries. However a large part of the assistance is still based on charity rather than professionalism. Several studies has documented the lack of proper needs assessments that should define and quantify the needs of the affected population. There are very few studies that aims at critically exploring the role for health care in disasters and define the type of needs that dominate and how to respond to these needs. We are convinced that our attempt to answer the above will contribute to improve the quality of health care relief following disasters.

Aim:

Our aim is to contribute to improved and targeted humanitarian assistance following disasters by developing evidence for how to best perform needs assessments and how to optimally design and provide health assistance following disasters in different contexts.

For 2012 we specifically focus on

1) Improved needs assessments in the early phase of sudden onset disasters

a. Within hours estimate the magnitude of a disaster.

b. Monitoring population movement using mobile phone network data

c. C-section rate- A method to measure coverage of secondary health care?

2) Defining the burden of disease in different time periods after sudden onset disasters

a. Health effects of earthquakes

b. Estimate DALYs after earthquakes and estimate cost effectiveness of different health interventions

3) Best practices for health care response to sudden onset disasters - focusing on the use of foreign field hospitals and surgical practices

a. Developing the evidence for surgical treatments in resource scarce contexts

b. Developing accountability tools for Foreign Field Hospitals

Methods:

1a) By using basic epidemiology, define which pre-disaster vulnerability indicators that are of most importance in predicting the outcome of a disaster. Collaboration with the Assessment Capacity Project (ACAP) and Columbia University

1b) A new method to analyse mobile phone network data to monitor population displacement after the 2010 Haiti earthquake has been developed and is now tested Collaboration with Digicel and Columbia University

1c) Secondary data from hospitals on C-section rates are compared with population data and birth rates to define coverage and we compare with different contexts Validation of results is done by comparing with other health facility coverage data. Collaboration with researchers in Sudan and WHO

2a) Secondary data from health facilities in three sudden onset disasters are used to compile diagnosis of top ten health conditions treated during the first month after the earthquake. Collaboration with Centre for Research on the Epidemiology of Disasters (CRED)

3a) Using a combination of expert panels, secondary data review and other opportunistic methods we compile information on best practices for a number of surgical trauma related conditions.

3b) In a collaborative approach we are providing support to develop ways to improve accountability for provision of health care in the aftermath of disasters. This is done in an inclusive way encouraging agencies to register and ensure that their contribution is based on existing evidence and in line with medical ethics. Collaboration with University of Manchester, WHO and PAHO

2b) An analytical framework for how to count DALYs for trauma conditions has been developed and is now being tested on a dataset from a hospital in China, following the 2008 Wenchuan earthquake. Collaboration with Centre for Research on the Epidemiology of Disasters (CRED) and Danang hospital.