Prioritizing humanitarian settings:
Turning disaster into an opportunity for resilient quality improvement in essential intrapartum and newborn care (EINC) services in the Philippines
Being affected by 20 major typhoons every year, flash flooding, volcanoes and earthquakes, the Philippines is considered the third most disaster-prone country in the world. In November 2013, Super Typhoon Haiyan hit parts of the Philippines affecting over 18 million people and causing infrastructural damage of an estimated US$1.5 billion. The hardest hit geographic areas belonged to the most deprived regions in the country with 40% of children living in poverty. Rapid assessments conducted 16 weeks following the typhoon revealed that health services infrastructure, logistics and human resources were severely impacted. In addition, existing service standards and provider skills were inadequate. Re-establishment of health services for mothers and children, particularly primary and secondary care for obstetric emergency, was identified as a top priority by the Department of Health (equivalent to the Ministry of Health).
In a first stage, emergency stakeholders conducted a multi-stage vulnerability analysis to identify priority areas for the humanitarian response. Based on preliminary data from the Philippines National Disaster Risk Reduction and Management Council and the United Nations Office for the Coordination of Humanitarian Affairs, 120 most affected cities and municipalities were identified. Criteria used included 1) 95% and above affected population, 2) category of typhoon signal and 3) highest potential for storm surge. In a second stage, additional data such as poverty incidence were analysed and a simple index and weighted averages to fine-tune area prioritization created. In a third stage, the status of existing and planned interventions across five sectors namely health, nutrition, education, child protection, and water, sanitation and hygiene, were categorized into high, medium and low convergence areas (high – all 5 sectors present; medium – 4 sectors; and low – less than 4 sectors).
In a fourth and final stage, the top 40 priority municipalities covering all high and some of the medium and low convergence areas were identified based on cumulative affected populations that would yield optimal coverage in relation to strategic response plan targets.
With technical support from the Philippines-based non-governmental organization Kalusugan ng Mag-Ina, UNICEF provided Essential Intrapartum and Newborn Care (EINC) trainings, Training of Trainers (TOTs), Cascade Quality Assurance workshops and supervisory visits in 40 priority municipalities. While trainings were based on updated guidelines endorsed by the World Health Organization for utilization in post-disaster areas, the content of each training session was tailored to the local context, taking into account gaps identified in previous rapid assessments. Gaps identified included Breastfeeding, Kangaroo Mother Care, Infant and Young Child Feeding in Emergencies, Basic Newborn Resuscitation, administration of magnesium sulfate, and postnatal care of mother and newborn.
In addition, two independent post-training evaluations were undertaken comprising of field visits to 56 facilities in the target areas. These evaluations revealed that 1) key commodities were now readily available at health facilities (e.g., magnesium sulfate from 38% to 94%, bag and masks from 0% to 88%-100% across the regions) and 2) service standards (partograph use, delivery room temperature and delivery records) had substantially improved. Dramatic increases in antenatal steroid use and Kangaroo Mother Care were also observed and recorded. Less progress was observed for handwashing, companion of choice during labor, BCG birth doses and monitoring of postnatal care.
This experience shows that post-disaster settings can provide opportunities to strengthen health systems and make them more resilient for future emergencies. The rapid restoration of EINC was a key entry point to quality improvement and health systems strengthening in this post-disaster setting.