J. Assessment Checklists
Note: Refer to chapter III, the Health section, for the methods used in calculating the prevalence and incidence rates of diseases and death.
a. Health and Demographic Information
- Determine total population affected (include host population as well as displaced), including age (under 5 years), male and female ratio, average family size, and numbers of arrivals and departures per week in displaced populations (internally or refugees).
- Identify vulnerable populations (numbers of female- or child-headed households, unaccompanied children, disabled, elderly, single women, pregnant and lactating women, etc.).
- Establish crude mortality rate. The rate of death in the entire population for all diseases.
- Establish under-5 mortality rate. The rate of death among children 59 months of age and younger.
- Obtain measles vaccination coverage for children between the ages of 6 and 59 months. (If coverage is less than 90 percent, plans should be made for a mass measles vaccination campaign that includes the administration of vitamin A to children ages 6 to 59 months. To protect the population from a measles epidemic, the coverage should be greater than 95 percent.)
- Determine diarrhea incidence (bloody/nonbloody) in adults and children less than 5 years of age.
- Establish incidence rates for other diseases of significant public health importance (cholera, yellow fever, dysentery, etc.). Ideally, the information should be disaggregated for adults and children under 5 years of age, although in emergencies it may be difficult to obtain. Identify and cite methods of diagnosis (clinical judgment, laboratory test, or other method).
- Determine or estimate the incidence of major traumatic injuries requiring surgery or hospitalization (e.g., fractures, head injuries, internal injuries).
- Identify incidence and trends of violence against women and children.
- Assess baseline data for HIV/AIDS and risk factors for increasing transmission. Due to the HIV/AIDS pandemic and increasing evidence suggesting that transmission is increased in emergencies, efforts to prevent new trans-missions must be started in the acute phase of an emergency.
- Conduct a rapid risk and vulnerability assessment.
- Those at risk for HIV transmission are often context-specific but are essentially women, youth, drug addicts, and certain ethnic and religious groups that face discrimination.
- Assess the presence of groups considered "core transmitters," such as commercial sex workers and armed military and paramilitary personnel.
- Evaluate interactions among displaced and local populations and communities for the risk of HIV transmission.
- Ascertain the existing level of risk and specific factors that make the risk groups listed above more vulnerable to HIV/AIDS (e.g., trading sex for food).
- Existing baseline data may include:
- Voluntary blood donor testing.
- New TB cases.
- Trends of HIV/AIDS case surveillance reporting.
- Incidence and trends of sexually transmitted infections disaggregated by syndrome (male urethral discharge, genital ulcer disease, syphilis at antenatal clinics).
- Percent and trends of hospital bed occupancy of persons between 15 and 49 years of age.
- HIV/AIDS information for the displaced population areas of origin.
c. Health System Capabilities
- Determine the number, location, and condition of all health facilities and number of usable beds. Consider using a map for graphic representation during the assessment.
- Determine the location and condition of all laboratory assets in country, including adequacy of equipment (microscopes) and supplies (reagents, gloves, slides, sharps containers, etc.). Determine laboratory capabilities for confirming major communicable diseases (malaria, cholera, shigellosis, meningitis, measles, yellow fever, and TB) and the testing of blood for transfusions for HIV/AIDS, Hepatitis B, and if possible, Hepatitis C and syphilis. Determine the effectiveness of lab referral systems.
- Identify available health personnel (doctors, nurses, community health workers, traditional birth attendants, midwives, lab technicians, etc.). Assess abilities and training needs.
- Determine the amount and type of medical supplies and drugs available locally or in-country.
- Ascertain the availability of specialized medical care at appropriate hospitals for emergencies, such as severe trauma, life-threatening diseases, and comprehensive emergency obstetric care, and the availability of transportation to these hospitals.
- Determine the availability of referral mechanisms for transferring patients to specialized care.
- Determine the presence of systems to prevent and manage cases of gender violence.
d. Local Health Programs
Describe the following health programs (if present):
- Diarrhea disease prevention and control (includes capacity of health facilities to treat dehydration from diarrhea, using oral rehydration therapy as well as capability to establish cholera treatment centers), adequacy and quality of water supply, and health education.
- Reproductive health programs including prenatal, antenatal, deliveries, emergency obstetrical care (placental abruption, post partum hemorrhage, ectopic pregnancy, obstructed labor, etc.), HIV/AIDS prevention (blood screening, use of universal infection control precautions, and condom availability), management of sexual violence, etc.
- HIV/AIDS prevention and control (access to free condoms, relevant information, and education, linked with reproductive health and primary care facilities and programs).
- TB prevention and control.
- Malnutrition assessments (see the Nutrition section of this chapter).
- Expanded Program for Immunizations.
- Determine routine immunization coverage rate (percent of children under age 5).
- Obtain dates of previous and/or proposed mass vaccination campaigns for measles, and possibly polio, if still present in the country. Assess whether vitamin A was given in the measles campaign. Determine if the host population and the displaced were included and the coverage rate.
- Assess capability of relief workers and/or local health personnel to begin or sustain an immunization program, including mass campaigns and routine immunization.
- Determine adequacy of coordination, logistics, infra-structure, cold chain (refrigerators/freezers/ freezer packs), availability of vaccines and equipment (sharps containers, adequate supplies of syringes to prevent reuse, etc.).
- Universal Infection Control Precaution Systems in health facilities and immunization campaigns to prevent trans-mission of HIV, Hepatitis B, and other blood-borne infec-tions in patients and healthcare workers.
e. Health Information/Surveillance Systems
- Determine whether a health information system is in place to monitor the health of the affected population and provide disease surveillance:
- Is a single authority responsible (e.g., the Ministry of Health) for its operation and data analysis?
- How often is routine analysis done, and how are the results disseminated?
- What proportion of the health facilities routinely send in health information reports and how often?
- What diseases or health conditions are included in the system?
- Are standardized case definitions used?
- Is the system able to detect early outbreaks and provide a quick and effective response?
f. Cultural and Social Health Factors
- Describe nontraditional sources of health care (traditional healers, etc.).
- Ascertain beliefs and traditions that could affect health care and delivery, such as food taboos during infancy and pregnancy, female genital mutilation, burial practices (special precautions needed for cholera and hemorrhagic fever deaths), blood-taking, injection, and patient isolation beliefs.
- Describe the social structure and traditional leadership systems (e.g., determine if the displaced are grouped in their traditional villages and what type of social or political organization exists).
- Discuss the presence of different ethnic groups/religions and their relationships.
g. Environmental Health Factors
- Determine the status and trend of climatic conditions of health interest, such as temperature, precipitation, flooding, etc. Obtain and cite relevant information from forecasts and local knowledge of weather conditions.
- Identify significant topologic features that may influence access to health care (e.g., areas that flood during the rainy season causing landslides or preventing access to services, vector breeding habitat).
- Identify water sources, and monitor quality, equitable access, and quantity.
- Determine the local availability of materials for shelter and fuel.
- Determine whether existing shelter, water, and latrine locations and arrangements pose a safety or security risk to women and children.
- See the Shelter, Water, and Sanitation sections of this chapter for other assessment information.