Health in Emergencies

The InterAgency Working Group (IAWG) for RH in Emergencies recently released the revised version of the Interagency Field Manual (IAFM) for RH in Emergencies. This excellent resource includes the latest WHO approved standards and guidelines for implementing reproductive health interventions during an emergency (natural or conflict related). The manual is in English at present and may be accessed at The Minimum Initial Service Package (MISP) for RH in Emergencies chapter as well as most of the other chapters have significantly changed since the previous version and we encourage you to review this manual carefully when developing or revising the country or regional level Emergency Preparedness Plans (EPP) and in planning emergency response activities in RH.

Online Resources for RH in Emergencies are available at (select library) and

The Global Health Cluster

The Global Health Cluster developed and is testing tools for all health cluster members to use in emergency response. CARE is a member of the global health cluster and two CARE staff participated in a global level training on these tools. Following is a brief description of the manual and tools that may all be downloaded in English and French at

A. Health Cluster Guide
The guide highlights key principles of humanitarian health action and how coordination and joint efforts among health sector actors working in partnership can increase the effectiveness and efficiency of health interventions. It is divided into nine sections: 1) role and functioning of a health cluster; 2) effective coordination; 3) assessment and health situation monitoring; 4) analysis and prioritization; 5) strategy development and planning; 6) standards; 7) advocacy and resource mobilization; 8) cluster performance monitoring – lessons learned; and 9) standard services and indicator lists.

B. Core Health Indicators
A set of Core Health Indicators and Benchmarks are classified into four categories: (i) health resources availability, (ii) health services coverage, (iii) risks factors, and (iv) health outcomes. These indicators may be found at

C. Tools for Data Collection and Analysis
There are three tools for data collection and analysis to be used at various stages of emergency preparedness and response and these may be accessed at

Preparedness and Planning

The HeRAMS and HIS Tools should be used for health including reproductive health and clinical management of rape. In order to maximize the capacity of people with the right skills, knowledge and attitudes to deliver effective emergency responses, it is important to map human resources and health services.

HeRAMS (Health Resources and Availability Mapping System)
The objective is to promote and support good practice in mapping health resources and services availability. The rationale for HeRAMs is that frequently there is:
· A lack of comprehensive understanding of resources and services availability over an affected region and inability to track its evolution over time; and
· Difficulty with identifying and addressing gaps, inequities and inequalities in the response.

The data structure provides information on health personnel, health facility and community services. This tool can be used to provide a baseline and may be easily updated. The health personnel data can be disaggregated by facility versus community-based; and female versus male providers.

Health Information System (HIS)
The HIS allows us to collect data in a systematic way by using a standardized toolkit of data collection and reporting tools that is accompanied by a manual and training material to support frontline staff that are collecting and reporting the data. The global health cluster has developed standard indicators that are measured by using the HIS. When setting up the HIS, it is important to keep the following principles in mind:
· All implementing partners (MOH and NGO staff should be trained on how to use the HIS in the field and should contribute to planning for transition to development phase
· Data should be used for decision making
· Data should be analyzed and shared

Emergency Response

Initial Rapid assessment (IRA)
The IRA provides a rapid overview of the emergency situation and provides information on the immediate impacts of the crisis, makes initial estimates of the needs of the affected population for assistance, and defines the priorities for humanitarian action (and funding for that action) in the early weeks. It should also identify areas that need more detailed follow-on assessments.

The IRA tool assesses the needs of the affected population in health, food security, nutrition, non-food items, and water, sanitation and hygiene (WASH). The tool includes an assessment form to be adapted to the context and an analysis tool in excel. This tool is included in the CARE Emergency Toolkit and Pocketbook. It is important to coordinate implementation of this assessment with the other sectors of CARE’s response.

The objective of the IRA is to answer the following core questions:
· What has happened? Is there an emergency situation and, if so, what are its key features?
· How has the population been affected by the emergency? Who is likely to be most vulnerable and why? How many people were affected, and where are they?
· Are interventions required to prevent further harm or loss of life? If so what are the top priorities?
· What are continuing or emerging threats that may escalate the emergency?
· What resources and capacities are already present (e.g., infrastructure and institutions) that could contribute to the response, and what are the immediate capacity gaps?
· What are the key information gaps that should be addressed in following-up assessments?

Data provided by an IRA are preliminary, and the quality of data depends on the skills of the assessment teams. The IRA should identify what types of more detailed sector-specific assessments should be conducted, which would then provide more statistically rigorous or qualitatively nuanced details for program planning.

The IRA should be launched as soon as possible after the onset of an acute crisis, ideally within 1 to 3 days of the onset of the crisis. It can also be used in a protracted emergency situation that becomes more acute and when access becomes available to areas that were previously inaccessible due to insecurity, weather conditions or other obstacles. After about 10 to 15 days, there is likely to be a need, and the capacity, to undertake more in-depth, sector-specific assessments.

Based upon recent experiences with using the IRA, UNOCHA is leading a revision of the IRA and other needs assessment tools but until a new tool is developed, I would suggest that CARE offices modify and implement the IRA unless you have other rapid assessment tools.

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