Rebuilding and strengthening health systems and providing basic health services in fragile states

The international community has compelling humanitarian, political, security and economic reasons to engage in rebuilding and strengthening health systems in fragile states. Improvements in health services and systems help to strengthen civil society and to restore legitimacy to governments. Effective engagement with fragile states to inform the design of health programmes and selection of interventions depends on donor coordination and an understanding of health system challenges. Planning requires consideration of allocation (services to be delivered), production (organisation of services), distribution (beneficiaries of services) and financing. The criteria for selecting interventions are: their impact on major health problems; effectiveness; the possibility of scale-up; equity; and sustainability. There are various options for financing and models of engagement, but support should always combine short-term relief with longer-term development. Stakeholders should aim not only to save lives and protect health but also to bolster nations' ability to deliver good-quality services in the long run.     

An adaptive governance approach to disaster-related behavioural health services

This paper explores the provision of disaster-related behavioural and mental health (DBH) services as a problem of institutional collective action in the United States. This study reviews the challenges that providers have in surmounting multi-organizational disconnects, unstable professional legitimacy, ambiguous information, and shifting disaster needs in developing a system for delivering DBH services. Based on the adaptive governance framework, it argues that existing protocols such as the National Incident Management System (NIMS) and Incident Command System (ICS) may be helpful in advancing collective action, but that real progress will depend on a recognition of norms, expectations, and credentials across many spheres-in other words, on the ability of responders to continuously adjust their procedures and administrative boundaries for behavioural health institutions.     

Reproductive health services for refugees by refugees: an example from Guinea

The need to involve refugees in their own reproductive health (RH) services has long been recognised, but there is a lack of published examples describing how this can be achieved collaboratively between refugee initiatives, UNHCR, bilateral development organisations and international relief agencies. This paper outlines the work, outputs and lessons learnt of the Reproductive Health Group (RHG), an organisation of Liberian and Sierra Leonean refugee midwives and laywomen providing RH services to fellow refugees in Guinea's Forest Region between 1996 and 2000. Working as part of the Guinean health system, RHG midwives and community facilitators helped make the RH services in their region the most effective in Guinea at the time. Looking at RHG's achievements, the challenges it faced and partly overcame, it is argued that refugee organisations can plan and implement RH services for refugees where UNHCR and its international partners ensure that they receive funding and technical assistance.     

Providing health services during a civil war: the experience of a garrison town in South Sudan

The impact of conflict, particularly conflict arising during civil wars, on the provision of healthcare is a subject that has not been widely considered in conflict‐related research. Combatants often target health services to weaken or to defeat the enemy, while attempts to maintain or improve health systems also can comprise part of counter‐insurgency ‘hearts‐and‐minds’ strategies. This paper describes the dynamics associated with the provision of health services in Malakal, an important garrison town in South Sudan, during the second Sudanese civil war (1983–2005). Drawing on the concepts of opportunity hoarding and exploitation, it explores the social and political dynamics of service provision in and around the town during the war. These concepts provide a useful lens with which to understand better how health services are affected by conflict, while the empirical case study presented in the paper illustrates dynamics that may be repeated in other contexts. The concepts and case study set out in this paper should prove useful to healthcare providers working in conflict zones, including humanitarian aid agencies and their employees, increasing their understanding of the social and political dynamics that they are likely to face during future conflict‐related complex emergencies.     

Quality design: a planning methodology for the integration of refugee and local health services,West Nile,Uganda

In an emergency, the international community responds to the immediate health needs of refugees through the establishment of action-oriented, life-saving services. Healthcare delivery is often managed with limited, if any, coordination with local health management structures. In situations where refugees remain in the host country for many years, sustainability issues inevitably arise. Refugee-hosting governments may ultimately be called upon to assume the management and funding of refugee services. Planning for service integration, while protecting against declines in service quality, is a challenge in the typically resource-poor host environments. This paper discusses these issues by presenting the experience of the West Nile districts in northern Uganda, and describes quality design as a relevant planning methodology. Quality design is a systematic planning approach that documents and directly incorporates the service users' self-defined expectations and needs.     

Responses to natural and man-made hazards in Borno, Northeast Nigeria

This is a study of the responses of the people of eastern Borno to the twin hazards of drought and of an irrigation project stranded by the recent low level of Lake Chad. The environmental awareness of the people has been much influenced by access to information, particularly radio. There was a perceptual dissonance; drought is discerned as a natural act of God, but lake recession is seen as man-made. There is also a gap between responses perceived as appropriate and actual responses consequent on the constraints imposed by the process of modernization, notably the introduction of the South Chad Irrigation Project (SOP). Traditional response mechanisms involving the norm of reciprocity, the use of community resources, agricultural adaptations and sharing have become relatively insignificant in Borno. These are being replaced by emigration, lake floor cultivation and household diversification     

Planning for chemical disasters in Greece

A mathematical model named DISASTER was applied in the Thessaloniki area for the assessment of potential hazards resulting from major accidents in local chemical industries. Some of these hazards are too severe to ignore and immediate measures are therefore required. Such measures need to comply with the EEC Directive 82/501/EEC on major accidents. The implementation of the Directive by the Greek authorities is examined and discussed.     

Planning environmental sanitation programmes in emergencies

Environmental sanitation programmes are vital for tackling environmental-related disease and ensuring human dignity in emergency situations. If they are to have maximum impact they must be planned in a rapid but systematic manner. An appropriate planning process comprises five key stages: rapid assessment and priority setting; outline programme design; immediate action; detailed programme design; and implementation. The assessment should be based on carefully selected data, which are analysed via comparison with suitable minimum objectives. How the intervention should be prioritised is determined through objective ranking of different environmental sanitation sector needs. Next, a programme design outline is produced to identify immediate and longer-term intervention activities and to guarantee that apposite resources are made available. Immediate action is taken to meet acute emergency needs while the detailed programme design takes shape. This entails in-depth consultation with the affected community and comprehensive planning of activities and resource requirements. Implementation can then begin, which should involve pertinent management and monitoring strategies.     

风险分析基本方法探讨

面对未来不利事件的不确定性,对其情景的认识只能进行风险分析。人们研究出了许多的风险分析方法,但基本方法只有5种:发生概率计算法、暴露评价法、危险辨识法、期望值计算法和经验合成法。它们的共同点是:(1)明确具体风险内涵,框定风险问题涉及的系统;(2)涉及风险源、影响和后果;(3)进行不确定意义下的量化分析。由此我们总结出风险分析基本原理,并确认了自然灾害风险分析基本原理和自然灾害风险分析的基本模式。     

城市规划与地质灾害

地质条件是城市发展的物质基础。随着经济社会的发展．由地质构造条件、人类工程活动等综合因素引起的生态地质环境恶化已日益显露出来．引发的各类地质灾害也日渐突出,城市地质生态环境问题已成为制约现代城市可持续发展的影响因素之一。地质生态环境则是城市生存与发展的重要依托,体现出其基础性、资源性的特点。     

小城镇的综合防灾减灾规划

我国幅员辽阔．地理气候条件复杂．是世界上自然灾害发生最频繁、灾害损失最大的少数国家之一。尤其是从2008年至今,南方雪灾、汶川地震、北方干旱、广西水患等相然灾害频发．经济和人员损失惨重．因此．综合防灾减灾已经成为摆在“统筹城乡发展”面前的一个重要课题。大中城市由于其地位上的重要性,多已制定了相应的防灾减灾规划及采取了相应的防灾减灾措施。但据资料显示．我国70％以上的城镇、半数以上的人口、75％以上的工农业产值分布在气象、海洋、洪水、地震等灾害严重的地区,这些小城镇的数量大．防灾基础薄弱．因此,防灾减灾所面临的困难也更大。     

自然灾害基本定义的探讨

自然灾害的研究,正在变为一门热门的学科.然而,大多数人是通过举例来回答"什么是自然灾害?"这一问题,一些学者则干脆对此避而不谈.显然,如果对"自然灾害"这一概念没有严格的定义,如果人们只热衷于提出各种概念模型,热衷于案例分析,则"自然灾害学"就很难上升为一门科学内核清楚的学科.从分析定义的本质人手,梳理出下定义的4条规则,指出了现有5个自然灾害定义的不足之处,建议了一个自然灾害的基本定义,并用它分别对<国家综合减灾"十一五"规划>中提及的13种自然灾害进行了界定.     

城镇防灾避难场所规划研究

城镇防灾避难场所是城镇灾后应急避难、救援、恢复重建的重要组成部分,也是城镇平时功能的主要构成部分。首先按照应对灾害的主要类型,将避难场所分为气象型避难场所和地质型避难场所,相对应的为建筑型避难场所与场地型避难场所。继而与城市规划中的用地性质相关联,从防灾避难的角度将城镇用地划分为"靶区""防灾避难据点"与"防灾避难通道"。总结城镇防灾避难空间结构的组成要素、组构原则与组成方式,并以三种模式进行模型化构建。进而概括了城镇防灾避难场所的规划要点、规划内容与技术路线,并以深圳防灾避难场所规划加以佐证。得出了结论:防灾避难场所是城镇整体空间不可分割的一部分;城镇防灾避难空间规划应从城镇整体空间结构出发,合理规划防灾避难场所与防灾避难通道,优化用地功能与规模,提升城镇整体的防灾避难能力。     

通用震害预测基础数据库管理系统

由于震害预测数据量多面广，以文件格式存取的数据不利于数据的管理与维护，也不利于GIS二次开发，因此建立一套较为完整的震害预测基础数据库管理系统，不仅有助于防震减灾信息管理与地震应急辅助决策系统后台的数据维护和管理，也便于更有效地应用所有数据资源。在广州市部分城区震害预测与防御对策研究中开发的震害预测基础（属性）数据库管理系统，是在我国城市震害预测与防御对策研究中第一次采用SQL Server 2000和基于C／S结构及数据字典管理的震害预测数据库。该系统功能完善，应用方便，实用性和扩充能力强，并可方便地移植到其它应用中。     

The need for innovative strategies to improve immunisation services in rural Zimbabwe

Gokwe South, a rural district in Midlands Province, Zimbabwe, reported the lowest rate of immunisation coverage in the country in 2005: 55 per cent of children vaccinated with three doses of diphtheria/pertussis/tetanus vaccine (DPT3) and 35 per cent dropout between the first and third dose of DPT. In January 2007, the authors assessed local barriers to immunisation and proposed strategies to improve immunisation rates in the district, in the face of nationwide economic and political challenges. A situational analysis was performed to assess barriers to immunisation using focus-group discussions with health workers, key informant interviews with health management and community leaders, and desk reviews of records. Responses were categorised and solutions proposed. Health workers and key informants reported that immunisation service delivery was hampered by insufficient availability of gas for cold-chain equipment, limited transport and fuel to conduct basic activities, and inadequate staff and supervision. Improving coverage will require prioritising gas for vaccine cold-chain equipment, identifying reliable transportation or alternative transportation solutions, and increased staff, training and supervision. Local assessment is critical to pinpointing site-specific barriers, and innovative strategies are needed to overcome existing contextual challenges.     

淮南市城市综合防灾规划简介

随着我国城市化进程的加快,自然灾害和事故灾害的发生给人民生命财产和城市经济带来的损失日益增大。以淮南市为例,探索了编制城市综合防灾规划的技术方法。规划在现状调研、灾害风险评估和用地安全评价的基础上,对应急指挥系统、应急通道、避难场所、应急物资保障等城市应急设施进行了规划布局;对防洪、抗震、消防、人防、地质灾害、突发水环境事故等防灾专项规划提出了指引;另外,规划也提出了防灾基本对策和实施措施。