WHO/EHA
EMERGENCY HEALTH TRAINING PROGRAMME FOR AFRICA
SPECIAL CONCERNS
2. TOOLS
Panafrican Emergency Training Centre, Addis Ababa, July 1998
WHO/EHA/EHTP
Draft 1-1999
WHO/EHA
EMERGENCY HEALTH TRAINING PROGRAMME FOR AFRICA
2. TOOLS
2.1. Information
for Emergency Management
Panafrican Emergency Training Centre, Addis Ababa, July 1998
WHO/EHA/EHTP
Draft 1-1999
2.1.
Information for Emergency Management
Overhead Transparencies
2.1.1.
2.1.2.
2.1.3.
2.1.4.
2.1.5.
2.1.6.
2.1.7.
Opening Statements
Data, Indicator, Index, Information, Intelligence
Which Information?
Which Quality of Information?
What is needed for Emergency Management?
Health Information System
Keep the data disaggregated
2.1.8. Health Information for National Disaster Management
2.1.9. Health and Nutrition Database
2.1.10. Surveillance, Monitoring, Update
2.1.11. Emergency Health Early Warning: Strategic Issues at District Level
2.1.12. Early Warning, Definition
2.1.13. Early Warning System, Definition
2.1.14. Early Warning System, Procedures and process
2.1.15. Early Warning System, Information and Analytic Constraints
2.1.16. Summary
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2.1.Information for Emergency Management
Trainers' Guide
Objectives:
To acquaint the audience with concepts and key-terms of information management; to help
systematise information in a functional framework; to clarify some essential qualities of
information for emergency management; to introduce the key-components of an emergency
data base and early warning system. (Knowledge/Attitudes/Skills)
Key-message:
Without intelligence information does not lead to decisions. Systematising information is easy.
Data that are not disaggregated lose usefulness. If one unit does not report, that unit has a
problem.
2.1.1. Opening Statements
Present and ask for consensus. To tackle a problem, one needs to know about it.
Disasters produce information on deaths and suffering. The MOH gets a lot of
information from the sub-national levels which has to be processed and can be used for
planning, early warning, management.
2.1.2. Data, Indicator, Index, Information, Intelligence
Present. It is important to know the differences. Data are the smallest units of
information. Indicator is a specific measurement, it shows a trend (think of the indicators
in a car) or a condition, and allows monitoring. Index is a mathematical pointer.
Information is processed data or analysed data. Intelligence is a conclusion processed
from all the gathered information: it is the highest level of information.
2.1.3. Which Information?
Present. For preparedness and response it is necessary to get information about what
may happen and what is happening. Information is needed about the area, population,
hazards, available resources and. The information needed is different for preparedness
and for response. In preparedness one needs information to be able to plan: data
collection is larger, to identify the most vulnerable populations and areas. For response,
information is needed on the affected population and areas: its needs to be less general.
When an emergency occurs, if information for preparedness has already been collected,
the second step, information for response will be more accurate and easier.
2.1.4. Which Quality of Information?
Present and discuss. Disaggregated: data must be collected and dealt with according to
operational areas: e.g. a Country’s administrative divisions. Qualified: one must know
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Draft 1-1999
the time and place to which the information refers, the source, and the eventual
limitations. User-friendly: it has to be expressed in a way that it is easily understood.
Economic: information systems must be sustainable. Reliable: the information has to be
correct, data handlers have to be trained. Complementing: information from different
health programmes can contribute to the overall picture. If other sectors have relevant
information, one must use it, e.g. agriculture, demography.
2.1.5. What is needed for Emergency Management?
Present and discuss. For purposes of emergency management, one needs the Country
health profile (the background), a health information system (to update the profile and
have early warning), a roster of resources (to know what can be mobilised), a list of focal
points and the procedures to Co-ordinate with them.
2.1.6. Health Information System
Present and discuss. A Health Info system must have some features. Data must be
disaggregated. There must be monthly and daily reports, the latter may become daily
during a crisis. Universally accepted indicators and benchmarks / cut-off values. The
capacity to conduct rapid surveys. Good transmission systems include feedback and
divulgence. Mechanisms to monitor the information flow: if one unit does not report, that
unit has a problem.
2.1.7. Keep the data disaggregated
Present and discuss. Each country has its own administrative division: disaggregate the
data accordingly.
2.1.8. Health Information for National Disaster Management
Present and discuss. Databases on health and nutrition (i.e. country health profile)
provide the information needed for mitigation/prevention and for preparedness: What
may happen? Surveillance systems provide information for updating plans, early
warning, rapid assessment and monitoring relief operations: What is happening?
2.1.9. Health and Nutrition Database
Present and discuss. The database (i.e. country health profile) must contain this
information.
.
2.1.10. Surveillance, Monitoring, Update
Present and discuss. The surveillance system must produce this information.
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2.1.11. Emergency Health Early Warning: Strategic Issues at District Level
Present and discuss. Showing how information is collected, what are the basic
requirements for the system to work, the early warning and what the warning means.
Underline that the final product must be Decision for Action.
2.1.12. Early Warning, Definition
Present and discuss. Underline the functional aspects: IDENTIFICATION,
INTERPRETATION and RECOGNITION. This is/takes Intelligence. Underline the
pro-active aspect: early warnings deal with POTENTIAL emergencies.
2.1.13. Early Warning System, Definition
Present and discuss EWS are more than simple data-collection. They must be conceived
and run with a clear vision of their objectives. They must sense relevant changes, and
provide a picture of the situation at hand that is enough for decisions on action.
Underline that EWS are hazard-specific.
2.1.14. Early Warning System, Procedures and Process
Present and discuss. Data-collection must be frequent (e.g. at least weekly for
epidemiological surveillance, otherwise the information will be too late to be useful for
early warning. Underline that also ‘ rumours ‘ deserve attention. Once reason for alert
is detected, action must be taken. Action will be easier if one is prepared.
2.1.15. Early Warning System, Information and Analytic Constraints
Present and Discuss. 1. Quantity refers essentially to the catch-area of the system: do we
have enough data? Is everybody reporting? Quality means credibility, of course: are the
data hard enough to justify discussing them? Are standard case definitions accepted
and used by everybody involved? Timeliness means that data must be collected and
processed in time so as to be useful. EWS can be hampered by excessive technical
scruples, by the fact that nobody likes to announce bad news, and by the fact that, at the
end of the line, they do impose hard political choices: the buck must stop somewhere.
2.1.16. Summary
Present, discuss and use as a wrap-up. Information is essential in all phases and all
aspects of disaster prevention and emergency management. More information is
available than usually thought. Organise the information according to its value and
meaning.
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Complementary and introductory, to Risk and Rapid Health Assessment (2.3. and 2.4.),
Surveillance (2.6.), Planning (2.2.) and Co-ordination (2.8.).
Essential Reading:
 Handbook on War and Public Health, P. Perrin, ICRC, 1995
 Data, Information and Intelligence, Notes on EWS, WHO/PTC, 1996
 Information for Emergency Management, WHO/PTC, 1997
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2.1.1. Opening Statements
“… Disasters bring famine
and death…”
“… Ministries of health
have far-reaching
information systems...”
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2.1.2. Data, Indicator, Index, Information, Intelligence
Date (sing. Datum):
Known facts, quantities or
characters used for inference or
in reckoning, evidence
Indicator:
that which (automatically)
shows the direction of a
movement or the condition
of a thing
Index:
Mathematical pointer,
sign or indicator
Information:
Items of knowledge,
news, instruction
Intelligence:
Knowledge and understanding,
the collecting of information
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2.1.3. Which Information?
WHICH INFORMATION
Area
Population
Hazards
Resources
Plans and
Arrangements
For
Preparedness
Name location,
limits main
features route of
access
Present: N and
characteristics
What is known to
occur?
What may occur?
For
Response
Is it still
accessible?
Fully?
Affected: N and
characteristics
When, how did it
occur?
Is it continuing?
Has something
else occurred?
What is in place? Is it enough?
Are they ready? Do they work?
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2.1.4. Which Quality of Information?
WHICH QUALITY OF
INFORMATION?
 Disaggregated
 Qualified:
- Space
- Time
- Source
- Limitations
 User–friendly
 Economic
 Reliable
 Complementing
- Other information from the sector
- Information from other sectors
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2.1.5. What is needed for Emergency Management?
WHAT IS NEEDED?
1. Country Health profile
2. Health Information System
3. Roster of experts, reference
centres and suppliers
4. Focal points and procedures,
sectoral and inter–sectoral
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2.1.6. Health Information System
HEALTH INFORMATION SYSTEM:
1. Data disaggregated by area
2. Monthly reports:
- Nutritional status
- Morbidity and mortality
- Activities and inventories
3. Weekly reports for notifiable diseases
4. Indicators and cut–off values
5. Capacity for rapid surveys and daily
emergency reports
6. Transmission systems and back–ups
7. Monitoring the information flow
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2.1.7. Keep the data disaggregated
KEEP THE DATA DISAGGREGATED
ACCORDING TO THE COUNTRY’S
ADMINISTRATIVE DIVISION
D. R. Congo: administrative division
1. REGION
2. SUB-REGION
Collectivity
1. ZONE
5. Groupement/Quartier
6. Locality:
village a
“ b
“ c
etc…
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2.1.8. Health Information for National Disaster Management
HEALTH INFORMATION
FOR
NATIONAL DISASTER MANAGEMENT
1. Health and nutrition database for
mitigation and preparedness
2. Surveillance and monitoring for
 Updating plans,
 Early warning,
 Rapid assessment,
 Monitoring of response
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2.1.9. Health and Nutrition Database
HEALTH INFORMATION
FOR NATIONAL DISASTER
MANAGEMENT
1. Health and nutrition database:
 Endemics, epidemics and other disasters
 Population
 Patterns of mortality, morbidity,
malnutrition
 PHC programmes: activities, access and
coverage
 Health network: personnel, facilities,
equipment
 Stockpiles and sources of medical
supplies
 Policies and technical procedures
 Roster of experts and references centres
for mitigation and preparedness
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2.1.10. Surveillance, Monitoring, Update
HEALTH INFORMATION
FOR NATIONAL DISASTER
MANAGEMENT
2. Surveillance, monitoring, update:
 Epidemiological and morbidity reports
 Activity reports
 Updates on stocks
 Flow of the health information system
for updating plans, early warning, rapid
assessment, monitoring of response
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2.1.11. Emergency Health Early Warning: Strategic Issues at District Level
ROUTINE
ACTIVITIES,
OPD consultations,
Emergency care,
infirmary, etc.
REGISTER OF
ACTIVITIES
INFORMATION
FROM ANOTHER
HEALTH UNIT
INFORMATION
FROM NGO
GOOD
COMMUNICATIONS
WITHIN THE
DISTRICT
TALK OF THE
COMMUNITY
MUTUAL TRUST
AND GOOD
RELATIONS
INFORMATION
FROM
ANOTHER
GOVERNMENT
OFFICE AT
DISTRICT
LEVEL
GOOD
COMMUNICATIONS
WITH THE CAPITAL
OF THE PROVINCE
ALARM
A certain area has
been hit by a
sudden disaster
floods, storm,
armed attack
A certain area
shows signs of
epidemic, drought
or famine…
A certain area is
experiencing a
sudden influx of
displaced or
refugees
Local health resources have been lost or
have become insufficient.
The population is at greater risk of illness
and death.
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INFORMATION
FROM
PROVINCAIL
LEVEL
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2.1.12. Early Warning, Definition
EARLY WARNING
The identification,
interpretation
and recognition
of
events that indicate
a potential emergency
(Cuny, 1988)
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2.1.13. Early Warning System, Definition
EARLY WARNING
SYSTEM
A system capable of collecting and
analysing information on




where crisis are emerging
what opportunities exist for prevention
approaches and alternatives
time-frame for action
(Source: International Alert and Inter–Africa Group in UNICEF, 1996)
(Implicitly, EWS are hazard-specific)
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2.1.14. Early Warning System, Procedures and process
EARLY WARNING
SYSTEM
Surveillance:
weekly
(“is every unit reporting?”)
Alert:
decision
action must be taken
(Suspects and rumours are important too)
Action:
 Do rapid assessment
 Get ready for response
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2.1.15. Early Warning System, Information and Analytic Constraints
EARLY WARNING
SYSTEMS
Informational constraints:
 Quantity
 Quality
 Timeliness
Analytic constraints:
Technical:
the ‘was the sampling correct?’
effect
Bureaucratic: the ‘CRY WOLF’ effect
Political:
the ‘HARD CHOICES’ effect
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2.1.16. Summary
Level Analysis, Source and Use of Information for Emergency Management
SERVICES' DATA FLASH
REPORTS & HINTS from
Direct observation, Gvt.,
NGO, Private services'
registers, Media, Rumors
Emergency
Response
Manifestations
Information
from
Epidemics
Epizoonosis
Other natural disasters
Economic crisis/instability:
SITUATION REPORTS
from
Contingency
Planning and
Early Warning
Development,
Disaster
Prevention and
Preparedness
Planning
Information
from
Weekly/Monthly
Epidemiological and
Nutritional surveillance
Bulletins from
Meteorological,
Agricultural and Geological
Sentinel systems
Activity reports from Gvt.,
UN agencies and NGO
Operational surveys and
Academic studies
Gvt. Press releases, National
and International Media
Immediate
causes
Economic and political updates,
every 6 months or yearly
Judicial/Human Rights crisis:
increase of cost of living
cash-flow crisis
low immunization coverage
breakdown of delivery systems
breakdown of lifeline systems
court cases backlog
arbitrary arrest
changes in government
changes in top administration
cuts in external aid
Social crisis
Under-lying
causes
Structural
causes
Baseline studies; Geographic,
Historical, Environmental,
Demographic,
Anthropological, Sociological,
Epidemiological
Infrastructural
causes
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Social and Health services crisis:
Political crisis, internal/external:
COUNTRY PROFILE
from
Information
from
Illness and Death
Malnutrition, Hunger and Starvation
Population Displacement
Death of livestock
Strikes/labor unrest
Violence, Armed robberies, Attacks
Closure of business, Disruption of markets
Increase of street children and prostitutes
Others ...............................
Decreased food availability
Access to water
Devaluation of currency
Ethnic/Communal/Religious conflict
High unemployment
Skewed attribution of state budget
Poor access to services
Poor governance
Tension with international partners
Spill-over of crisis from neighboring countries
Undifferentiated economy
Skewed distribution of property and internal revenue
Skewed distribution of workforce among sectors
Illiteracy
Poor agricultural production
Inadequate access to farming land and water
Inadequate access to seeds, fertilizer and tools
Skewed distribution of power in the government and state
Inadequate governance, community empowerment and participation
Vulnerability attitudes: gender discrimination
intolerance of cultural diversity
neglect of Human Rights
neglect of Environment
Insufficient capital/maintenance investment in infrastructures
Economy marginal to International Market/External Debt
Un-sustainable population growth/Demographic entrapment
Population structure & composition: High Dependency Rate
Ethnic/Religious/Other Rifts
Natural Hazards: meteorological, geological, biological
Fragile/degraded Environment
Insufficient resource-base: limited area, marginal lands
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