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Skip to 0 minutes and 10 seconds JESS PETZ: In order to prioritise health interventions in humanitarian settings, you first need to have an estimation of the population size affected by the emergency and their demographic profile. Once this information has been determined, there are a multitude of frameworks and tools used to collect and analyse data and trends in crisis situations. A settings existing Health Management Information System, or HMIS, is an integral part of the health system as it collects routine data and can inform pre-crisis levels of diseases that require ongoing treatment, such as HIV, TB, or NCDs. Generally, data is collected from all levels of a country’s health system and is populated and analysed at the district level or national level.

Skip to 0 minutes and 57 seconds Then, through a feedback loop, this data is disseminated back down to the other levels of the health system where it is then used to inform decision making and response. This is often one of the first data sources informing health intervention priorities, particularly as part of disaster preparedness. Another tool in some settings is the Early Warning & Alert Response System tool, or EWARS. This is a disease surveillance alert and response system that identifies disease outbreaks in emergencies. Although this is a separate tool in emergencies, it becomes incorporated back into the regular HMIS data collection system after an emergency has passed. Many low resource settings have weak or nonexistent HMIS and EWARS which makes both disaster preparedness and response challenging.

Skip to 1 minute and 51 seconds Other tools include the Health Resource Availability Mapping System, or HRAMS. This is a cluster tool that maps local health facilities and highlights gaps and inequities in terms of geography and health service provision.

Skip to 2 minutes and 5 seconds There was also OCHA’s 4W tool: who’s doing what, where, and when, that helps to identify gaps, inform decision makers, and alleviate duplication. Finally, there’s MIRA, or the Multi-Cluster Initial and Rapid Assessment tool, that provides a report within the first 72 hours of an emergency that can be used to inform initial decision making and service provision. Based on its findings, humanitarian actors can develop joint strategic plans, prioritise interventions, mobilise resources, and monitor the emergency. Information collected from these tools including pre-crisis information on the local population, disease burden, information on crisis emergent risk factors, or health service functionality, can be analysed to produce a picture of what is needed in terms of an initial emergency service package that prioritises the expected burden.

Skip to 3 minutes and 0 seconds As the crisis progresses and new data is collected, health service packages can be further tailored to meet more specific needs.

Skip to 3 minutes and 7 seconds AMANDA MCLELLAND: It’s extremely important to collect data so that we understand what’s happening within the situation and how it’s changing. So data helps us make decisions in real time. It also helps us understand what isn’t happening as much as what is happening. We use surveillance systems to pick up disease trends. So we use surveillance to monitor trends that we know are occurring so depending on the crisis setting depends on which data we collect.

Skip to 3 minutes and 35 seconds But simple things like the rate of births and the number of people presenting with pneumonia, diarrhoea, and general events, but we also can use surveillance to pick up unusual events, and we use this data specifically in crisis situations to help us know if disease patterns are changing significantly, so if we’re having increased mortality or if we potentially are looking at an increase of an outbreak-prone disease that hasn’t been present in the context before. Community based surveillance systems are an extension of health system surveillance. So community based surveillance is really about providing a communication channel for the communities back up into the health system for when something unusual has occurred.

Skip to 4 minutes and 20 seconds So communities know when something’s going wrong in their own environment, but often don’t know who to tell, or it takes some time to find the right person that can assist, in terms of an outbreak investigation or an immediate response. So community based surveillance really provides some skills in terms of understanding how to interpret what’s happening in the community and then providing a communication channel, usually through a volunteer, but for us it’s a Red Cross volunteer up into the Ministry of Health system. So it’s really making sure that the health systems surveillance is reaching all the way down to the community level and can detect changes in health patterns early.

Skip to 5 minutes and 4 seconds One of the crucial components of community based surveillance is really about how we provide a communication channel. So some of the areas that we work in are very hard to reach or have limited transport options, and so the old paper based system meant that we weren’t getting that data in real time. So we used commercially available software that helps us set up data collection systems using SMS.

Skip to 5 minutes and 29 seconds So we’re able to train volunteers at the community level to collect data and to send in coded messages using SMS, and those messages come into a central database and are interpreted by the community into an Excel spreadsheet that allows us to interpret and analyse that that data, either directly in the Excel spreadsheet or in our big programmes. We transfer that to a dashboard and make it a visual analysis so we’re able to see the trends and the thresholds related to that data coming in. The impact is a little bit different depending on the context. At the moment, we’re running community by surveillance in Sierra Leone with the idea of picking up unusual events.

Skip to 6 minutes and 13 seconds So this is post-Ebola where we’re trying to make sure that we don’t miss the next Ebola case. But a team in a very remote location called Kunudungu picked up some measles cases a few weeks ago. They were able to report that and a vaccination campaign was started straight away. And we’ve actually just had an example today where the Ugandan Red Cross has picked up an unusual cluster of deaths, and the Ministry of Health is investigating that. And it appears there’s some sort of illness in that community that’s affecting a number of families, but we don’t have a diagnosis for that yet.

Skip to 6 minutes and 49 seconds But this idea that this– an unusual event is picked up early by the community, and then the result is usually an outbreak investigation in some sort of response to prevent ongoing transmission of that disease.

Skip to 7 minutes and 8 seconds So within the Red Cross, we collect a lot of data, both structured and unstructured, and the trick is trying to combine the two and analyse that in the context to help you prioritise and programmes.

How do we collect data?

Collecting information around health needs and local environments is essential for planning.

In the video, Jessica Petz Msc introduces some of the ways in which data are collected in humanitarian settings. ICRC Emergency Health Advisor Amanda McClelland then discusses the importance of data collection and surveillance, giving a practical example of how surveillance data can be used to stop the spread of disease.

Are you aware of any specific data collection tools being used in your community or professional setting?

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This video is from the free online course:

Health in Humanitarian Crises

London School of Hygiene & Tropical Medicine