How do we prioritise health interventions in a crisis?
In this step we take a look at the different tools and protocols used to prioritise healthcare in emergency settings. We will discuss the SPHERE humanitarian charter, MSF rapid health assessment tool, and different U.N agency guidelines and protocols.
Several guidelines have been developed to assist humanitarian agencies in prioritisation of their interventions. Among them are the:
- Medecins Sans Frontières (MSF) Refugee Health handbook, including the top ten priorities for refugee health in the emergency phase (1997)1
- WHO Health and Nutrition Tracking Service (HNTS; 2009), highlighting several key health and nutrition assessment indicators to be used during emergencies2
- UNICEF Emergency Field Handbook (2005)3
- Johns Hopkins and Red Cross Red Crescent public health guide (2008)4.
Collectively or individually, these tools aid in the guidance of humanitarian action.
In the humanitarian world, there is some consensus on the various steps required to set priorities in emergencies. The previously mentioned documents and guidelines help inform humanitarian practice and aid in this prioritisation process. Using this information, the following steps are often viewed as the first three main priorities at the outset of an emergency:
- Conducting health needs assessment. Assessing the health needs of populations by identifying the major causes of morbidities and mortality, including reasons for consultation and hospitalisation, incidence and prevalence rates, and identifying existing resources, such as water, access to food, structure, and capacity of the health system
- Delivering evidence-based health interventions to respond to major causes of morbidity and mortality
- Monitoring key health indicators to identify whether health needs change over time and inform the provision of services.
Reducing excess mortality and morbidity
In emergency settings the main aim of healthcare interventions is to reduce excess mortality and morbidity in the affected population5 and return the daily crude mortality rate to less than 1/10,000 people per day6.
Vaccine-preventable and communicable diseases are the major causes of excessive mortality and morbidity in emergencies7. MSF prioritise health interventions by determining which diseases occur most frequently in the affected population, which present the highest epidemic risk, or for which diseases can immediate and possible actions be taken. When conducting rapid health assessments, MSF include aspects of nutrition, food, and water, sanitation, and hygiene (WASH) as they have a major impact on health1.
SPHERE recommends that interventions should be targeted and evidence-based at the outset. Once mortality rates have dropped, a more comprehensive health care package can be offered. As a result, often one of the first steps in emergency healthcare provision will be the mass administration of measles vaccines, as it has proven to be effective at reducing mortality in emergency settings8. However, recently, there has been increasing pressure to also carry-out polio vaccination campaigns during emergencies.
Although a focus on infectious diseases is useful as a baseline for health care provision, prioritisation of the health services required will differ depending on the type of emergency and the burden of disease in affected populations, especially in middle-income countries. We will hear more about changes in burden in the following steps and at the start of Week 3.
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