2010年-世界发展银行全球_Health_8页_719kb

EAP DRM KnowledgeNotes Summary

Core Content

This document outlines strategy and principles for recovery and reconstruction in the health sector following natural disasters, with a specific focus on lessons from the Wenchuan Earthquake in China and international experiences from Pakistan and Turkey. It provides a framework for rebuilding a more resilient and equitable health system, emphasizing the need for a transition strategy to restore essential services quickly and a long-term reconstruction plan to improve the system overall.

Main Views and Key Information

1. Transition and Reconstruction Phases

• Transition Phase (3-12 months): Prioritize the rapid restoration of essential health services. This includes:

  • Ensuring access to basic health care services and public health programs.
  • Providing mobile services, community-based outreach, and temporary facilities.
  • Establishing epidemic prevention programs and strengthening surveillance systems.

• Reconstruction Phase (1-3 years or longer): Focus on rebuilding and improving the health system. This includes:

  • Rationalizing and streamlining health care facilities.
  • Reconstructing seismically safe hospitals and health facilities.
  • Implementing long-term reforms to address systemic issues.

2. Key Principles for Recovery and Reconstruction

• Equity: Expand access to underserved areas, the poor, and vulnerable populations.
• Effectiveness: Improve access to and quality of key health services (e.g., surgery, diagnostics, inpatient care).
• Appropriateness: Adopt new service delivery models that respond to changing health needs.
• Efficiency: Use savings to finance improvements and ensure overall efficiency.

3. Health Sector Reform Opportunities

• The Wenchuan Earthquake presents an opportunity for health sector reform in China, including:
  • Reducing out-of-pocket expenditures.
  • Improving health insurance coverage and benefits.
  • Ensuring accessibility for vulnerable groups.
• A risk-based, all-hazards approach should be adopted for emergency preparedness and response.

4. International Experience

Pakistan

• Coordination: Effective coordination was crucial in ensuring efficient implementation.
• Strategy: A two-phase approach was used, combining short-term revitalization with long-term reconstruction.
• Facility Rationalization: Redundancies were reduced, and facility numbers were rationalized based on detailed assessments.
• Public Participation: Ensured transparency, accountability, and community involvement.
• Epidemic Prevention: Early warning systems were used to prevent disease outbreaks.

Turkey

• Institutional Framework: Emphasized the importance of an effective institutional setup and capacity building.
• Insurance Mechanism: The Turkish Catastrophe Insurance Pool was established to support recovery.
• Mental Health and Trauma: A mental health strategy and trauma program were introduced.
• Community Support: Programs for psychological support and community-based rehabilitation were developed.

Recommendations

• Build Back Better: The health sector should be rebuilt to be safer, more prepared, and more equitable.
• Communication and Coordination: A strong national or provincial authority should lead and coordinate reconstruction efforts.
• Two-Phased Approach: A transition strategy is essential to bridge the emergency and reconstruction phases.
• Standardized Damage and Loss Assessment (DLA): A comprehensive and standardized DLA should be conducted to guide both short-term and long-term planning.
• Monitoring and Evaluation (M&E): A limited number of critical indicators should be used to measure progress. M&E should be implemented by a multisectoral team.
• Financing Mechanisms: An exit strategy should be developed to phase out free services, balancing cost modeling and per-capita payments.

Environmental and Social Considerations

• A thorough environmental impact analysis should be conducted.
• Human resource development and institutional arrangements should be designed to ensure long-term sustainability.
• Infrastructure capacity (e.g., communication, electricity, transport, water supply, sewage) must remain functional post-disaster.

Conclusion

The document emphasizes that recovery and reconstruction should be guided by sector-specific lessons, equity, preparedness, and community involvement. It recommends a comprehensive DLA, a two-phase strategy, and the adoption of all-hazards preparedness to ensure a resilient and improved health system in the aftermath of disasters.