On 19 March 2015, the world has come to the first major international agreement in the post-2015 agenda. Adopted by representatives from 187 countries, the Sendai Framework for Disaster Risk Reduction 2015-2030 captured unprecedented momentum and political commitment to build resilience. It has been a long two-decade journey that our perception evolved from ‘‘prevention, preparedness and mitigation’’ to ‘‘disaster reduction,’’ and more recently to ‘‘disaster risk reduction’’ with a clear objective to safeguard human life and reduce economic loss. Member states and the civil society left the Third World Conference on Disaster Risk Reduction (WCDRR) with a vision that sustainability starts in Sendai.
One month later, a cataclysmic earthquake of 7.8-magnitude struck Nepal, killing over 8,000 citizens, injuring over 22,000, and affecting the livelihoods of 8 million more. The tragedy ruthlessly reminds the world that it is an imperative to take action because disasters do not wait until countries are ready.
As observed in previous disasters in other low and middle-income countries, international fund poured in Nepal rapidly during acute phase. For a country with only 0.17 doctors and 0.50 nurses per 1,000 population, the financial assistance was hardly matched with adequate human resource to deliver essential health services. Naturally, waves of foreign workforce rushed into affected areas to fill the gap. Dr Ramesh Vikram Singh, Director of Health for Nepal’s Central Region, stressed that coordination of the various medical teams – Nepali and international – was the key to effective team work.
Despite their selfless act and noble intention, the influx of foreign humanitarian workers occasionally strains the local coordinating capacity. In emergency, it is difficult to maintain the quality of personnel. WHO recognizes that in many cases the deployment of Foreign Medical Teams (FMTs) is not based on assessed needs and that there is wide variation in their capacities, competencies and adherence to professional ethics.
Dr Prasanta Poudyal is a medical officer in the Children's Hospital for Eye, ENT and Rehabilitative Services in Manahara, Bhaktapur. He coordinated the relief works and health camps during the 2015 earthquake in Nepal with the hospial;
“The experience has convinced me that teamwork and coordination among local health workforce, students, hospital administrators, health professionals, the community and the government is very important for effective work and better outcome.
The referral center hospital in Kathmandu, Nepal was successful in managing the demand for emergency care; but the local health workforce should be made more educated on the disaster preparedness in the days to come. In Nepal, there is only a very brief introduction to disaster medicine in the medical undergraduate curriculum and there are no accredited postgraduate courses. A few short courses that focus on theories are available but an intensive practical approach is lacking. There were disaster awareness campaigns (such as radio programmes, street dramas) being conducted since a couple of years ago. But we can do better – we should step into the community apart from providing curative and rehabilitative services. Students can get involved in advocacy and awareness campaigns at community levels.
We also need to critically address the underlying risk factors of vulnerability for specific groups of the population. Human settlements should be shifted from high risk zone in the long term to a more stable and safer zone with the support from the government and international humanitarian aid organisations.”
Continue reading about the Sendai Framework and the role of education and training after the images
In the Sendai Framework, the role of education and training at national and local level is highlighted in Priority 3: Investing in disaster risk reduction for resilience :
30 (i) Enhance the resilience of national health systems, including by integrating disaster risk management into primary, secondary and tertiary health care, especially at the local level; developing the capacity of health workers in understanding disaster risk and applying and implementing disaster risk reduction approaches in health work; and promoting and enhancing the training capacities in the field of disaster medicine; and supporting and training community health groups in disaster risk reduction approaches in health programmes, in collaboration with other sectors, as well as in the implementation of the International Health Regulations (2005) of the World Health Organization;
The Framework, with abundant elements of health, provides a guidance for the health sector to scale up their effort. However, there are still some crucial points for students and educators to reflect on :
What exactly are the necessary competencies for local and foreign health workforce to effectively respond to emergencies? Are the education institutions aware of the gap in education and training? There is a pressing need to obtain baseline data of current curriculum and education initiatives, before a concrete action plan can be devised at local, regional and international to strengthen the capacity of health workforce to face the challenges brought by disasters and conflicts
Do different sectors have the same understanding in vulnerability? How should the health workforce be taught on disaster risk reduction? Have they been convinced that this is a priority to take action on and that their role is indispensable? (career guidance)
Have we been underestimating the potential of a health workforce with diverse skill-mix? In 2011, the Global Health Workforce Alliance (GHWA) together with WHO, IFRC, UNICEF and UNHCR published a joint statement on Scaling-up the Community-Based Health Workforce for Emergencies, describing numerous ways that community-based health workforce can contribute to reduce vulnerability and respond to emergencies. Have they been given the training and opportunity to contribute? How do we foster interprofessional education in disaster medicine and disaster risk reduction programmes?
How can we minimize dependence on foreign aids? Have national and regional strategic plans aiming to enhance preparedness put enough emphasis on building up local resilience at community and health system levels?
The crippled health system in Nepal due to health workforce shortage was – and remains to be – a risk factor that puts the country extremely vulnerable to negative impacts of disasters. After the earthquake, researchers have called for a separate division within Nepal’s public sector that coordinates activities around HRH. The tragedy should enlighten the country and neighboring regions to strengthening HRH management and education for health professionals.
The agenda of capacity building is especially urgent in Asia-Pacific region. In the last decade, Asia endured almost 40 % of all natural disasters in the world and almost 50 % of the total disaster losses, with 1730 natural disasters resulting in loss of approximately USD 750 billion. Between 1975 and 2011, 75 % of the disaster deaths happened in Asia. As an example of how students can take the lead, the Asian Collaborative Training on Infectious disease, Outbreak, Natural disaster, and refugee management (ACTION) is a transnational IFMSA project that has been active since 2004. In addition to holding workshops in students’ own countries, ACTION also holds an annual international summer camp. This year it will be hosted by Taiwan under the theme “City Disaster and Evacuation.”. The network aims to educate peers with essential knowledge and skills required to prevent, relieve, and rehabilitate victims of disasters. The students strongly believes they can make a difference in shaping better education opportunities in disaster medicine for future health workforce in the region and beyond.
We need more students to join the discussion and face the reality of humanitarian crises. There is an upcoming opportunity to engage a wider audience. The UN Secretary-General Ban Ki-moon has initiated the World Humanitarian Summit (WHS) process that signifies a once-in-a-generation opportunity to reshape humanitarian aid. To be concluded in Istanbul in May 2016, numerous consultations are currently being conducted with experts and the civil society. The Doha Global Youth Consultation in September 2015, for instance, will allow the global youth community to reach agreement on key priorities and recommendations. IFMSA is one of the UN MGCY WHS working group Deputy Organising Partners and is therefore one of the hosts and coordinators of the event.
We must carry on and renew our commitment to train an effective workforce for emergencies in post-2015 era.