Republic of the Philippines

Department of Health
OFFICE OF THE SECRETARY
April 10, 2019

DEPARTMENT CIRCULAR
No. 2019-_ 0137

FOR : ALL DIRECTORS OF BUREAUS AND CENTERS FOR

HEALTH DEVELOPMENT, MOH-BARMM MINISTER OF
HEALTH; CHIEFS OF MEDICAL CENTERS, HOSPITALS AND
SANITARIA, AND OTHERS CONCERNED
SUBJECT : Dissemination and Implementation of the Disaster Risk Reduction
and Management in
Health (DRRM-H) Planning Guide

In line with the Fourmula One Plus (F1Plus) for Health, the goal of Disaster Risk
Reduction and Management in Health (DRRM-H) are threefold: (1) to provide uninterrupted
health services, (2) avert preventable morbidities and mortalities; and (3) ensure that no
outbreaks occur secondary to disasters. This is in line with the Strategic Pillar 2 that ensures
accessibility of essential quality health services and products at appropriate levels of care even
in times of emergencies and disasters.

With this, the institutionalization of DRRM-H

governance is necessary. An approved, updated, regularly tested and
in
the health system across
disseminated
levels of
DRRM-H
all
plan is one of the minimum indicators in the DRRM-H institutionalization, along with an
organized and trained health emergency response teams; available and accessible essential
health commodities; and a functional emergency operations center.

In order to assist planning committees at all levels of service delivery formulate their
DRRM-H plan, the Health Emergency Management Bureau developed a guide that covers the
fundamental principles and concepts of DRRM-H planning, the step-by-step procedures, and
the tools and templates needed for participatory planning. Aside from preparedness and
response, the other thematic areas- prevention and mitigation, recovery and rehabilitation are
incorporated. It builds upon the firm foundation laid by previous efforts in planning for health
emergencies and disasters, as well as investment planning for the health sector.

Relative thereto, this is to formally disseminate the DRRM-H Planning Guide all
concerned offices and implementers. It is with trust and optimism that this guide shall assist
to
our planners, DRRM-H managers, partners, and stakeholders to improve service delivery in
emergencies and disasters.

For your information and compliance.

Thank you very much.

By Authority of the Secretary of Health:

on
RNA C. CABOTAJE, MD, MPH, CESO ITI
ndersecretary of Healt
Public Health Services Team
Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila e Trunk Line 651-7800 local 1108, 1111, 1112, 1113
Direct Line: 711-9502; 711-9503 Fax: 743-1829 e URL: http://www.doh.gov.ph; e-mail: fiduque@doh.gov.ph
Disas Islas mA O O O »)
) Q= O=O
+

Management in Health (DRRM-H)

Planning Guide
Disaster Risk Reduction and Management in Health Planning Guide
March 2019

Published by the Heaith Emergency Management Bureau (HEMB)

Depariment of Health, San Lazaro Compound, Rizal Avenue, Sta. Cruz, Manila
1003 Philippines, with the assistance of the United Nationals Children's Fund (UNICEF)
FOREWORD

The Department of Health,

through the Health Emergency
Management Bureau (HEMB]), takes the lead in the
prevention and mitigation, preparedness, response,
recovery and rehabilitation for health emergencies and
disasters.

Institutionalizing Disaster Risk Reduction and

Management in Health (DRRM-H) through a
comprehensive plan consistent with national and
international policies such as the Sendai Framework for
Action, RA 10121 or the Philippine Disaster Risk Reduction wo
and Management Act, National Objectives for Health, Fourmula One Plus, and RA
:

11223 or the Universal Health Care Act is paramount in addressing health risks and
inequalities aggravated during emergencies and disasters.
This DRRM-HPlanning Guide is a user-friendly and easy-to-read reference that covers
the fundamental principles and concepts of disaster risk reduction and management
in health, outlines step-by-step procedures, and provides tools and templates needed
for participatory planning. It aims to assist committees at all levels of service delivery in
formulating their DRRM-H plans to ensure health systems resilient to disasters and
emergencies. It focuses on the central paradigm shift in disaster risk reduction and
management efforts - from preparedness and response to incorporation of alll
thematic areas ~ and builds upon the foundation laid by previous efforts in planning
for health emergencies and disasters, incorporating novel concepts such as
investment planning for the health sector. It also provides a coherent framework for
interaction between different levels of governance - from the local government units,
to hospitals, to centers for healtn development in the regions, and shapes how alll plans
fit into the grand scheme
of
national disaster risk reduction and management.
|
trust that this guide will partners, and
assist our planners, DRRM-H managers,
stakeholders improving health service delivery emergencies and times
in
of
disasters,
and will pave the way to a more resilient and responsive health system Filipinos.
for

FR ISCO DU Ili, MD, MSc

Secretary of Health
ACKNOWLEDGEMENTS

The following individuals and groups dedicated their time and skills fully to the
development of the Disaster Risk Reduction and Management in Health (DRRM-H)
Planning Guide.
The members of the core and expanded core groups: Dr. Maridith D. Afuang, Engr. Aida
C. Barcelona, Ms. Mara Blaise P. Cervania, Ms. Winselle C. Manalo, Ms. Monaliza A. Pardo,
Ms. Naomigyle Kammil V. Maata, Ms. Janice P. Feliciano and Ms. Elmie Joy T. Villegas
from the Health Emergency Management Bureau (HEMB} and Ms. Tanya Mara F.
Gagalac, Health Policy Development and Planning Bureau (HPDPB); Dr. Mariella S.
Castillo, Dr. Raoul Bermejo and Ms. Johanna S. Banzon from United Nations Children’s
Fund (UNICEF); all Centers for Health Development, Hospital Directors, Medical Center
Chiefs and their staff; the DRRM-H Managers; the Local Government Units that have been
involved in the different multi-stakeholder workshops that provided valuable insights.

Special thanks to Center for Health Development Il, the Province of Isabela, Municipality
of Tumauini of Isabela, Barangay Buenavista of Tuguegarao City for their participation in
the pilot implementation. —

Dr. Ronald P. Law, Dr. Arnel Z. Rivera, Ms. Florinda V. Panlilio, Ms. Maria Lovella Rnodora
M. Rago who provided valuable technical assistance and support.
Last but not the least, to Director Gloria J. Balboa who
led the group in this another DRRM-
H endeavor
.

ijPage
ACRONYMS
AOP Annual Operation Plan
DOH Department of Health
RRM
|
Disaster Risk Reduction and Management
DRRMH Disaster Risk Reduction and Management in Health
™. '

EOC Emergency Operations Center

'

HEM Health Emergency Management

HEMB
Health Emergency Management Bureau
HEPRRP Health Emergency Preparedness, Response and Recovery Plan
HSI Hospital Safe Index
HSFD Hospital Safe from Disaster
ICs Incident Command System .

LCE Local Chief Executive

LORRMP Local Disaster Risk Reduction and Management Plan
LGu Local Government Unit
LIPH Local Investment Plan for Health
MHPSs Mental Health and Psychosocial Support
MISP-SRH Minimum Initial Service Package for Sexual and Reproductive
Health
NDRRMP National Disaster Risk Reduction and Management Plan
OPCEN Operations Center
WASH Water, Sanitation and Hygiene

iii|Page
we
DEFINITION OF TERMS

Capacity — the combination of all the strengths, attrioutes and resources available
within an organization, community or society to manage and reduce disaster risks and
strengthen resilience.' (UNISDR, 2015)

Community — consists of people, property, services, livelinoods and environment; a

legally constituted administrative local government unit of a country (e.g.
municipality or district) that is small enough to be able to identify its own leaders (to
make participation meaningful) and large enough to control its resources (e.g.
village, district, etc.}?

Damage Assessment and Needs Analysis (DANA) - assessment to rapidly diagnose

remaining functions and operational capacity of the systems, the damage suffered,
its causes and required repairs and rehabilitation; used locate and quantify the needs
that must be met in order to establish key services and to estimate the time need

Disaster a serious disruption of the functioning of a community or a society involving

—

human, material, economic, or environmental losses and impacts, which exceeds the
ability of the affected community or society to cope using its own resources?
Downlines — the level of institution immediately within one's jurisdiction; lower level of
institution (i.e. provinces, independent cities, and highly urbanized cities are
downlines of regions; component cities and municipalities are downlines of provinces;
and barangays are downlines of cities and municipalities)4
Disaster Risk Reduction and Management in
Health (DRRM-H) - is an integrated,
systems-based, multisectoral process that utilizes policies, plans, programs, and
strategies to reduce health risks due to disasters and emergencies, improve
preparedness for adverse effects and lessen adverse impacts of hazards to address
needs ofaffected population with emphasis on the vulnerable groups 4
Disaster Risk Reduction and Management in
Health (DRRM-H) Institutionalization — is
the establishment of a functional DRRM-H system which includes the following key
indicators: updated, approved, disseminated and tested DRRM-H plan with
necessary budget allocation, organized dnd trained health emergency response
teams, minimum health emergency commodities, and functional hub or an

‘
United Nations International Strategy for Disaster Reduction (UNISDR). (02 February 2017). In Terminology on DRR. Retrieved
from: https:/Awww.unisdr.org/we/inform/terminology
?
Health Emergency Management Bureau. (2015). Manual of Operations on Health Emergency and Disaster Response Management.
Manila, Philippines
3
United Nations International Strategy for Disaster Reduction (UNISDR). (May 2009). UNISDR Terminology on Disaster Risk
Reduction. Geneva, Switzerland

iv|Page
 |

Disaster Risk Reduction and Management in

Health (DRRM-H) Plan — is a three-year
strategic plan containing disaster risk reduction and management measures four in
thematic areas: Prevention and Mitigation, Preparedness, Response, and Recovery
and Rehabilitation4

Emergency - an actual threat

to public health and safety; unforeseen or sudden
occurrence that demands immediate action2
Essential Health Service Package package of services that aims to provide a
—

focused approach for all affected individuals especially the vulnerable and
marginalized populations during emergencies and disasters. It is focused on four (4)
DOH-led clusters namely Medical and Public Health, Nutrition, Water, Sanitation and
Hygiene (WASH), and Mental Health and Psychosocial Support (MHPSS).5

Hazard - a process, phenomenon, or human activity that may cause loss of life, injury
or other health impacts, property damage, social and economic disruption or
environmental degradation! |

Hazard Mapping- process of establishing geographically where and to what extent

particular hazards/phenomena are likely to pose a threat to the community4

Hospital Safe Index Tool —

a rapid and low-cost diagnostic tool for assessing the
probability that a hospital will remain operational in emergencies and disasters¢
|

Incident Command System - establishment of an organizational structure that clearly

defines the key offices and officials responsible for the overall management of the
event, with specific roles and functions to perform during pre-impact, impact, and
post-impact phase?

Mitigation — the lessening or minimizing of the adverse health impacts of a hazardous

event!

Preparedness “the knowledge and capacities developed by governments, response

and recovery organizations, communities and individuals to effectively anticipate,
respond to, and recover from the negative health impacts of likely, imminent or
current disasters’

Prevention — activities and measures to avoid existing and new disaster health risks!

Recovery the restoring or improving of livelinoods and health, as well as economic,

—

physical, social, cultural and environmental assets, systems and activities, of a

5
Departmentof Health. (2017). Guidelines in the Provision of Essential Health Services Packages in Emergencies and Disasters
(Administrative Order 2017-0007). Manila, Philippines.
®
World Health Organization. (2015). Hospital Safe Index: Guide for Evaluators. Geneva, Switzerland

v|Page
disaster-affected community or society, aligning with the principles of sustainable
development and “build back better”, to avoid or reduce future disaster risk! |

Response actions taken directly before, during or immediately after a disaster in

—

order to lives, reduce health impacts, ensure public safety and meet the basic
save
subsistence needs of the people affected!

Resilience the ability of a system, community or society exposed to hazards to resist,

-
absorb, accommodate, adapt to, transform, and recover from the effects of a
hazard in a timely and efficient manner, including through the preservation and
restoration of its essential basic structures and functions through risk management!

Risks the combination of the probability of an event and its negative consequences
—

(e.g. death, injury, illness and disease, damage toinfrastructure) *

Uplines the level of institution immediately higher to one's institution (i.e. regions are
—

the uplines of provinces and independent cities or highly urbanized cities; provinces
are the uplines of component cities and municipalities; and cities and municipalities
are uplines of barangays) 4

Vulnerabilities the conditions determined by physical, social, economic and

-—

environmental factors or processes, which increase the susceptibility of an individual,

a community, assets or systems to the impacts of hazards!

vi|Pa ge
TABLE OF CONTENTS

FOP WOM oo. cccsscccssccsssscecsssccesseeeensuceessnecssseeseneeeseseeecesneesssseesssaeecesseesesaeeesssaeeseesneeesssaecesseeeseneeeseenees

i

ACKNOWICCGEMENSS ........esccecessseceescecsnsceesseeesssseeessssesesseecsssacseeeecsseeessuseesesaueseneuscessnssenseeseaeeees ii

ACTONYINSG.....ccssscccesssscesessceceesesseeccesecsasseesneseceessenseesessneeeecessaeeseseedeeesessuanaeeesesensuseecessaeeesesenauaaess ili

DeFINITION Of TOP ..........cccccesccccesssccesseeeesccssneecssneecesecessnsecenseseseseescseeseeatecsessesessseeseaeecesseeeeses iv

EXECUTIVE SUMIMOTY......ccesccesssecsssessseenseceeevensseseceeseceseessaecesscessecesaeeesesesseeseaesseasesnseeaeesasessnesens xi

PART 1: DRRM-H PLANNING CONCEPTS, PRINCIPLES AND GUIDELINES

INTOCUCTION....eeeescsscesseseessesseesecssesecsnessesccesecsecseesssseesesaesnesotsiecsesaseneeseceneeeeeaeseesedeaseneeansenseatens 1

What is DRRM-H PIONNING? ........ccesccssessscsseesecesecssecescesecesecenecsecesscesessneesseeenetsuesesecsesseeseesenseaseass 2

Why CONCUCT DRRMG-H PIONNING?
«00... seeseeessesescnseeseessecnsscnaceseesseessecaseeecesecetaseeeesseneetarenseeens 3
Who shall be involved in DRRM-H PIONning?............cccsescscssssccesssecssseeceessesesesesessseeesssesessseesees 3
DRRM-H Planning MAandgeMent StrUCTUre oo... eeeeeceeeessceaceeeceseeeseceaeeeseeenecesetseesnesensseressrees 4
When is DRRM-H PIONNING CONE? ...... ee eeeeeeceseeseccteeescesserseeeeeeasseecesaesseeeseesseesseeeseeessereseaesasones 5

How to CONCUCT DRRMG-H PICNNING? .......ccccccssseccessceccsseecceseeeeseneceseneseseaeecssacecessasesteesesseeeeses 5

PART 2A: DRRM-H PLANNING — PUBLIC HEALTH

1. PFEPOriNg TO PION... cecccccccsseccessscesseeessesseeessesenseecesseeseesseeeesaeeseeseecssaeesssaseeessusecenseeenseeeens 8

2. Data Gathering AN ANAIYSiS .........ccceccesseessscssecesecstsesenseeseecsaeeseescessscsseecsesecssaeeesenseeenas 11

3. Developing/UPCatiNg the PION... eeecesscescesseseseeseeseesseeeceesecesscesecssecseessecsseeeesseeeass 19

3.1. Public Health Prevention ANd Mitigation PION... ee cecessecceestecestsceesseesens 2)

3.2. PUblic Health Preparedness PION 0.0... cccccescccsssecesseeeceseeeesseecesseeeesseeseeneeeees 23
3.3. PUBIC Health RESOONSE PION ....... cece eccesscceessecesseecssseeestaeeeesssseceessseessseesesseeeees 26
3.4. Public Health Recovery aNd Rehabilitation PION... cececsssecesteeeesseeeees 30
4. Translating and Integrating the PIN ........ cc ccsccsssccssrcessseccsssecesssseceseseseseesaeeeesesessesensaes 32
5. Implementing the PION... seeneeesaeesneesaeesanecesecesseeeeeenacensaeeesaeessaesecasesseeeesseesaaees 35
6. Monitoring and Evaluating the PION... cseeseeeneesesseeseeseseseteesesessesesstsesserensenesens 35
PART 2B: DRRM-H PLANNING — HOSPITAL
LT.
PF@PAring TO PION .......cceccsssssseessesseesecescesseescessessecesscsessscesesrseseeesseseesesaseatesssessseasenssenseess 37
2. Data Gathering ANd ANlySis ........ cc ceescccesseessecensecessecseeessseseseesseeesesuecsseesssesessessseseseeeaes 38
3. Developing/UPCating The PIAN..........cccsecsesscsssssceesneccsseecssseecseeeceessstsesseeeeesssessreveseneees A]

3.1 Hospital Prevention ANd MitiQation PION .........ccesscssssccessseecessscessesesseecensees 4]

3.2 Hospital Preparedness PION ..........ccccssssesecesscessecesssesssecstecessecessessnecssecesesesaeesues 42
3.3. HOSPITA] RESPONSE PION .........cccsccessscessscccssssceseseccssaesccesacecessceecsssececsecesseseessues 44
3.4. Hospital Recovery ANd RENADbIITATION PION
...... eee ceesecssteceseeseecetecesteeseeeenee 46
4. Translating and Integrating the PION.......... ecesescestscessecesecssecssseesseecssseesecssssseseseeeerees
ce 49
5. IMPIEMENTING the] PION... ceccessccsssteecssssecesseceeessceesssecessseeesseesesesueessssaesessuesenseresseesesses 50
6. Monitoring and Evaluating the PION... eeesescesesteeessecesseessaceesteeseneeseseseseenseesseeenes 50

ANNEXES
1: Sample Gantt Chart for DRRM-H PIANNING ACTIVITY
.......c cece ccesecseesseeesseseeeteceseeeeeseeeees 53
2: Strategic Tool for AnalyZing Risk (STAR) .......cccccesccsscssscessscsssscesseceeeseseceseeceueesssesaseceseeseses 54
3: Possible SOUrCES Of DOT oo escscsesteesersecteeteceecsssesetstceeesseeseesesessaessreseetaseeetseeessessenees 62
A: Criteria for DRRM-H INStitUtiONliZAtiOn oo...
eee eseesceeeeseesseceseeeseceeeceseeesesteesseeeseessseseeerees 64
5: RESPONSE MANAGEMENT FrAMEWOKK...... cc eccccsssecsseecesssscessseecsessecseseeesessseeesesseeesseeessseesaeees 65
6: Response Management per Phase for PUDIIC HEIN... cescccesssecesssecesssessesentseees 66
7: Sample Emergency Response Flow for Local GovernMe nt UNits oo... cceescereceseeeeeees 68
8: Sample Recovery and Rehabilitation Plan TEMPlAte 2.0... cccesssssescessececensesenensees 69
9: Proposed Outline of the Public Health DRRM-H PION ..........cccccccssssccessceesssscessssesttseeserees 70
10: Policies and Guidelines related to DRRM-H PION iNg uuu... ccecccesccessessrsessesesteseeeesesenes 73
11: Proposed Outline of the Hospital DRRM-H PION .......ccccccccsscssecsscsecssecssecesesseeessesesseeees 75
12: Sample External HAZ MOD ......ccccesscccesssecessceesscecsesseecesnsesessescsssssecesssseeesasesssasenseeeessaees 783

13: Response Management Framework per Phase for HOSPITAL

0... cee ceccestsceseeeceeessees 79

REFERENCES

viii] Pa ge
LIST OF TABLES

Table 1: Public Health

Table 2: Public Health

—

—
Previous Disasters and Lessons LEArned

Hazard PrioritiZation
oe eeeseetseeseees

MOTHiX oo... ee eecesesteeseceseseneetteeseeeneeenecses

12

12

Table 3: Public Health — Vulnerability Assessment MAITHrix.......ccceceessecsssscesstecessseeeesseees 14

Table 4: External DRRM-H InstitUtionaliZation MOtrix oo... cessececensestesseceesesseesseessseneeens 17

Table 5: Inventory Of RESOUrCE NETWOKKS.........csscccsssscssnscccssssceseseeecssseeceseseesssateessseeeeaees 17

Table 6: Public Health — Risk AssesSMENt MOtrix

0... esecesesseceeeessereceeeeeceseeeesneeereeseees 18

Table 7: Public Health — Prevention and Mitigation PIAN...........csscsesssesessrsesssseeeseeees 2]

Table 8: Public Health — Preparedness Plan Matrix 1: Risk REGUCTION .........eceeeeeeeeeee 23

Table 9: Public Health —

Preparedness Plan Matrix 2: Minimum Requirements of
DRRM-H INStiTUTIONANIZATION.....eeeeeseteeeceseeteetsseeecnceseceacececscessceasesseseseceesesesatentenssesseseenens 24

Table 10: Public Health — RESPONSE PIN ........eccssccesscessceesseceseecessecescssseessetesseeesseesesees 26

Table 11: Public Health - Recovery and Rehabilitation Plan: Standard Operating
PFOCCOUSES oo. secescesecssecesecessencensersseeseeeseeessessecesacesesessosssesseesesesessadsnsessessesessecseseseceasenaeeneees 30

Table 12: DRRM-H Operational PAN Matrix ...cccccsscessscssesersestecsesesensecstsesssecessscseesens 34

Table 13: Hospital — Previous Disasters and Lessons LEArNe......eeecscssessssssceceeceees 39

Table 14: Hospital — Vulnerability ASSOSSMENE........ceccsescessecetscssseceeecesseeesssecseteesesesseeee 40

Table 15: Summary of Risk Assessment for HOSPITOIS

0.0... ccsssceeeseecsesssccessseessrsesesseeees 40

Table 16: Hospital — Prevention ANd MITIGATION PIAN wu...

ce ceecesssseeesstesessscessteeeeseeees 42

Table 17: Hospital —

Preparedness PICN.........ccsccsssscccesssccssnecesssecesesseeceseesesssseeenatsesaaees 44

Table 18: Hospital - Standard Operating Procedure for RESPONSE .......eeeecssseeteeeee 45

Table 19: Hospital — Standard Operating Procedure for Recovery and

RENADINITATION
0... eccccssccsssceesecesscenseceseceeeeceseeessecsesecseeesseceseeceseesesseeeaesseaeecsascesaeseseeensees 47

ix|Page
LIST OF FIGURES

Figure 1: Planning MANageMeNt StUCTUFE

oo. esessessensesecsscetscesssssessessesestessrevsssrecenens 4

Figure 2: The Six Steps IN DRRM-H PIONning..........ccsccsccssccssscseceseecsecsesesessesesescssveesesecesasaes 6

Figure 3: Health Quad Cluster Health Services 00... cccccssesssseesssssessesscsssescssessessesseeees 20

x|Page
EXECUTIVE SUMMARY

Disaster Risk Reduction and Management in Health (DRRM-H) Plan is one of the four vital
indicators in the DRRM-H institutionalization. It is a product of a participative process that
requires the involvement of the head of institution/organization, the DRRM-H managers;
technical program managers of the DOH-led Health cluster namely— Medical and Public
Health to include Minimum Initial Service Package for Sexual and Reproductive Health
(MISP-SRH); Nutrition; Water, Sanitation and Hygiene (WASH}; and Mental Health and
Psychosocial Support (MHPSS) — and other relevant stakeholders at the different levels of
governance and service provision — centers for health development (regional offices),
hospitals and local government units.

Each level of governance should develop a DRRM-H plan that is approved, tested
annually, updated and disseminated regularly. It is formulated from actual disaster
experience, exercise/drill findings and changes in the policy environment. DRRM-H
planning is done every three years or when a major disaster occurs.
This Planning guide contains three parts: Part 1
details the concepts, principles, and
guidelines on DRRM-H; Part 2 A contains the discussion on the steps on DRRM-H planning
in public health, while Part 2 B contains that of the hospital.

Part 2 discusses in detail the six steps identified in the conduct of the DRRM-H Planning
namely: First, Preparing fo Plan in which authority, approval and support of the head of
institution is sought for the planning committee to convene and plan; Second, Data
Gathering where the necessary information are analyzed including lessons learned from
previous disasters; Third, Developing/Updating the Plan wherein strategies and activities
are laid down considering the four (4) thematic areas - prevention and migration,
preparedness, response, and recovery and rehabilitation; with planning matrices
provided Fourth, Translating and Integrating the plan to ensure the alignment of the
plans to achieve the national goals, integration to the different DRRM, health, and
development plans at all levels of governance and operationalization; Fifth,
Implementing the Plan with the provision of budget: and Sixth and last, Monitoring and
Evaluating the Plan.

xi|/Page
introduction

The goals of Disaster Risk Reduction and Management in Health (DRRM-H) are threefold: (1)
to provide uninterrupted health services (2)avert preventable morbidities and mortalities:
and (3) ensure that no outbreaks occur secondary to disasters. This is in line with the Strategic
Pillar 2 of the Fourmula One Plus (F1+) for Health that ensures accessibility of essential quality
health products and services at appropriate levels of care even in times of emergencies and
disasters.

Thus, institutionalization of DRRM-H in the health system across all levels of governance is
necessary in order to achievethe said goals. Minimum indicators of an institutionalized DRRM-
H are: an approved, updated, regularly tested and disseminated DRRM-H plan; an organized

and trained health emergency response teams; available and accessible essential health
commodities; and a functional operations center. This will be done through the 5K approach
or the Kaligtasang pangKalusugan sa Kalamidad sa Kamay ng Komunidad (Health Disaster
Safety in the Hands of the Community}, consistent with the National Disaster Risk Reduction
and Management Framework’'s (NDRRMF} vision of the country to have safer, adaptive and
disaster-resilient Filipino communities toward sustainable development.

The 5K will guide planners at all levels of governance to formulate disaster risk reduction
measures for each of the four thematic areas: Prevention and Mitigation, Preparedness,
Response, and Recovery & Rehabilitation. This requires proper DRRM-H planning and
implementation, coupled with gender-sensitive, culturally appropriate, and inclusive
approaches in service delivery.

1|Page
DRRM-H institutionalization also entails the creation of issuances that adopt a policy ensuring
that are in place such as creation of a dedicated unit with a permanent employee
all systems
as lead, Operations Center (OPCEN) with Concept of Operations (CONOPS), and Manual of
Operations (MOPs).

What is DRRM-H Planning?

PARTICIPATIVE PROCESS DRRM-H PLAN RESILIENT HEALTH SYSTEM

DRRM-H planning
is a participative process, carefully studying the hazards, vulnerabilities
and risks of an area, Additionally, it
a systematic, systemic, strategic, evidence-based,
is

and consultative process to come up with a regional, provincial, city, municipality,

barangay, and hospital DRRM-H Plan and properly implement it to ensure resilient health
systems at all levels of governance.
DRRM-H plan generally similar to the previous Health Emergency Preparedness,
is

Response and Recovery Plan (HEPRRP). The distinction lies on the most recent framework
that includes planning for the equally important prevention & mitigation, and recovery &
rehabilitation thematic areas.

There are other plans which are equally important however, will not be covered in
this
guide. One
isthe Contingency Planning, a management process that analyzes specific
potential events or emerging situations that might threaten the health of the population
already affected or to be potentially affected. This includes establishing arrangements in
advance to enable timely, effective and appropriate responses to such potential events
and situations, resulting to a specific scenario-based plan. The second is the Public
Service Continuity Planning, a strategy that recognizes threats and risks facing an
institution, including protection and functionality of personnel and assets in the event of
a disaster. It involves defining potential risks, determining how those risks will affect
operations, implementing safeguards and procedures designed to mitigate those risks,
testing those procedures to ensure that they work, and periodically reviewing the process
it
to make sure that is up to date. Also are evacuation plan, information, education and
communication plan.

5 j Peg e
Why conduct DRRM-H Planning?
The DRRM-H planning process can optimize disaster prevention and mitigation
opportunities; develop adaptive capacities; activate response systems in a timely and
efficient manner; and apply the “build back better” principle therefore, reduce injuries,
illnesses, mortalities, health-related damages and losses. DRRM-H planning also guides
resource acquisition and allocation in the health system for emergency and disaster
management and enhance networking and coordination with other health agencies,
government organizations and non-government organizations

Who shall be involved in the DRRM-H Planning?

'

|
Head
of
the Office/ Institution
Center for Health Development: CHD
»
Director
|
Hospital: Medical Center Chief/Chief of Hospital |
_
Provincial/City/Municipal: Governor/Mayor
Barangay: Barangay captain

DRRM-H Focal Person

{(DRRM-H Manager / Health Officer and LGU-
designated Manager)

_
Other DRRM-H Planning Committee Members
Technical Personnel on Health Programs especially on
the health cluster, Planning Officer, Administrative
Officer, Provincial/City/Municipal DRRM Officer; and
_

counterparts in the barangay

3 Page
:
DRRM-H Planning Management Structure

Rarer
Disaster Risk Reduction and
Management in Health Goals integration

Figure 1
Figure 1. Planning Management Structure
eo
ea
Oe
shows how planning is to be executed at different levels of governance. This
framework ensures that each level will take care of its downlines, guiding them towards
institutionalization of DRRM-H.
The structure implies that the Health Emergency Management Bureau (HEMB), as the
national lead of the DOH in DRRM-H, is responsible for creating and maintaining the
national DRRM-H plan, using regional data on DRRM-H institutionalization. It also
supervises, provides technical assistance, coaches and mentors, monitors, and evaluates
the development of the DRRM-H plans of all the centers for health develooment/regional
offices and hospitals under national jurisdiction including but not limited to the DOH
specialty hospitals and medical centers located in Metro Manila, hospitals under the
Department of National Defense (DND}, and hospitals under the Philippine National
Police (PNP).
The Centers for Health Development, in turn, shall provide technical assistance, coach
and mentor as well as supervise the development of the DRRM-H plans of the provinces,
highly urbanized cities (HUC), as well as the independent cities (IC). The CHDs also
monitor and evaluate the implementation of the Provincial, HUC, and IC DRRM-H Plans.
Further, they will perform the same tasks for the DRRM-H planning of the hospitals under
regional jurisdiction.
In the same manner, the Provinces will supervise the planning process, monitor, and
evaluate DRRM-H institutionalization of the Municipalities and Component Cities as well
as the LGU managed hospitals and private hospitals within their jurisdiction. Coaching
—-

4 ip5 g Ss
and mentoring shall be provided especially in the development and implementation of
the DRRM-H Plans.
Lastly, the Citiesand Municipalities will oversee DRRM-H Planning of the Barangays. They
will also extend coaching and mentoring and provide technical assistance during
planning process of their downlines including hospitals within their jurisdiction.
This management structure ensures that the plans, at different levels of governance, are
aligned in order to achieve the DRRM-H goals and contribute to the priorities of the
Philippine Health Agenda.
However, in order to ascertain the contribution of the plans to the national goals,
necessary to integrate it to the different health plans, DRRM plans, and development
is
it
plans, at each level of governance. Integration is necessary to ensure sustainability of the
plan by allowing for the different strategies and activities to be budgeted and
implemented accordingly. Also this ensures alignment of the DRRM-H plan to the bigger
and more comprehensive DRRM and Health plans.

When
DRRM-H
isStrategic
DRRM-H Planning done?
Planning is done every three years or when a major disaster occurs for
the necessary revision of strategies. The plan is annually reviewed and tested, and
regularly updated. However, the operational plan of the DRRM-H plan should be crafted,
reviewed, and updated annually based on the strategies identified.

How to conduct DRRM-H Planning?

In conducting DRRM-H Planning, six (6) key steps are observedin a cyclical manner,
illustrating the process of continuous appraisal: (1) Preparing the Plan; (2) Data Gathering
and Analysis; (3) Developing/Updating the Plan; (4) Integrating and Translating the Plan;
(5) Implementing the Plan; and (6) Monitoring and Evaluating the Plan. This also
emphasizes that planning is.a continuous process and does not end with the production
of the plan document.
These steps shall be undergone in a systemic and sytematic manner to ensure
comprehensiveness, soundness, and feasibility of the plan as well as proper
implementation and further improvement based on data that will be gathered in the
process. The illustration below summarizes each key step.

5|Page
 i
oe ROR ERE ED A ENR CEU
Preparing to Plan
"etm ERNE SIRES

|te |

RE
andAnalysis
The Six
Steps in
DRRM-H
Planning i
Developing /
Implementing the Updating the Plan
Plan

Figure 2. The Six Steps in DRRM-H Planning

Step 1: Preparing to Plan: This is the arbitrary starting point, which includes the
authorization of the head of the office/institution/hospital or of the local chief executive
for the conduct of the DRRM-H Planning. It ends with having a schedule to convene the
Planning Commitiee;

Step 2: Data Gathering and Analysis: Making available needed data and information
utilizing tools for analysis to understand the existing hazards, health vulnerabilities, health
risks, and capacities of the institution;

Step 3: Developing / Updating the Plan: Devising effective strategies and activities for the
four (4) thematic areas of DRRM-H namely prevention and mitigation, preparedness,
response, and recovery and rehabilitation;

Step Translating and Integrating the Plan: Prioritizing and translating the strategies and
4:
key activities into specific activities and consolidating it in an operational plan, ready for
integration to different budgeted plans such as Disaster Risk Reduction and

6 iPage
Management Plan (DRRMP), Work and Financial Plan (WFP), Investment Plan for Health
(LIPH) and Gender and Development (GAD) Plan, among others;

Step 5: Implementing the Plan; and

Step 6:Monitoring and Evaluating the Plan: Monitoring of the DRRM-H plan should be
done regularly and the results reported to the Planning Committee and at least annually
the uplines annually for the the review and testing of the plan. Evaluation shall be done
at least every three years to guide the updating of the DRRM-H pian.

7|Page
Part 2A of the Guide discusses the planning process in the regional offices and local
government units — provincial, city, municipal health offices and the barangay,

PREPARING TO PLAN A
This section deals
mainly administrative
prerequisites in planning. The Health Offices at
with
-
What needs to be done?
\
different levels need to organize a DRRM-H Planning ¥ Get the approval of the
Committee and seek the approval of the Head of Head of Institution on
their respective Institutions’ for the conduct of DRRM- DRRM-H Planning
H Planning.

The Disaster Risk Reduction Management in Health ” Organize a DRRM-H

(DRRM-H) Managers in the Regional Offices and Planning Committee
hospitals and Head of the Health Office, in the Local
. . . through an Executive
Order containing the
Government Unit, as the lead on DRRM-H Planning, shall:
; :

roles of each member

Orient the Head of Institution”,7 the management
. ‘
1.
+

VY
Dratta DRRM-H
committee (Mancom) , and health-related Planning Schedule
committees on the DRRM-H goals’ and objectives
and discuss the importance of planning to
contribute to the reduction of health risks and
X
oY )
7 The Heads of Institution at different levels are the: Regional Director, Governor, Mayor, and Barangay Captain
8 The DRRM-H goals for year 2017-2022 are:
{a} Guarantee uninterrupted health service delivery during emergencies and disasters
(6) Avert preventable morbidities, mortalities and other health effects secondary to emergencies and disasters
(c} Ensure that no outbreaks secondary to emergencies and disasters occur.

.
Bip ag :
 management of health consequences of a disaster. Emphasizeon its benefits to
development, citizen productivity, and monetary return of investment.

. Secure authority to plan and support to implement the formulated plan,

particularly budgetary

In the case of the Barangay, lobby support for the activity by enlisting the
assistance of the city/municipal DRRM-H officer or designate and the barangay
council.

. Establish the Planning Commitiee. The Planning Committee shall be composed

the Chairperson, Vice Chairperson, Members and Secretariat. It is recommended
of
that the DRRM-H manager/ LGU health officer or designate DRRM-H coordinator
assumes the Vice- Chairperson position, if not the Chairperson . Members of the
DRRM-H Planning Committee, may include but not limited to the DRRM Officer,
Program Managers or Focal Point Persons of the health cluster, Planning and
Development Officer, Administrative Officer. The secretariat is preferably to come
from the staff of the health emergency unit and is tasked to document minutes of
committee meetings, as well as keep documents and records.

. Draft an Office Order/Executive Order enumerating the names of the Planning

Committee head and members and identify the roles and responsibilities of
each relative to planning. The Chairperson convenes the Planning Committee
which agrees on the schedule of planning activities through a Gantt chart
{Annex 1) to reflect also the budgetary requirements.

9|Page
Roles and Responsibilities of the DRRM-H Planning Committee
Develop, review, and update the previous plan;
Gather required information and secure commitment of key people and
organizations
Initiate testing of the plan for its functionality and adaptability to current
situation
Develop annual operational plan and other plans relevant to health
emergencies and disasters
Monitor and evaluate the plan

Roles and Responsibilities of the Chairperson

Preside the meeting and facilitate planning

Provide feedback to the Head of
institution in relation to progress of planning
Roles and Responsibilities of the Vice Chairperson

the Chairperson
Assist
Take over the role of the Chairperson in his/her absence

Roles and Responsibilities of the Members

Provide necessary technical inputs

Attend meetings regularly
Assist the Chairperson in advocating the plan
Roles and Responsibilities of the Secretariat

Document minutes of the meetings

Is responsible for safekeeping of documents and records

10|Page
 DATA GATHERING AND ANALYSIS

\
AN Step 2 of DRRM-H Planning looks at factors
affecting health when a disaster hits the area. It
begins with gathering data and information
which should be updated regularly.
What needs to be done?
Different tools -hazard, vulnerability, and risk
¥ Process data, information, (HVR) can be used to assess and analyze the data
and lessons from previous
disasters gathered and process information to guide
planning. Discussed here are some of the
¥ Identify hazards, assessment tools utilized in the Public Health and
vulnerabilities, capacities Emergency Management in Asia and the Pacific
and health risks (PHEMAP) training. Another alternative
methodology is utilizing the Strategic Tool for
¥ Analyze gathered data
2.
/
Assessing Risk (STAR}. Refer to Annex

vr
1. Gather baseline data using Annex 3 as a reference. Adopt the data used in the
DRRM
if
plan available.
Documents such as post incident evaluations (PIEs), inventory of resources
including mobilized health emergency response teams and possible partners in
times of emergencies and disasters, commodities, list of functional health
facilities, and previous HEPRRP can be used as baseline data.

2. Conduct a situational analysis during one of the meetings of the DRRM-H Planning
Committee to process the data gathered and provide information for planning.

2.1. Review previous disasters and lessons during the incident, in the context of
health. Use the Table below.
1

ay | Pa S g
 Table 1. Public Health - Previous Disasters and Lessons Learned

Before.

e.g. 2010 7.935 families and Health Medical Psychos Before; There is a need to
Typhoon 34,637 individuals emergency consultati ocial LGU Hospital; City provide for additional
Emil were affected. response ons, support Health Office: evacuation centers
There was feams were WASH. services Regional Office (ECs) and proper
increased designated and were PBuring: assignment to reduce
pneumonia cases per Nutrition given LGU Hospital; City overcrowding in ECs in
in the evacuation evacuation services Health Office; order to prevent
centers; one EC cenierand were Regional Office; increase in
had dengue municipalit delivered youth volunteers pneumonia cases.
outbreak; around y; health After: Increase procurement
Php 3.9M worth of commodifi LGU Hospital; City of mosquito nets.
damages to es were Health Office;
health facilities preposition MEIPSS response
were estimated ed team from RO

2.2. Hazard Identification and Prioritization. Identify priority hazards based on

the matrix in Table 2. When assessing the different criteria, discuss previous
encounters with the hazards identified.

Table 2. Public Health - Hazard Prioritization Matrix

.
Typhoon
3 4 4 4 4 i] It
Fire 4 i 3 i 3 6 4
Armed 4 3 4 2 10 and
conflict
Earthquake 3 3 5 ] 3 9 gr

2.2.1. From table 1, note down in the first column the hazards that affect
your area. Indicate additional hazards based on additional
information such as health trends and political climate of the area.

2.2.2. Rate each criterion per hazard (severity, frequency, extent,

duration and manageability) from 1-5, with 5 as the highest. Below
is the description of each criterion.
 Criteria:
Severity - how serious the health consequences of the hazard are; its
transmission potential (if the hazard is biological); and the
possible prolonged disruption of routine health services
Frequency - number of times that an emergency/disaster happen during
a particular period
Extent - the range of damage in terms of people affected, lifelines,
health infrastructure, and others
Duration - the length of time that an emergency/disaster lasts
Manageability - howcapable the institution is to address the hazard. If we can
lessen the impact of the hazard, then the rating for
manageability would be high. If it were manageable only after
it had occurred, then the rating would be low

2.2.3. Compute for the total by adding the rating from columns a to d
minus the rating in column e.

2.2.4. Rank the hazards based on

the total obtained with the largest total
being first.

2.3. Hazard Mapping. Secure the appropriate maps of your specific area. This
may be acquired/viewed in
the internet website of National Mapping and
Resource Information Authority (NAMRIA) or that of the Mines and
Geosciences Bureau (MGB) of the Department of Environment and
Natural Resources (DENR), and the Philippine Institute of Volcanology and
Seismology {(PHIVOLCS).

2.3.1. Identify and mark areas likely to be exposed to hazard.

2.3.2. Enumerate specific hazard/s on exposed areas.
2.3.3. Represent each specific hazard in codes through symbol or
number for ease of referencing.

2.4. Vulnerability Assessment. Determine the susceptibility of the community to

the impacts of the hazards identified and ascertain the areas most at risk
for the top hazards’. Determine characteristics of the people, environment,
property, services and livelihood that make the area more vulnerable to
the hazard.

° From the ranking of the hazard, the Committee may opt to assess and plan for a number of hazards {either top 2 or top
3} in order to save time and have a focused discussion on planning.

13|Page
 2.4.1. Take into account the following parameters when determining the
vulnerabilities:

2.4.1.1. Access to health services in potentially affected areas

2.4.1.2. The health status of populations at risk based on health
service coverage, population immunity, disease burden,
etc.
2.4.1.3. Social determinants of health such as access to good
housing, water, sanitation, education
2.4.1.4. Presence of vulnerable groups in affected areas
2.4.1.5. Social/organization aspects: Health leadershio and
decision-making structures; administrative structures and
institutional arrangements; community participation
levels (may be included under the column “People” in
Table 3)
2.4.1.6. Motivational/attitudinal aspects: health-seeking
behavior of the community; attitude towards change;
understanding of their role in reducing health risks;
initiative to get things done; cooperation (may be
included under the column “ People” in Table 3).
2.4.2. Refer to the matrix below for the vulnerability assessment.
Table 3. Public Health - Vulnerability Assessment Matrix

af

e.g. High proportion Health Consistent Coastal Fishing as

Typhoon of existing commodity delay in barangays primary
pneumonia warehouse procurement comprises source of
cases located in of 40% of all income
alow lying commodities barangays
PHO and area
PDRRMO not Inadequate Poor access
communicating/ supply of to water
coordinating measles sanitation
vaccines facilities and
Low health water system
seeking Lack of
behavior for water festing Many
males and laboratory breeding
adolescents services places of
mosquito
vector

2.9. Starting with the top hazard, determine possible health consequences
associated with the hazard.

14|Page
 2.6. Identify areas that are most vulnerable to the hazard. Vulnerable areas
depend on the level of governance. For the regional level, indicate
provinces and independent cities as the vulnerable areas; for the
provincial level, indicate the component cities and municipalities as the
vulnerable areas; and at the city/municipal level, indicate the barangays
as the vulnerable areas.

2.7. Identify different vulnerabilities for each element of a community.

—_
Sample vulnerabilities:
1. People 4. Environment F
e High proportion of elderly population, ¢ Health facility located on a 4

infants, children, women, or persons landslide/flood-prone/storm surge- :

with disability prone area ;
e Large proportion of GIDA barangays « Coastal and Island communities 1

2. Properties §. Livelihood
e Warehouse
small
for health commodities is e Primary source of income
municipality is mining
in the
e Lack ofcold chain for vaccines

3. Services
e Lack of health human resource to deliver the service
e Lack of trained emergency responder

15|Page
 Note: Another tool that can be used in
assessing vulnerabilities is the Problem Tree
in which causes and effects of a central problem (in brown), Usually the hazard,

ones
are identified and the causes (in gray) of the effects (green) are explored.
x
{
No available PPEs; '
people wadingin |
cee eee eee .
i
I
Use of non- \ vad
floods because of
lack of health I

ann
eee
typhoon \
1
1
! 1 information |
| resistant
materials
I
SoU v!
s
| because of I I Improper waste '
cheaper costs t j disposal; lack of 1

1 and limited "1 proper sewerage

ee
1

' budget ! I
system
eee ee L — ee
I
‘S - ¢

t
Change in 1
Human activities
atmospheric pressure
Climate change aa contributing
global warming
toy
I
'
i

Vulnerabilities can be drawn from the items in the boxes with broken lines. Only
cull out the vulnerabilities that can be addressed by the health sector.

Capacity Assessment. Determine the capacity of the institution to address the

vuinerabilities,particularly Assess the internal and external institutionalization
.

capacities and the resource networks. Minimum indicators of DRRM-H

institutionalization include an approved, updated, tested, and disseminated DRRM-
H plan; organized and trained
emergency response team; available and accessible
essential health commodities; and a functional operations center.

3.1. Assess the status of the internal DRRM-H_ institutionalization of an

organization or office by referring to the HEMB monitoring and evaluation
plan and its
tools.

3.2. For the external DRRM-H institutionalization inventory, which refers to

assessing the status as to the “downlines” of the organization or office, use
Table 4 below:

ar |
Page
Table 4. External DRRM-H institutionalization Matrix

aor gon faa” vw wv oe foe dO

Campina ord '

Faustino
.
(Midwife)
Brgy. Mr. Felipe
Brgy. Capt. De
Lakay Sebastian Guzman v v ~
v .
Callum (Midwife)
Kalinuan
City
Hospital
Dr. Noel Ramos N/A v v “ ~

3.2.1. List the different health offices and the hospitals under the
jurisdiction of the institution that doing the planning or the
is
“downlines”.
3.2.2. Identify its respective head, and the head of its health office.
Determine the presence of the components of DRRM-H
institutionalization, using the criteria in Annex 4. Put a check mark
(VY) on the column
if
ALL of the criteria for that item are met. If not,
place a dash (-) on the appropriate column.
3.3. Identify resource networks and possible partners in times of emergencies
and disasters. Refer to Table 5
Table 5. inventory of Resource Networks

e.g. Provincial Air transport; communi

DRRM Office equipment; air transport: Ocampo 134-37
additional ambulance;
stretchers and spine boards
UNICEF WASH equipment: water Dr. Marissa +6398870002 PHN: Ms.
testing machine with reagents; Llaneta Thessa
water bladders; aquatabs Martinez

17|Page
 3.3.1. Identify government agencies, non-government organizations,
and civil
emergencies
society organizations that can be tapped in times of
3.3.2. Identify possible services/products
of disasters
that may be provided in times
3.3.3. Determine the contact person of the agency and its contact
details
3.3.4. Assign a focal person within the committee who will coordinate
with the agency

4. RiskAssessment. Identify the health risks associated with the vulnerabilities identified
and the existing capacities of the institution.
Risks must be assessed based on the characteristics of the hazards, the
vulnerability of the area, and the institution’s capacity to reduce the vulnerabilities.
In analyzing, there should be strong consideration on the different basic and
essential services to be provided. Use the matrix in Table 6 to assess the health risks.
Table 6. Public Health - Risk Assessment Matrix

L
Be

it

e.g. Typhoon * High proportion High

of existing
pneumonia
cases
« Health
commodity
warehouse
located in low
lying area
e Consistent delay
in commodity
procurement
e Coastal
barangays
comprises 40%
of the
barangays

4.1. Cull out the hazards and vulnerabilities in Table 3 .

4.2. Assess capacity by enumerating strengths and weaknesses of the

institution and its
system in relation to identified hazards and vulnerabilities.

ar ] 5 ag e
 4.3. Determine the level of risk of having the health consequences associated
with the hazard by considering both the vulnerabilities and the level
capacity of the institution to address them. High risk if the capacity level
is low such that there are limited and with significant
gaps, medium risk if
the capacity cannot address identified gaps, and risk if the capacity
low

level can address gaps.

STRATEGIC TOOL FOR ANALYZING RISK (STAR):

The Strategic Tool STAR isan evidence-based approach to risk assessments that
calculates the level of risk based on the recorded data. It is excel-based. The instructions
of the electronic version of the STAR is contained in the USB complement of this guide.

The data generated including the information will be used as reference for the
formulation of the plans. It is essential that the data be updated regularly to ensure
evidence-based planning.

UPDATING THE HVR TOOLS:

In updating the tools, information from previous disasters is necessary. Documents such as
but not limited to Post Incident Evaluations (PIE}, minutes of the quad cluster meetings, and
response monitoring and evaluation should be considered.

»
DEVELOPING/UPDATING THE PLAN
Thisstep of planning is the actual development of strategies and activities to address the
hazards, vulnerabilities, and risks identified in the previous step. This shall be done in
accordance with the procedures provided for by the National Disaster Risk Reduction
Management Council (NDRRMC)} and shall observe Local Government provisions.
Further, it guides planners to determine areas of focus in terms of disaster risk reduction
management. This step requires the development of four plans based on the four
thematic areas namely, prevention and mitigation, preparedness, response, and
recovery & rehabilitation plans.
Strategies for each of the thematic areas shall focus on the health quad cluster namely
Medical and Public Health to include Minimum Initial Service Package for Sexual and

se
49] Pa g S
 Reproductive Health (MISP-SRH); Water, Sanitation, and Hygiene (WASH); Nutrition in
Emergencies (NiE); and Mental Health and Psychosocial Support (MHPSS}"°,

Component services: Component services:

Maternal and Child Health; Prevention Nutritional Assessment; Infant and Young
and Control of Communicable Child Feeding; Management of Acute
Diseases, Minimum Initial Service Malnutrition; and Micronutrient
Package - Sexuall and Reproductive Supplementation
HEALTH
Health (MISP-SRH); Management of
Injuries, and Control of Non- CLUSTER
communicable diseases

Component services: Component services:

Hygiene Promotion; Safe and adequate Water

Supply; Excreta Disposal; Vector Control; Solid
Psychosocial support in all relief efforts
Psychosocial care such as Psychological First
;
Waste Management; and Drainage; Aid to identified high-risk individuals
Protection from vector-borne diseases including service providers:
Referral for tertiary care management

Figure 3. Health Cluster Services

also worthwhile to consider each essential health service package

It is drafting the
DRRM-H plan. Refer to the HEMB Menu of Strategies for a sample list of strategies specified
in
per quad cluster and per each thematic area at each level of governance.

"©
Department ofHealth. (2017). Guidelines in the Provision of the Essential Health Service Packages in Emergencies and Disasters
(Administrative Order No. 2017-0007). Manila, Philippines

20|/Page
 3.1. Public Health Prevention and Mitigation Plan
The Prevention and Mitigation
a Plan is
combined hazard exposure prevention and
vulnerability reduction plan. It consists of
strategies that aim to:
1, Strengthen day-to-day operations of
different health programs (Tuberculosis,
Malaria, Expanded Program on
Pie
%

Immunization, Water and Sanitation 4 a cf ig

Program, Nutrition, Mental Health, etc.) by reducing exposure to the
at the community level. hazards and the existing
Prepare systems to address chemical vulnerabilities of the community.
and biological hazards (malaria,
emerging and re-emerging diseases,
etc.)
Assess and reduce risks in structural resiliency or integrity of health infrastructure
facilitieshealth infrastructure through engineering and maintenance

Table 7. Public Health - Prevention and Mitigation Plan

Hazard prevention
strategy |
Activity 1.1 Time 1.1) RR1.1 Source 1.1 In charge 1.1. Indicator 1.1
Activity 1.2 Time 1.2 RR1.2 Source 1.2 In charge 1.2 Indicator 2.1
|

|
Hazard prevention
strategy 2
High 1. Expand treatment 2078 PHO Percentage
proporti options for MHOs
on of pneumonia cases providing
@.g.
existing free
Typhoon
pneumo treatment for
nia pneumonia
cases 1.1. Conduct Qi-Q2 Php Provincial PHO, PHN, Number of
case finding 2018 80,000 and MHO, NDPs, cases
Health and provide Municipal Midwives diagnosed
commo treaiment funds for and provided
dity health with
warehou treatment
se 2. Sirengthen 2018 PHO Percentage

21|Page
 located immunization of MHOs
in low program of the implementin
lying province g catch up
area immunization
program
Consiste
nt delay
2.1. implement Q1-Q2 Php Provincial PHO, PHN, Number of
catch-up 2018 90,000 and MHO, NDPs, children and
in immunization Municipal Provincial elderly
commo for children funds for Hospitals, provided with
dity and elderly health District catch up
procure Hospitals, immunization
ment DOH RO City,
vaccines Hospitals
Coastal Vulnerability Time 1.2 RR1.2 Source 1,2 Incharge 1.2 Indicator 1.2
baranga reduction strategy 3
ys
compris
es 40%
of the
baranga
ys
Hazard
#2
*Fund sources can be obtained from the 5% allotment for Regional Offices or 5% calamity fund of the LGU and other funds

Incrafting the Prevention and Mitigation Plan, the Planning Committee may choose to
use the top priority hazard in the area. Follow the steps below to accomplish Table 7:
1. Start with the first priority hazard.
2. Identify hazard exposure prevention strategies and indicate key activities for the
strategy.
3. Identify the timeframe (specify the year and quarter), resource requirement,
source of funds/resources, as well as the person-in-charge to implement the key
activity.
4. Craft an indicator to measure the accomplishment the activity. of
5. After this, list down the vulnerabilities associated with the hazard, and repeat the
process. Vulnerabilities to be addressed shall come from Table 3.

22|Page
 3.2. Public Health Preparedness Plan
The Preparedness Plan aims to:
1. Increase capacity to efficiently manage
the health risks of emergencies and
disasters and achieve orderly transition
from response until recovery.
nee Vay yy o ” of
1

vy

communities to anticipate, Ensure DRRM-H institutionalization internally

cope, and ensure early in the institution and its respective
recovery the negative
from downlines.
health impacts of emergencies
and disasters. Build health system resilience by
mainstreaming DRRM-H in all health
programs.
Taking into consideration the capacities and
risksaccomplish the preparedness plan on
, risk reduction and DRRM-H Institutionalization
matrices below.

Table 8. Public Health - Preparedness Plan Matrix 1: Risk Reduction

Strategy 1: Ensure adequate supply of commodities for evacuees and home-based IDPs
Provide buffer Ql Php 63,000 LDRRMF PHO / Percentage of
stock of 2018 PDRRMO buffer stock
commodities against total
health
commodity
budget
Stockpile and QI-Q2 Php 2,000 (for PDRRMO PDRRMO/ Percentage of
@.g. preposifion 2018 transportation) Logistics allocated
Diarrhea equipmeni, Officer commodities
Flu tools and prepositioned
Leptospirosis other
Injuries emergency
Respiratory supplies
diseases (in
evacuation Ensure availability 2018 Php 20,000 PHO/ PHO Percentage of
centers) of HRH in ECs MHO/ ECs with
DOH RO assigned HRH
Organize Ql Php 10,000 PHO / PHO / Percentage of
standby HRH 2018 (for meals) MHO MHO / MHO/Hospital
from MHOs Chief of that provided
and Hospitals Hospital standby HRH
and set their
schedule

-23|Page
—
 Conduct
“readdinessche
ck” for first
responders
and second
responders

Preparedness Plan: Risk Reduction Matrix.

1. For the identified health risk of the community in Table 6, identify one strategy
and key activities to address the health risk.
2. Determine the timeframe (specify the year and quarter), resource
requirement and its
source of fund and the person in charge to implement the
activity.
3. Formulate an indicator to track the accomplishment for the specific activity.
Repeat the process for the next strategy.

In the formulation of the Preparedness plan, it is important to include

strategies and activites that concern delivery of essential health service
packages that include health human resources and health commodities
Consideration to incorporate the 10 P's namely 1. Policies,
protocols,procedures, guidelines, 2. Plans,
.
3.People,4.Partnership
building, 5.Program development, 6. Physical infrastructure development, 7.
Practices, 8. Pesoand logistics, 9. Promotion and advocacy, and 10.
Performance management

Table 9. Public Health - Preparedness Plan Matrix 2: Minimum Requirements of DRRM-H

Institutionalization

Gather support for 2018

DRRM-H planning
Conduct Q2-Q3 Php 500K LDRRMF DMO / Percentage
advocacy 2018 DRRM-H of
Internal activities for Focal/ component
e.g. Component PDRRMO / cities and
DRRM-H Plan cities and Mayor municipalities
municipalities that hosted
the
advocacy
activity

oA ip ag °
 Conduct Q?2 DMO Percentage
orlentation of and /DRRM-H of schools
DRRM-H in O4 Focal/ oriented on
schools 2018 PDRRMO / DRRM-H
Education
Unit
Strategy 2

Strengthen reporting 2018

capacity of
component cities
and municipalities
Conduet data Ql Php 10K LDRRMF_ Provincial Percentage
harmonization 2018 Information of
External
workshop with Officer component
e.g. C/MDRRMO cilles and
OPCEN
and C/MHO municipalities
with
representatio
nin the
workshop
Strategy 2

Preparedness Plan: DRRM-H Institutionalization Matrix.

1. From the analysis of Table 4: External DRRM-H institutionalization matrix results

and the results of HEMB institutionalization monitoring tool, identify priority

areas to improve or strengthen the internal and external DRRM-H
institutionalization.
2. Craft strategies and key activities to improve the identified priority for internal
DRRM-H institutionalization.
3. Determine the timeframe (specify year and quarter}, resource requirement,
fund source, person in
charge, and the indicator to measure performance.
4. Repeat the process for the next strategy.

Aside from the matrices above, part of the preparedness plan is conducting contingency
planning wherein strategies to address specific hazards are delineated, considering
detailed resources of the organization or institution.

25|Page
|)
3.3. Public Health Response Plan
The Response Plan aims to:
1. Ensure availability of critical lifelines |

related to health (e.g. safe water, §&

electricity/fuel, communication devices) 7

2. Guarantee physical and mental wellness

of affected communities through quad- | pODU m
during or
cluster response (Medical and Public immediately after an
Health, Water Sanitation and Hygiene, emergency or disaster.
Nutrition, and MHPS)

The Response Plan

a compendium of
is

Standard Operating Procedures (SOPs) that

must be activated or followed once an emergency
core or minimum activities during response.
or a disaster occurs. Table 10

lists the

There are five major components of Response that need be effectively managed. These
are: (1) the event/incident; (2) the victims/survivors; (3) the service providers; (4) the
information system; and (5) the non-human resources. Activities for each component
must be properly implemented during the following timeline: pre-impact (0 days), during
impact (0-48 hours), and post impact (>48 hours} (see Annexes 5 & 6).

It is the institution such as fire alarm, tynoon

important to install early warning system in
signals from PAG-ASA, tsunamin alert from PAG-ASA, regional and local disaster risk
reduction management council, seismology alert from Philvocs; and at the same time
implementation of the code alert system. This should be reiterated in the preparedness
phase that would be significant during response.
Table 10. Public Health - Response Plan

: Post-
Pre-impact Impact
Oda
(Oday) | 0-48 hrs )
impact
(43 hie)
Management of the Event/Incident
Raise appropriate code e.g.
1. Receive/ Monitor Monitor /
alert" 1, PHO DRRM-H
validate compliance compliance Focal
Information with Code e with
from the Alert raised Code Alert
PDRRMO raised
Code raised
2. Disseminat to 2. Verify PHO / DRRM-H
e issued issuance of Focal

26 [Pa ge
 Pre-impact impact —
Post-
(0 day) (0-48 hrs) impact
(>48 hrs)
order correspondin code alert
activating g alert deactivatio
code alert n

. Comply PHO Staff

with
deactivatio
n of code
alert
Activate Operations Center
{OpCen) on a 24/7 basis and
Incident Command System
(ICSU
Inform higher level of OoCen,
if not DOH-OpCen

incident through fastest

of the

means of communication!!!
Coordinate with respective
DRRM Office, with partner
agencies, and
attend/conduct meetings as
necessary (DRRMC, health
sector, cluster partners) 1
Management of Information System
Gather information regarding
the event!
- Coordinate with health
representatives and get
initial report
- Deploy Rapid Health
Assessment (RHA) Teams
when no
communication/ report
from the health
representative in 6 hours
post impact
- Submit initial assessment
report using official RHA
form.
Continuous monitoring and
dissemination of information
updates!!
Submission of daily situation
report or HEARS report to the
upline"!

"' Department
of Health (2017). Activity checklist in emergencies and disasters (Department Memorandum 2017-0168). Manila,
Philippines.

57 iPag °
 Pre-impact
(O day) (0-48 hrs):
-
Surveillance
inand
Post extreme
Emergencies
Disaster(SPEED}) activation’?
Management of Service Providers
Check status of health
personnel in affected areas!!
Mobilize own human
resources or request
assistance for: !!

- Additional RHA team

- Emergency medical
and public health
team
- WASH team
- MHPSS team
- team
Nutrition
- RESUteam
Other teams that may be
needed (maintenance,
admin support, etc.}
Provide personal safety kits
and personal protection
gears to service providers
Management ofNon-human Resources
Update/check
status/inventory of logistics!2
Preposition logistics as per the
result of inventory!2

Mobilize own non-human

resources or request
assistance for:!
- Medicines and
medical supplies
- WASH supplies and
equipment
- Nutrition commodities
- MHPSS supplies and
commodities
- Funds
- Others: e.g. trauma,
hygiene kits

12
National Disaster Risk Reduction Management Council. (June 2014). National Disaster Response Plan for Hydro-Meteorological
Disaster. Manila, Philippines.

58 iP age
 Post-
Pre-impact Impact
{0 day} (0-48 hrs)
impact
(>48 hrs)
Management of the Victims
Provide pre-hospital and
hospital care
Provide quad cluster health
services
(e.g. general consultation and
treatment, vaccinations,
reproductive health services,
chemoprophylaxis, health
education, promotion and
advocacy including hygiene,
nutrition and psychosocial
support}

Response Plan Matrix.

1. For each of the core/minimum activity enumerated, list the steps to be

undertaken by the institution pre-disaster impact, during impact, and post-

impact. Please refer to Annex 6 for the response management per phase.
2. Identify the responsible person, institution or agency for each step.

*Other activities may be added, if the institution needs it.

For the local government units, coordination with their local disaster risk reduction and
management committee will be carried out, e.g. for deployment of health emergency
response teams, along with other service providers. Please refer also to an example of
emergency response flow adapted by a local government unit, Annex 7.

59 | Pa ¢ =
=
—
3.4. Public Health Recovery and Rehabilitation Plan
The Recovery and Rehabilitation Plan
aims to:

1. Assess long-term health -GOAL-

needs of community to
guide recovery efforts. ea and improve health
2. Maximize opportunities to facilities, nealth conditions, and
further increase community organizational capacity of
health resilience. affected communities, and
wdtesy
Aga PUN IS
Po

There are two matrices of the Recovery compliant with the principles of
and Rehabilitation Plan. One of which is Bullding Bac!
crafting the SOPs on main recovery and
rehabilitation activities, as shown in
Table 11 below. The second matrix is
used in planning for the recovery and rehabilitation of the affected area after a disaster
occurs. (See Annex 8). This should take into consideration different factors depending on
a specific disaster.
Table 11. Public Health ~ Recovery and Rehabilitation Plan: Standard Operating
Procedures

Within 1
year 1 to 3 years
Post damage assessment
and needs analysis Send a PHO
representative
when the
PDRRMO Health representative
convenes the
assessment
team PHO / Health
. Conduct on site representative
assessment of PHO /[ DRRN-H Focal
damaged
health facilities
within 3days
Prepare cost of
needs
Submit report
Post incident evaluation
and documentation of best
practices,lessons
learned, problems

30 P ag °
 Within 1
year 1to 3 years
encountered, challenges,
and recommendations
Review and updating of
DRRNM-H plan

Psychosocial interventions
Continuous monitoring of
health conditions of the
affected population e.g.
surveillance

Repair of damaged health

facilities and lifelines
Replenishment of utilized
resources
Compensation and
recognition of responders

Response and Rehabilitation SOPs Matrix.

e Identify the steps to be undertaken for the set of activities that must be done
during recovery and rehabilitation phase, and determine the responsible
person/agency.
*Other activities may be added, if the institution needsit.
After completing the different matrices, finalize the DRRM-H Plan using the outline
proposed in Annex 9. Test the plan by checking for the soundness, feasibility, and
acceptability of the plan. Feasibility checks can be done by considering the available
budget and manpower.
is
Part of testing the plan through the conduct of drills and exercises. It shall be based on
It
the top identified hazards, vulnerabilities, and risks experienced by the area. is highly
suggested to conduct emergency drills concerning public safety and health such as
evacuation drills during flood and armed conflict.
A Post Incident Evaluation (PIE) shall be conducted at the end of the drill to document
possible gaps and consolidate suggestions, recommendations and comments. The drill
evaluators shall come from the DRRM-H team as well as the DRRM Office.

Present the final DRRM-H plan for approval of the head of institution. Upon approval,
disseminate the plan to the downlines, the DRRM Council, Quad Cluster, members of the

34 | p ag 5
Provincial/City Planning Committee, and stakeholders. Also provide a copy of the plan
to the uplines.

Updating the Plan

The plan shallbe reviewed annually and updated every three (3) years or wnen a major
event/disaster affects the area. Activities to operationalize the strategies of the specific
plan shall be reviewed and updated annually. Convene the planning committee and
review the existing plan, ensuring that data and information collected in the previous
year or event are accounted for. Update the necessary matrices and have the plan
approved by the head of institution.

Sources of funds for DRRM-H

Section 21of RA 10121 or the local disaster risk reduction and management fund
(LDRRMF) previously known as the local calamity fund, stipulates that not less than 5% of
the estimated revenue is set aside for this particular fund to support disaster risk
management activities. Of this amount, thirty percent (30%) is allocated as Quick
Response Fund (QRF), for relief and recovery programs, while seventy (70%) for pre-
disaster preparedness activities. Details of the LDRRMF, such as purposes, where to source
out from,documents to support is found in Commission on Audit Circular No. 2012-002.

Other sources of funds for DRRM-H activities are the Gender and Development (GAD)
fund based on Magna Carta for Women provision, local climate change adaptation
program fund (RA 9729), people's survival fund, comprehensive emergency program for
children fund RA 10821) and comprehensive land use planning fund,
(

}
TRANSLATING AND INTEGRATING
THE PLAN

Upon completing the DRRM-H Plan, activities must be prioritized in order to craft the
operational plan for the year. This will ensure the implementation of the set strategies for
each of the thematic areas.
In order to craft the operational plan of the DRRM-H Plan, follow the steps below using
the operational plan matrix (see Table 12):

32|Page
 . Listdown priority activities for each of the thematic area, along the essential
health service packages.
Indicate the timeframe (specify the quarter or month) of the activity.
Formulate the performance indicators for each of the activity. More than one
performance indicator may be listed for each.
Indicate the target per quarter for each of the indicator. Compute for the total.
Indicate the frequency of the activity and specify the unit cost of the target item.
Compute for the total cost following this formula:
total physical target x frequency x unit cost
List the source of funds (e.g. GAD, LIPH, CCAP, etc.) and indicate the responsible
agency/office/individual.
8. Have the plan approved by the head of institution.
Ensure integration of the plan with budgeted plans like Work and Financial Plan of the
Region, Annual Operational Plan of the Local Investment Plan for Health (LIPH) of the
LGUs, Disaster Risk Reduction and Management Plan (DRRMP) of the DRRM Council,
Local DRRM Plan, Gender and Development (GAD) Pian, Climate Change Action Plan
(CCAP), and other development plans. Additionally, the DRRM-H operational plan may
be integrated with the plans of other government, non-government, and partner
agencies, community organizations, as well as other stakeholders.

33|Page
Table 12. DRRM-H Operational Plan Matrix

Agency/Office:
Financial Year:

Prevention and ation Plan

Activity |
Activity 2
ness Plan
Activity 1

Aciivity 2
R Plan
Activity 1

Activity 2
Recov and Rehabilitation Plan
Ac ]

Ac 2

Prepared by: Approved by:

<Planning Officer> <Governor/Mayor>

<Position/Designation

34|Page
~ IMPLEMENTING THE PLAN
Implementation of the DRRM-H operational plan shall commence upon approval of the
plan. Since the activities are integrated in different plans, the role of the DRRM-H
Manager/Health Officer is to ensure smooth execution of the targeted activities and
proper utilization of funds. This shall be done through close monitoring and management
of implementation gaps and guided by the indicators set in each of the matrices that
were accomplished.
1. Identify the implementers of the plan and other key stakeholders
2. Ensure that resources (e.g. technical assistance, budget augmentation) are
focused and available upon implementation
3. Orient the Heads ofthe institutions/Local Chief Executives and other stakeholders

on the final and approved plans.

4. Communicate to the stakeholders and decision-makers the results of the
implementation
The DRRM-H Manager shall ensure that accomplishment reports are submitted to the
DRRM-H Planning Committee order to monitor the progress of the plan. Utilization
in
reports shall also be regularly provided to Planning and Development Office, DRRM
Council, government, non-government, and partner agencies, and community
organizations that pledge budgetary support to the DRRM-H operational plan.

2
» MONITORING AND EVALUATING
THE PLAN
The Regions/Provinces/Cities/Municipalities should include a monitoring and evaluation
part in their DRRM-H Plan.

The DRRM-H plan shallbe reviewed annually and updated as necessary, especially when
a major event/disaster affects the area. Likewise, the DRRM-H Plan should be tested
through drills and exercises to ensure functionality and determine possible
implementation challenges.

Monitoring results and plan evaluation shall guide the updating of the plan. Indicators
formulated for the prevention and mitigation plan and preparedness plan shail be used
co
3678 ag .
to monitor the progress in implementing the strategies formulated for each. Additionally,
the response and recovery and rehabilitation plans shall be regularly tested using drills
and exercises. Progress shall be reported to the uplines and the DRRM-H Planning
Committee members annually during the review of the plan. This snall be complemented
by the accomplishment reports generated in monitoring the DRRM-H Operational plan
for specific activities of each strategy.

Evaivation shall be done every three (3) years, prior to the review and updating of the
DRRM-H Plan. The DRRM-H Committee shall conduct post implementation evaluation for
every incident/event to ensure the appropriateness of the existing plans. The results of
these evaluations shall be documented and presented for consideration to guide the
updating of the plan.

All accomplisnment reports, quad cluster meeting documentation, post incident

evaluation (PIE) results as well as documentation of lessons learned from an incident shall
be compiled, reviewed, and processed, to assess the success of the plan relative to the
accomplishment of its objectives.

In doing the monitoring and evaluation of the DRRM-H plan, whether in the form of a
consultative workshop or doing field visits, the intention is three-fold: 1. recognize good
practices and lessons; 2. identify implementation gaps and provide recommendations
for improvement: 3. generate insights to support policies, programs on DRRM-H and
capability-building.

36|Page
 PREPARING TO PLAN
1. Orient the Hospital Director/ Head of Hospital on the need for DRRM-H Planning
emphasizing relevant provisions of DOH policies indicated in Annex 10: Policies and
Guidelines related to DRRM-H Planning.
Identify composition of the DRRM-H Planning Committee with the concurrence of the
Hospital Director/ Head of Hospital. Members may include the following but not
limited to:
2.1. Heads of hospital programs/ committees
2.2. Department/ Section/ Unit Heads
2.3. DRRM-H Manager
2.4. Planning Officer
2.9. Safety Officer
Prepare a hospital order/ issuance indicating the DRRM-H Manager/ Focal person as
the lead and the committee's roles and responsibilities. Suggested roles and
responsibilities may include the following but not limited to:
3.1. Develop, review and update the hospital DRRM-H Plan
3.2. Gather required information and gain commitment of key people and
organizations
3.3. Initiate testing of the plan for its functionality and adaptability to current
situation
3.4. Monitor and evaluate the plan
3.5. Develop Annual Operational Plan/Work and Financial Plan and other plans
relevant to health emergencies and disasters

37 Pa ge
 4. Upon approval of the hospital order/ issuance, convene the committee to prepare
the planning activity schedule and identify implementers of the plan. Refer to Annex
1
for Sample Gantt Chart for Planning Activity schedule.

5. Invite representatives from the following stakeholders to align objectives, strategies

and activities.
9.1. For government-owned Hospitals: Health Facilities/ Offices within their
respective administrative jurisdiction (e.g. Regional Office Provincial Health,

Office, City/ Municipal Health Office,) and hospitals within their network
5.2. For private Hospitals: other hospitals and local DRRM-H focal person within
the area of jurisdiction
6. Request budgetary support for the planning process.

DATA GATHERING AND ANALYSIS

1. Gather baseline data by accomplishing Hospital Safety Index Tool!? Form indicating 1

general information about the Hospital, which includes demographic profile,

geographic description, health statistics, socio-economic situation, information (e.g.
resource networks and possible partners, etc.}. Output of this process shall form part
of item VI “General Information about the Hospital” as indicated in Annex 11.

2. Lessons learned generated as a results of Post Incident Evaluation and other activities
such as but not limited to testing of plan based from previous disasters can also be
used as basis for the development/updating the DRRM-H plan. Refer to Table 13
below for a sample lessons learned matrix.

13
Hospital Safety Index Philippine Evaluation Forms, Department of Health, December 2015

38|Page
fable 13. Hospital - Previous Disasters and Lessons Learned

Effects
What were the What were the
(Who
actions/interventions done learnings/realiz
Disaster were before, during and after the Who —
ations from
(consider ener disaster were the managing this
natural, 2 (event/Incident,.victims, service players. disaster?

|
biological, providers, information system, non:
_

societa (oo human resource) ae -ateach Specifica

Before During After

e.g. 2016 2M Designate Evacuati Damage Administrati Materials and

Earthquak individu space for on of and ve Officer resources are
e al surge victims, needs & Engineer- inadequate for a
affecte capacity manage assessme Before greater than
d, incident, nt Magnitude 6 EQ.
33,000 Prepare/all treatmen DRRM-H
deaths ot tof manager- Incident
and commoditi injured During management
114,000 es systems need to be
injured. Engineer- strengthened
After

3. Conduct Hazard Vulnerability Assessment using Module of the Hospital Safety Index 1

Tool. Based on the result of the hazard assessment, produce hazard maps which shall
be indicated under item IX “Hazard Vulnerability and Risk Assessment (refer to Annex
11: Proposed Outline of the Hospital DRRM-H Plan).

3.1. Internal hazard map is

a representation of the hospital layout plan indicating
various areas of the hospital which are
likely to be exposed to hazard (e.g.
emergency room, dietary/kitchen, wards, operating room, laboratory, etc).
Use code (numbers or color) and legend for hazards that can possibly affect
hospital areas.
3.2. External hazard map show the areas (municipality/city/barangay) within a
locality where a hospital is located. It highlights areas that are affected by or
vulnerable to hazards including but not limited to earthquake/ground shaking,
landslides, floods, and tsunami. Use color code and legend. See Annex 12 for
example
4. Conduct self-assessment using Hospital Safety Index Tool to identify
gaps/vulnerabilities and weaknesses.
4.1. Accomplish the Hospital Safety Index Tool by indicating corresponding safety

39|/Page
 ratings for Module 2: Structural Safety; Module 3: Non Structural Safety; and
Module 4: Emergency and Disaster Management of the HSI evaluation tool.

—
4.2. Based on the overall Hospital Safety Index Rating, determine if there are
interventions that need to be addressed either urgent or within short-term
period.
down gaps/vulnerabilities and weaknesses per Indicator which scored low and
List

average, based on the Summary of Safety Ratings using Table 14.

Table 14. Hospital Vulnerability Assessment

nee
Indicator
es _ Findings (gaps/
vulnerabilities and
:
oe
Recommendations
.

weaknesses)
Presence of heating, ventilation, 1. PoorHeating. Ventilation, Conduct Facility Enhancement
and air-conditioning [HVAC] and Air-conditioning (HVAC) Activities
systems system

Note: The examples above are intended for GUIDANCE ONLY. They do not collectively represent an ail-
inclusive list.

NOTE:
Results from item 4: hospital vulnerability assessment will be used
as basis for identifying strategies and activities for the prevention

5. Conduct a risk assessment using appropriate tools.

9.1. Conduct a risk assessment using Strategic Tool for Assessing Risk (STAR).
Accomplish Assessment
Risk accordance Matrix in the provided with
instruction. See electronic copy of STAR and Annex 2 for instruction.
5.2. Based on the results of the Risk Assessment Matrix, accomplish the Summary
Risk Assessment for Hospitals (Table15) giving priority to those that scored high
and moderate risk level

Table 15. Summary of Risk Assessment for Hospitals

_ Capacities
eaths , Mass
casualties, crush
oe
More han tf
Strengths
Response plans
Weaknesses
Materials and
people are developed, resources to
and trauma. potentially at risk in including inter- respond fo the
burns, the Metro Manila regional support event are
communicable (MM) area, urban networks. Regular inadequate fora
disease with very high conduct of drills greater than
outbreaks in densify population. and simulation Magnitude 6 EQ.

40 | Pag e
 displaced Based on MMEIRS, exercises. have
ERT Incident
populations, 38% of buildings will been organized management

—
psychological be damaged. and can be systems need to
trauma 33,000 deaths and rapidly sent to be strengthened,
114,000 injured. affected areas.

NOTE: The examples above are intended for GUIDANCE ONLY. They do not collectively represent an all-inclusive list.

NOTE:
Results from step 5: Risk Assessment will be used as basis for
identifying strategies and activities for Preparedness Plan

3 DEVELOPING/UPDATING THE PLAN

Thisstep of planning is the actual development of strategies and activities to address the
hazards, vulnerabilities, and risks identified in the previous step (data gathering and
analysis). Further, it guides planners to determine areas of focus in terms of disaster
response, and recovery and rehabilitation.
Formulate the DRRM-H Plan using the suggested outline indicated in Annex 11: Proposed
Outline of Hospital DRRM-H Plan.

Specific plans shall align to the long-term goal of the four thematic areas of the National
Disaster Risk Reduction Management Plan 2011-2028, namely thematic areas namely,
prevention and mitigation, preparedness, response, and recovery and rehabilitation
plans.

3.1. HOSPITAL PREVENTION AND MITIGATION PLAN

Disaster prevention is the outright avoidance, while disaster mitigation is the

lessening or limitation of the adverse impacts of hazards and related disaster. The
hospital Prevention and Mitigation Plan shall adhere to the goal: Avoid hazards
and mitigate their potential impacts by reducing vulnerabilities and exposure and
enhancing capacities of the hospital.
3.1.1. Develop objective/s that will support the goal of the hospital Prevention
and Mitigation Plan:
3.1.2. Identify applicable strategies to address the gaps, vulnerabilities and
weaknesses as output of the in-house assessment as summarized in Table
14: Hospital Vulnerability Assessment. Strategies may focus on facility

41|Page
 enhancement, retrofitting, and disease surveillance/early-warning system,
among others.
3.1.3. List activities to operationalize strategy.
3.1.4. The timeline to be allotted to complete the activities should be expressed
in quarter-year(e.g. Q4-2019)
3.1.5. Identify resource requirement needed to accomplish the activities.
Resource requirement should be expressed in what type of resources is
required (e.g. fund, manpower) and source (e.g. hospital
income/GOP/calamity fund, in-house}
3.1.6. Identify personnel who is
in-charge in accomplishing the listed activities
3.1.7. Determine indicator to measure each activity

Table 16. Hospital - Prevention and Mitigation Plan

Reyes
iF
C ae ee eee
mer
Negsiibeabenunte exposure
2

of
frie personnel and
ene 11

1.Poor Heating, Strategy 1: Facility Q4- Department

Ventilation, Enhancement 2019 «a. Fund Hospital head, a. 75% of HVAC
and Air- Activities: Income Engineering system
conditioning a, Rehabilitate or Safety rehabilitated
(HVAC) existing HVAC Officer b, Quarterly
system System Maintenance
b. Conduct lb. Manpower In-house done as
quarterly indicated in
maintenance available
records
NOTE: The examples above are intended for GUIDANCE ONLY. They do not collectively represent an all-inclusive list.

3.2. HOSPITAL PREPAREDNESS PLAN

Preparedness planning is building the capacity of the hospital to effectively or efficiently

respond to emergency or disaster. It shall address the identified risks and focus on
minimizing/improving the identified weaknesses and sustaining strengths. The
hospital preparedness plan describes applicable strategies and activities to
supports the goal: Establish and strengthen capacities of hospital to anticipate,
cope and recover from the negative impacts of emergency occurrences and
disasters

42|Page
3.2.1. Develop objective/s that will support the goal of the hospital Preparedness
Plan
3.2.2. Identify applicable strategies toinstitutionalize Disaster Risk Reduction and
Management in Health system in hospital and build the capacities to
reduce risks identified as an output of Risk Assessment summarized in Table
15: Summary of Risk Assessment for Hospital.

Strategies may focus on capacity development in terms of 10 Ps:

1. Policy, guideline, procedure and system development:
2. Plan development (updated, approved and disseminated plan)
3. People-human resource development (e.g. organized and trained
health emergency response teams)
Peso and Logistics (e.g. Allocation of funding for DRRM-H; Availability
of readily available fund for the purchase of drugs, medicines and
supplies; Buffer stocks of drugs, medicines and medical supplies
available within 24 hours; Designated ambulance; emergency
equipment; communication equipment)
Physical Infrastructure Development (Functional Emergency
Operation Center (EOC) capable of command and control,
coordination and communication; EOC system with communication
equipment capable of receiving and transmitting information, Pre-
identified spaces to accommodate additional patients in case of
surge)
Partnership Building (Establishment of Network and referral system,
memorandum of Agreement with pharmaceutical companies for
special arrangements)
Promotion and advocacy ( Public Information; Availability of
Information Education and Communication (IEC) materials
Package of Services (e.g. Basic Life Support, First Aid, Reproductive
Health services including Caesarean section, Emergency room care,
etc.)
Practices Documentation (e.g. Documentation of Post Incident
Evaluation activities, Conduct of researches, Preparation of Case
Reports)
10. Program Development (e.g. Poison Control Program, Hospital Safe
from Disasters Program}

3.2.3. List activities to operationalize strategy.

3.2.4. The timeline to be allotted to complete the activities should be expressed
in quarter-year(e.g. Q2-2018)

43|Page
 3.2.5. Identify resource requirement needed to accomplish the activities.
Resource requirement should be expressed in what type of resources is
required (e.g. fund, manpower) and source (eg. hospital
income/GOP/calamity fund, in-house)
3.2.6. Identify personnel who is
in-charge in accomplishing the activities
3.2.7. Determine indicator to measure each activity All
hospitals shall include in their preparedness plan a section on MCI
management ( AO 155 s.2004)
3.2.8.

Table 17. Hospiial - Preparedness Plan

Mass Strategy 1:
casualties, Logistics
crush and
trauma, burns,
communicable
Ton "

basic
90% of Basic

emergency
disease Fund tospital
OspiTa upplies
Q2 2018 DRRM-H Team
outbreaks in cvophes ong income including
displaced equipment crugs an q
medicines
populations, including
psychological drugs and
procured
trauma medicines
Strategy 2: Head of
People- Training Unit 80% of Target
Learning and QI 2018 Participants
Development Travelling Hospital capacitated
I. Capacitate Expenses income on Ics
staff through training
attendance
to ICS
training

NOTE: The examples above are intended for GUIDANCE ONLY. They do not collectively represent an all-inclusive list.

3.3. HOSPITAL RESPONSE PLAN

A Hospital Response Plan describes the use of the existing capacities to deliver
response. It involves the actual implementation of procedures for the

44|Page
—
 developed systems, and provision of life-saving and essential services during
or immediately after a disaster.

The response plan should address not only the mass casualty incident that has
occurred within the catchment area of the hospital, but should also address
the situation where the hospital itself has been affected by a disaster (e.g. fire,
explosion, flooding or earthquake, etc.). includes compendium of Standard
It
Operating Procedures (SOPs) that will support the goal of Hospital Response
Plan: Provide life preservation through uninterrupted health service delivery
during emergencies and disaster. The SOPs must be activated or followed
once an emergency or
a disaster occurs.
3.3.1. Prepare SOPs for the five major components of Response that need
be effectively managed. These are: (1) management of the
event/incident; (2) management of
the victims; (3} management of
the service providers; (4) management of the information system; and
(5) management of the non-human resources. Activities for each
component must be properly implemented during the following
timeline: pre-impact (0 day), during impact (0-48 hours), and post
impact (>48 hours) (see Annexes 5 & 13).
3.3.2. For each of the core/minimum activity enumerated, list the
steps to be undertaken by the institution during pre-disaster
impact, during impact, and post-impact.
3.3.3. Identify the responsible person or official for each step/action.
See Table 18 below for Sample Standard Operating Procedure

Table 18. Hospital - Standard Operating Procedure for Response

Raise appropriate code alert ].Receive/ Hospital OpCen

validate Staff/ Information
Information Staft/Operator on
from sources Duty

2.Notify the Monitor I].

Monitor
Head/Senior compliance compliance DRRM-H Focal
House Officer with Code with Code Alert Person
Alert raised raised

3./ssued order 2.4ssuedorder

activating deactivating Head of Hospital
code alert code alert

se 48|Page
 240 a 2 Oo
He eis KE 5
'

Pre-impact Impact Post-impact =e{e arge

day}
{0 {0-48 hrs) (>48 hrs)
Activate Hospital Emergency |.Assume as 1. Transfer Senior Officer-on-
Incident Command System Incident Command Duty
(HEICS) and Operations Commander {as need
Center (OpCen) on a 24/7 arise}
basis 2.Declare
activation of 2.Prepare Incident
OpCen ona Incident Brief Commander
24/7 basis and
activate 3.Conduct Incident
command Initial Meeting Commander
center
4,.Develop Incident
Incident Commander &
Objective Planning Section
Chief
§5.Conduct
Tactics Operation Section
Meetings Chief

6.Canduct LContinuously Planning Section

Planning conduct Chief
Meeting meetings
7. Conduct 2.Review plans Planning Section
Operational Chief
Period 3. Prepare
Meeting Demobilization
plan
&.Execute 4.Execute Operation Section
plan and Demob Plan Chief & Planning
CSSESS Section Chief
progress
Coordinate with partners Inform higher 1, Attend 1. Attend DRRM-H Focal
(catchment area, local, level of coordination coordination Person
regional, national)as need OpCen/ meetings meetings
arise Partner
hospital about 2.Present 2.Present resulis DRRM-H Focal
the incident results of of meeting Person
meeting
NOTE: The examples above are intended for GUIDANCE ONLY. They do not collectively represent an all-inclusive list.

3.4. HOSPITAL REHABILITATION AND RECOVERY PLAN

Disaster Rehabilitation and Recovery Plan of the hospital shall support the
goal: Restore and improve facilities and organizational capacities of hospital
operations to reduce disaster risks in accordance with the “building back

46|Page
 |t
better” principle. is important to note that early recovery encompasses the
return of personnel and the hospital to normal operations the earliest time
possible.

For this thematic area, operational timelines are used to give an overall
guidance on the rapid timeline element in recovering from disasters: a)
Immediate Term - within year after the occurrence of disaster; b) Short Term
1

-within to 3 years after the occurrence of disaster; c) Medium Term- within 3

1

to 6 years after the occurrence of disaster; and d) Long Term- beyond 6 years
after the occurrence of
the disaster (Source: National Disaster Risk Reduction and
Management Plan, 2011-2028)

3.6.1. Prepare SOPs for activities that focus on recovery and rehabilitation
of resilient infrastructure, providing physical and psychological
rehabilitation of persons affected by disaster, among others. Use the
following strategies as guide for rehabilitation and recovery plan:

a Post Disaster Needs Assessment (PDNA)

Repair of damaged facilities
oan5o
Reconstruction of damaged facilities
Replenishment of Resources
Post Incident Evaluation and Documentation of Lessons from
previous disasters
. Review and Updating of Plan
g. Psychosocial Interventions
h. Research and Development

3.6.2. Listactivities to operationalize strategy.

3.6.3. For each of the core/minimum activity enumerated, list the
steps/actions to be undertaken by the hospital according to timeline
3.6.4. Identify the responsible person or official for each step/action. See
Table 19 below for Sample Standard Operating Procedure

Table 14. Hospifal - Standard Operating Procedures for Recovery and Rehabilitation

Activity
Conduct Post Disaster
“
Convene the assessment
edie —
Be to) elk—
Person in charge
ae
_

Needs Assessment fear within | day

(PDNA) Conduct on sife assessment
of haspital damaged Hospital Engineer
infrastructure and
equipment within 3 days

47|Page
 Prepare cost of needs
Submit report
Hospital Engineer

DRRM-H Focal
Person
Reconstruction of Prepare building plans and Actual construction of Hospital Engineer
damaged facilities estimates physical facility
Prepare program of works Installation of hospital Hospital Engineer
and bidding document equipment
Conduct procurement
procedures
Administrative
Officer
Nofe: The examples above are intended for GUIDANCE ONLY. They do not collectively represent an all-inclusive list.

If DRRM-H Plan
is already available for updating:
1, Convene the DRRM-H Planning Committee to discuss any of the
evaluation results from the following activities conducted:
e Annual in-house assessment using Hospital Safety Index (HSI} Tool
e Post Incident Evaluation (PIE)
e Drills and exercises
e Lessons from previous disasters
Present the recommendations of the committee to the Hospital Director/
Head of Hospital and secure approval for revision/ updating of the plan.
Convene the DRRM-H Planning Committee and prepare the planning
activity for updating the DRRM-H Plan
Request budgetary support for the planning process.

1.7 Present the plan to the Head of Institution/ Hospital Director for his/ her approval.
1.8 Once signed by the Head of
Institution/ Hospital Director, disseminate the plan to
the department heads of
the Hospital and hospital staff.
1.9 Provide copy of the Hospital DRRM-H Plan to respective Administrative Health
Office

Regional Hospital --* DOH Regional Office

Provincial Hospital —* Provincial Health Office
LGU Owned Hospital —-* City/ Municipality Health Office

rT i Da ge .
 NOTE:
For Private Hospital, ensure that plan is disseminated to all staff
and is readily available in case hospital is invited for
collaboration/ partnership during emergencies and response
operations in their respective areas

Sas
‘ TRANSLATING AND INTEGRATING
THE PLAN

DOH Hos ora

gg
arty
Bab

. Submit DRRM-H Plan to Regional Office to harmonize

strategies/activities and present resources for partnership.
. Incorporate activities identified in the DRRM-H Plan to
Hospital Work and Financial Plan/ Operational Plan /
Annual Procurement Plan to ensure funding allocation.
Lou
BPM
Mosolals Present DRRM-H Plan to respective Administrative Health
DT EL Bab
amy oe yung ang
Low

Office, stakeholders and networks in order to be included in

the system for referral or responding hospital
Ensure that activities identified in the Prevention Mitigation
and Preparedness Plan are integrated to LIPH to ensure
funding allocation.
ryiNgres yd iosmlicls Ensure that resources and funds are available upon
implementation of the plan

SPECIAL NOTE:
For private institution, you may collaborate with the existing
network initiated by the LGU.

49|P a ge
 IMPLEMENTING THE PLAN
1. Orient the LCEs and other stakeholders on the final and approved plans
2. Ensure that (e.g., technical assistance, budget augmentation, human
resources
resources, logistics) are available upon implementation.
3. Utilize appropriate resources per type of activity.
4. Conduct activities based on timeline or as scheduled.
5. Evaluate appropriateness of the response plan and consider contingency
measures as necessary.
6. Communicate to the stakeholders and decision-makers the results of the
implementation.

6 MONITORING AND EVALUATING

THE PLAN
Upon the approval of the DRRM-H Plan, the Chairperson of the Planning Committee shall
lead the annual review and updating of the plan. The plan shall be reviewed annually
and updated as necessary, especially when a major event/disaster affects the hospital
to determine possible implementation challenges.

1, Results-oased monitoring and evaluation shall be used in ensuring that

implementation of activities pertaining to prevention and mitigation plan as well
as preparedness plan is
on time. Monitor and evaluate to determine if
the desired
indicator used per activity is achieved. Conduct monitoring quarterly and
evaluate implementation annually.
Progress including status of DRRM-H institutionalization using Annex 4 shall be
reported to the uplines annually.

Post incident evaluation for every incident/event to ensure the appropriateness of

SOPs shall be conducted. The results of these evaluations shall be documented
and presented for consideration to guide the updating of Response Plan, and
Rehabilitation and Recovery Plan

Likewise, the Response Plan and Rehabilitation and Recovery Plan should be
tested annually through drills and exercises to ensure functionality, acceptability

.
BOTP 3 ge
 and feasibility of SOPs. Revise accordingly for major and minor changes if any.
5. Allaccomplishment reports, post incident evaluation (PIE) results as well as
documentation of lessons learned from an incident shall be compiled, reviewed,
and processed as basis for the updating of the DRRM-H Plan.

51|Page
52|Page
ANNEX 1: Sample Gantt Chart for DRRM-H Planning Activity

Consultative Php
Feb 13-16 Dr. X
Meeting 1
ee xX
PRP
Kil Feb 28 Ms. ¥
XXX

Consultative
Meeting 2
Mar
5 Php
XXX
Dr. X

Mar 23-25 Php

|
Workshop 1

XXX
Mr. Z

.
Writeshop
Mar 31- Php Core
Apr 2 XXX Group
male)
Presentation
.
Apr 10 Dr. X
XXX

Php Core
Writeshop 2
.
Apr 20
xX Group

TOTAL Php
XXX

oe

|
53
Page
 ANNEX 2. STRATEGIC TOOL FOR ASSESSING RISK (STAR)

The Strategic Tool for Assessing Risk (STAR) an evidence-based approach to risk is

assessment so that processes and outputs are comparable, reproducible and defensible.
An excel file is provided wherein data on hazard-based scenario will be inputted to
calculate an associated level of risk. The STAR approach follows the following key
principles:

a. Implementation of a risk management cycle, focusing on assessment and

proactive management of high and very high risks, rather than a reactive
approach to
events as they occur.
b. All-hazards approach, developing, strengthening and using elements and systems
that are common to the management of all hazard types.
c. Multi-sectoral, recognizing that the various government agencies, private sector
entities and civil society have a role to play risk management. in
d. Time-based, basing the assessment on a snapshot of existing capacities and
information.

The scope of includes all-thazards with the potential to cause emergencies and
STAR
disasters. The STAR is used prior to the commencement of DRRM-H planning. The
methodology presented is
based on existing guidance on risk assessment from the World
Health Organization (WHO) and the Inter-Agency Standing Committee (IASC). It
proposes an all hazards approach, thereby integrating emergency planning for all
natural and human-induced hazards.
STAR Input Table:
Hazard andl Exposure Likelihood bey, Vuleraily and Coping Capac

iil a
Confdene

' ig Rist
illu shld slolvlo
hazard Heath Consequences Scale Exposure Frequency Likelihood Seventy eletel

mei
1 2 3 4
5 OB 6 7 8
9 10 7
11 12 | 13

co]

a]

em

ari

sa]

eel

sap

ea] Pag S
ve
 How to use the STAR Matrix:

Column 1: Hazard

List all existing or emerging hazards with potential cause to public health emergency
vertically. Identify Hazards based on the following:

a) Geological (earthquake, volcanic activity, landslides, liquefaction, Tsunamis)

b) Hydro meteorological (typhoons, storm surge, drought, flooding)
c) Biological (Emerging and Re-emerging Dis. , FWBD)
d) Human-Induced ( Armed Conflict, Terrorism, Poisoning, technological)

For the next steps, address each hazard, one at a time, horizontally across each
variable until you obtain the risk level for each hazard.
Column 2: Health Consequences

For eachidentified hazard, identify possible negative health consequences and how
itmay affect primary services of the public health program and facility or the hospital
as receiving and as responding facility.

For example, the hazard identified was Flood, the

risks may include:
Immediate Consequences: Drowning, injuries, hypothermia, environmental hazards,
trauma
Secondary Consequences: water borne diseases, vector borne diseases, mental
illness, extended disruption to health services, Death
As receiving hospital: Damage to hospital equipment, shortage of manpower due
to flooded roads
As responding: Surge capacity

Summarize the identified risk either in bullet form or paragraph form.

Column 3: Scale

Describe the most likely or worst based scenario that would require the activation of
Incident Command System, of the institution e.g. Hospital Incident Command System
(HICS) . Identify areas that are likely to be affected by the health consequences

Column 4: Exposure
Estimate the number of
people likely to be exposed to the hazard considering the
number of people capable of developing disease if the hazard will continue for a
longer period of time
Colurnn 5: Frequency

For each hazard define whether the hazard frequency is:

e Perennial — regular or seasonal events during the year.
e Recurrent — events occurring every 1-2 years.
e Frequent — events occurring every 2-5 years.
e Rare - events occurring every 5-10 years.
e Random - unpredictable events for which the frequency cannot be
determined

Column 6: Seasonality

For each hazard, and as appropriate, identify the months of the year during which
the hazard is most likely to occur. For instance, for a hazard that may occur every
year between March and July with a peak every May, this would be filled in as:

the occurrence of the identified hazard is unpredictable such as earthquake or

If

volcanic eruption, do not fill the seasonality column.

Column 7: likelihood

In answering likelihood, take into account the historical information on the

the

hazard, the recent trends, the frequency and the seasonality of each hazard to
define the likelihood the hazard will occur in the next 12 months aft the scale
3.
|

defined in Column
Assign the score from 1
to 5 as follows:
— 1: Very unlikely
— 2: Unlikely
— 3: Likely
— 4: Very Likely
— 5: Almost certain

Column 8: Severity
When conducting severity assessment for biological hazards of an infectious nature,
use the algorithm below to determine the severity:

ee Pa 3 6
 Is the disease serious?
morbidity, mortality)

Can it affect a significant

number of people?

is it easily spread from human Isit easily spread from human}

to human?

Are thereatreatment treatment

Are there a ‘|

Arethereatreatment ||

Are there a treatment

andforprevention and/or prevention and / or prevention
||

{|}

and/orprevention [}

in the country?| in the country?}

SIS
measures [measures [measures in the country ?} [measures in the country?}

Existing / potential /
Existing potential Existing/ potential /
Existing potential
resistance or risky
behavior by pop.?
resistance or risky
behavior by pop. ?
resistance or risky
behavior by pop.?
resistance orrisky
behavior by pop.?

Very low severity Low severity | Very high severity

|

When conducting the severity assessment for geological, hydro meteorological,

technological and societal hazards, use the algorithm below to determine the
severity:

—§7|Page
 Will the prolonged incident/event disrupt
public health or hospital services?

Will the event increase Will the event increase

morbidity and mortality morbidity and mortality
cases? cases?

Yes
<> Yes

Does the public heaith Does the public health Does the public health Does the
public health
institution have the institution have the institution have the institution have the

capacity to response? / capacity to response? / capacity to response? / capacity to response? /

the hospital have the
Does Doesthe hospital have the Doesthe hospital have the the hospital have the
Does

capacity for surge? capacity for surge? capacity for surge? capacity for surge?

Yes
Yes
Yes an >

high epaha
ia
cs
Very low severity low severity Moderate High
severity
.
Column 9 and 10: Vulnerability and Coping capacities

Help |
input table Vulnerabilities and capacities Risks matrix |
Risks Summary |

58 |
Pag e
 From the same excel file, accomplish vulnerabilities and capacities worksheet to
automatically fill out column 9 and 10 of STAR.

Vulnerability

Vulnerability refers to the characteristics and circumstances of

the hospital, system
or asset that make
it
susceptible to the damaging effects of a hazard. When rating
the vulnerability of the facility to a given hazard, the hospital should consider the
following parameters. Below is an example on vulnerability, particularly for the
hospital. You can refer to page 15 for sample public health vulnerabilities.

ede em alates ite

Probability of Soread of Disease
External Hospital Vulnerabilities
Surge Capacity

Probability of Disease or Injury Social Determinants of Health

Probability of breakdown in Security Lifelines Available

Breakdown in Essential Services Presence of Vulnerable Groups

Displacement of Patients
Structural and Non-structural Components
of Hospital
Disruption of Hospital operations
Manpower
Systems / Protocols in Place

Using information on the parameters above, use the following scale for rating
existing vulnerabilities to the hazard and consequences:

- 1: Very high
- 2:High
- 3:Partial assessment
- 4:Low
- 5: Very low

Coping Capacity

Coping capacity measures the means by which the institution use available
resources and abilities to face adverse consequences. The coping capacity
associated with a hazard will be determined by the following:

59|Page
 e Can the institution detect,
identify, and respond to the hazard and its
health
consequences at
the given scale?
Can the hospital, specifically manage surge of patients?
e Do you have existing policies, plans or protocols that will be used during the
event?
Do you have trained and equipped response team?
e Do you have logistics and financial resources to respond to the event/ or
affected area? (logistic and security challenges?)
« Do you have existing networks within your area that can augment your needs?
(logistics, transportation, etc.)
e What is the
response capacity / resilience level in the affected area (regional
level and within the community)
e Do you implement Safe from Disaster Program for Hospitals; for Public Health-
Public Health and Medical, Mental Health, Nutrition, WASH)

Using information on the parameters above, use the following scale for rating
coping capacity available for the hazard and consequences identified:
1: Very high
2: High
3: Partial assessment
4: Low
5: Very low

Column 11: Impact

The model will determine impact automatically using the following scale based on a
aggregation of the scores given for severity, vulnerability and coping capacity. This
score is then translated to a scale of 1
-5 according to the Impact matrix below.
1: Negligible
2: Minor
3: Moderate
4: Severe
5: Critical

Column 12: Confidence Level

The column for confidence level defines the quality of data entered in the matrix. By
scoring the confidence level for each hazard, users can identify where further data
gathering is needed so that the confidence level can be improved at the next STAR
assessment. Rate the confidence level as follows:
> Good (good quality evidence, multiple reliable sources, verified, expert

6
opinion concurs, experience of previous similar incidents)

\Pag s
 > Satisfactory (adequate quality evidence; reliable source(s); assumptions
made on analogy; and agreement between experts)
> Unsatisfactory (little poor quality evidence, uncertainty/ conflicting views
amongst experts, no experience with previous similar incidents)
Column 13: Risk Level

Based on the inputs per hazard, the tool will automatically compute for the risk of
the identified hazard. This will clearly illustrate the priority hazards needing
preparedness and risk reduction activities and where priority action should be
directed.

61|Page
ANNEX 3: Possible Sources of Data

Type of Data Specific Data Possible Sources

e Topography
Geographic e Geo-hazard mapping (i.e., Environmental
areas prone to erosions and Management
flooding, presence of fault Bureau of
lines and volcanoes} Depariment of
Location of communities and Environment and
health facilities vis-a-vis this Natural Resources
map Provincial or City
Risk or hazards ({i.e., Disaster Risk
occurrence of typhoons, Reduction and
landslides, storm surge) Management
Disasters that have occurred Offices
inthe past 5 years to include DRRM or DRRM-H
the lessons learned and the Plans of the
gaps in response (narrative) component
cities/municipalities
and barangays
Population
Demographic Population density Provincial or city
Number of households planning office
Number of barangays Philippine Statistical
Death rate Authority (PHA)
Vulnerable populations Depariment of
needing more health care Interior and Local
such as youth, Indigenous Government (DILG)
Peoples, women and Department of
children indifficult situations,
those living in GIDAs, Urban
Social Welfare and
Development
Poor, Persons with Disability (DSWD)
(PWD), and Senior Citizens in National Economic
specific geographical and Development
locations Authority (NEDA)
Special government
offices for
Indigenous Peoples

Health situation Three- to five-year year Provincial, city,

reports on leading causes of health, planning
morbidities and mortalities and development
Infant mortality rate offices
Maternal mortality rate DILG
Nutritional status/ Malnutrition Consolidated health
rate reports from the

~B9 i Pag 6
 Vaccination coverage Community Health
Indicators for basic health Teams, or
services and preventive Development
health programs Management
Environmental sanitation, Officers
sources and status of potable Community-based
water Management
Health human resource Information Systems
(number and capacity for where available
health) Other special studies
Health facilities from development
Hospitals, lying-in, partners
laboratories, blood banks
Hospitals with special areas
and services
Resources and Inventory of: DRRM Plans
Possible Partners resource
assets
networks
organizations that may be -

tapped in times of health

emergencies and disasters.

Socio-Economic Major economic activities Provincial or city

People’s sources of income planning office
Poverty incidence and areas
of concentration
Education
Peace and order
Source({s) of food such as
agricultural or fishing industry
Support facilities such as
transportation,
communication, access to
information

63|Page
ANNEX 4. CRITERIA FOR DRRM-H INSTITUTIONALIZATION
of O L LI C

CO) enemy

==
pdated Disseminated reste
the annually
DRRM-H organization
Plan

O O C]

Organized to
Health provide initial Trained on BLS
Emergency basic services
Response
Team

Available Health
reese
.

Health Emergency
Emergency Medicines”
Commodities

C] C] C]

Functional Command and

Communication Coordination
Emergency Control
Operations
Center
*Health Emergency Medicine may pertain to anti-infectives, analgesics, antipyretics, fluid/electrolytes, respiratory drugs,
dietary/nutritional products essential for emergencies/disasters (e.g. cotrimoxazole, amoxiccilin, mefenamic acid,
paracetamol, ORESOL, lagundi, vitamin A and skin ointment}

64|Page
ANNEX 5: RESPONSE MANAGEMENT FRAMEWORK

Heal Emergency and Disaster tespamse Management Framework

HEALTH EMERGENCY AND DISASTER RESPONSE MANAGEMENT

A well-organized
and effective
response

Reference: Manual of Operations on Health Emergency and Disaster Response

Management, Health Emergency Management Bureau, 2015

65|Page
 a
ANNEX 6. RESPONSE MANAGEMENT PER PHASE FOR PUBLIC HEALTH
In principle, the following essential elements for each component of response management
the timelines indicated. However, considerations must be made depending on the type of
follow
emergencies and disasters affecting the institution — as indicated by the broken arrow lines. Some
overlaps and continuation of service may occur following emergencies and disasters produced
by multiple hazards.

TTT
|

MANAGEMENT OF EVENT
©: EWARS p |----------+------------ >
° Alert Activation p -------- eee eee een eee »
* ICS
panne nen ene eee eee >
© Coordination —»>
"

©
-
Mass casualty incident

/Evacuation
>

i
‘e@
Community >.
Center
e Surge. Hospital >
Capacity.
>

eee
e Package of Services |

©
Management of the
Dead
e———>._ ---------------------- 6 eee >

e =Teams for special |

events

ce ne
© Teams for
emergency /disaster
:

.
e Teams for foreign
assignment
SN
> | frre rc >
@
Management of
volunteers

66 Da 9 é
~
=
—
:
¢

e¢

©
MANAGEMENT

Rea
e:..

¢
management
§©6Knowledge

management
Documentation
OF
Data and information
INFORMATION SYSTEM

OF NON-HUMAN RESOURCES

Logistics management

Financial. management

Lifelines
> [ -nn-2 nnn nnnnnnnn

it
eee
>
_©

>

iieteneneiaieiaieneheiene

67|Page
>
ANNEX 7: SAMPLE EMERGENCY RESPONSE FLOW FOR LOCAL
GOVERNMENT UNIT

ee cay
Response according to alert level
aoe
/
: implement
Se ups
Response plan

ae
we

Mee PME cee,

Uae
a

Pelee cries
LT

<

ia
no n —

Pe ed
ft
fica all ahei
7
re

Dy, OO oa ea TEV ag issued

:

fi : |

ee
Activate Code Alert System

JS yes AR
e Ble seer
procedures:

Note: Lifted from Regional Program Implementation Review, 2018

68|Page
ANNEX 8: SAMPLE RECOVERY AND REHABILITATION PLAN TEMPLATE

Activity ]

Activity 2

Activity I

Activity 2

Activity 1

Activity 2

Activity

Pees
1

Activity 2

CT
| Activity 1 _
Strategy

se
Activity 2
leprae cues om lichuroenurl
Pelee
Activity 1
une
Activity 2

Strategy |
Activity 2

69/Page
ANNEX ?: PROPOSED OUTLINE OF THE PUBLIC HEALTH DRRM-H PLAN

l. Cover Page
ll. ‘Title Page

- Signatures of the Head of Institution and DRRM-H Manager/Focal Person

and the DRRMO
(for LGUs}
lll. Message from the Head of the
institution: CHD Director/Hospital Medical Center
Chief or Chief of Hospital/Local Chief Executive (1 page)
- The head of
institution shall sign a letter of approval in support of the DRRM-
H Plan.
IV. Vision Mission Goals of the Health Sector on Emergencies and Disasters (1 page)
- Thissection highlights the three DRRM-H Plan goals, namely: to guarantee
uninterrupted health service delivery during emergencies and disasters, to
avert preventable morbidities, mortalities and other health effects
secondary to emergencies and disasters, and to ensure that no outbreaks
secondary to emergencies and disasters occur.
V. Background (2-5 pages)
- This chapter includes the City/Municipality’s geographic description,
demographic profile, health statistics, socio-economic situation, and
information and lessons learned from previous disasters. An inventory of
resources and possible partners, and information should also be included.
The gathered data must be evidence-based and presented in narrative,
tabular, and/or graphical form.
A. Geographic Description
1. Topography
2. Geo-hazard mapping {i.e., areas prone to erosions and flooding, presence
of fault lines and volcanoes)
3. Location of communities and health facilities vis-a-vis this map
4. Risks or hazards (i.e., occurrence of typhoons, storm surge, disease
outbreaks)
5. Disasters that have occurred with lessons from previous disasters and gaps
in response

B. Demographic Profile
1. Population
Wh
Population density
Number of households
Number of barangays
aank
Death rate
Vulnerable populations

70 Pas -
 C. Health Statistics
1. Three- to five-year year reports on leading causes of morbidities and
mortalities
Infant mortality rate
AWN
Maternal mortality rate
Nutritional status/ Malnutrition rate
Vaccination coverage
Indicators for basic health services and preventive health programs
WONAM
Environmental sanitation, sources and status of potable water
Health human resource (number and capacity for health)
Health facilities
a) Hospitals, lying-in, laboratories, blood banks
b) Hospitals with special areas and services
D. Soc io-economic Situation
> Major economic activities
People’s sources of income
Poverty incidence and areas of concentration
Education
Peace and order
N&aARON

Source(s) of food such as agricultural or fishing industry

Support facilities such as transportation, communication, access to
information
Vi. Planning Committee Structure and Functions
Vil. Hazard, Vulnerability, and Risk Assessment
Vill. Plan per Thematic Area
The content of this chapter puts focus on the four (4) plans per thematic area with long-
term goals, strategies, objectives, and outcomes, considering essential service health
packages
_ A. Prevention and Mitigation Plan

B.
Preparedness Plan

—71|Page
 C. Response Plan

Management of the Event/Incident

Management of Information System

Management of Service Providers

Management of Non-human Resources

Management of the Victims

D. Recovery and Rehabilitation Plan

IX. Monitoring and Evaluation Plan

chapter contains the systematic monitoring and evaluation plan that shall
This
be based on the indicators, targets, and activities in the four thematic areas.
X. Annexes
The annexes include supporting documents for the DRRM-H Plan
ANNEX 10: POLICIES AND GUIDELINES RELATED TO DRRM-H PLANNING

1. Administrative Order (AO) 168 s. 2004 dated September 9, 2004 entitled “National
Policy on Health Emergencies and Disasters”. The AO indicates Policy Statements
including but not limited to:
a. ItemA. “Organizational Structure No. 1” - Allhealth facilities should have an
Emergency Preparedness and Response Plan (now DRRM-H Plan) and a
Health Emergency Management Office/ Unit/ Program.
b. Item C. “Support Systems No. 7” - Hospital Emergency Preparedness and
Response Plan, Code Alert and Hospital Emergency Incident Command
System (HEICS) should be a requirement in hospital licensing
c. Item D. “Program Development No. 1” - All health facilities should develop
an Emergency Preparedness and Response Plan which should be holistic,
to include amongst others the following: Emergency Planning Committee,
Hazard and Vulnerability Assessment, Identification of Resources and Gaps,
Response to respective hazards, Organizational and Implementing
Structure; Training and Drills; Information Dissemination and Advocacy;
Networking and coordination; Research and Development. This should be
disseminated and tested for the functionality of the plan and its inert-
operability with other health facilities and institutions in their respective area.

2. Administrative Order 2013-0014 dated March 21, 2013 entitled “Policies and
Guidelines on Hospitals Safe from Disaster”. Hospital Safe from Disasters Policies
and General Guidelines as well as Roles and Responsibilities include:
a. Item VI. G. POLICIES AND GENERAL GUIDELINES indicates “All Hospitals and
other healthcare facilities shall develop and regularly update, disseminate,
implement and test their Hospital Emergency Preparedness, Response and
Recovery Plans (HEPRRP} to include among others, their changing hazards
and vulnerabilities.”
b. Item VII.A.4. ROLES AND RESPONSIBILITIES OF HOSPITALS AND OTHER HEALTH
CARE FACILITIES indicates that “Hospitals/Healthcare Facilities shall:
e (Item c} Conduct yearly self-assessment using the Hospitals Safe from Disaster
Tools and Indicators
e (Item dd} Facilitate the improvement of structural, non-structural and
functional hospital components as suggested by assessment findings
e (Item f} Institutionalize Hospital safe from Disasters program in relevant
hospital plans such as building plan and hospital emergency preparedness,
response and recovery plans
e (Itern g) Ensure revision, updating and testing of HEPRRP.

73 | Pag S
Administrative Order 2012-0012 dated July 18, 2012 entitled “Rules and
Regulations Governing the New Classification of Hospitals and Other Health
Facilities in the Philippines”. Among the Criteria included in the Assessment Tool for
Licensing a Hospital indicated ANNEX K — 2 of AO No. 2012-0012 are as follows:

a. Criteria No.43- Presence of a management plan, policies and procedures

addressing safety with its corresponding indicator No.4. “Presence of
Emergency and Disaster Preparedness”
b. Criteria No.70- Emergency Preparedness Response and Recovery Plan with
corresponding indicator “Proof of implementation of the plan”. Result of
its
Self-Assessment and how gaps were resolved must be evident.

74|Page
ANNEX 11: PROPOSED OUTLINE OF THE HOSPITAL DRRM-H PLAN

Cover Page

Title Page
contains the names and signature of those who prepared and reviewed.
This
Thisshould also be signed by the Hospital Director/ Head of institution with
corresponding date when approved.

Message
Contains message from the Hospital Director/Head of Institution)

Vision, Mission, Goal including Goals and Objective of Hospital DRRM-H

Thissection may highlight the goals of the DRRM-H, namely: {1) to guarantee
uninterrupted health service delivery during emergencies and disasters, (2) to
avert preventable morbidities, mortalities and other health effects secondary
to emergencies and disasters, and (3) to ensure that no outbreaks secondary
to emergencies and disasters occur.

Background
This section may include brief history and milestones on DRRM-H
institutionalization

Vi. General Information about the Hospital

This contains summary in narrative and tabular form of the highlights

generated from Form of the Hospital Safety Index Tool. Details of the Form
1

1: General Information about the Hospital should be appended as annex of

the Plan

Vil. scope and Context of the Hospital DRRM-H Plan

Vill. Planning Committee members including roles and responsibilities

Hazard Vulnerability and Risk Assessment

a. Hazard maps (internal / external)
b. Table 14: Hospital Vulnerability Assessment
c. Table 15: Summary of Risk Assessment for Hospitals

75|Page
X. Four Thematic Area Plans
a. Prevention and Mitigation Plan
Narrative description and scope of the plan

b. Preparedness Plan
Narrative description and scope of the plan

Source
|

Required

Cc. Response Plan

Narrative description and scope of the plan

of Victims

76|Page
 d. Recovery and Rehabilitation Plan
Narrative description and scope of the plan

Xl. Annexes:
May include the following but not limited to:
Qa. Details on the General Information of the Hospital using Form
1

8 Hospital issuances related to DRRM-H

Hospital Protocols and Systems
a0
Hospital Emergency Incident Command System (HEICS) structure, members
and job action sheet
o Directory of contact persons and networks in case of emergency
> Contingency Plan
Public Service Continuity Pian
sa
Evacuation Area/ Surge Capacity Identified Areas
Reporting and Documentation Forms

77|Page
ANNEX 12: Sample External Hazard Map
Sample Hazard
Hospital A in Makati City
Map
of

LEGEND

* Hospit
GeoRygic
~~ West Valley Fault
‘Landslide

round Liquefaction
~.
Ground Shaking
Indensity Vu
-s
vensity Vil

Hydrometeorologicat
~ 200 Year Flood
Cycle (Depth in Meters)
GB 0:1
Taguig City
10 0.5 (Ankle Desoto Knee Deeo)

BB 0.51 10 1.0 Kree Deep to Waist Deseo)

a 1.07 to 2.0 (Waist Deep io Too of Head Deep)

a 2.07 10 3.0 (Top of Head Dees io T-storey High)

a 3.01 to 4.0 (1-storey High to 1.5-siorey High)

4.07 and above (1.5 storey high and above}

ea Level Rise
coe entetin vues
wos - doe

ues . coe ene

78|Page
ANNEX 13. RESPONSE MANAGEMENT PER PHASE FOR HOSPITAL

In principle, the following essential elernents for each component of response management
follow the timelines indicated. However, considerations must be made depending on the
type of
emergencies and disasters affecting institution as indicated by the broken arrow lines. Some
the —

overlaps and continuation of service may occur following emergencies and disasters produced
by multiple hazards.

a. Pre-lmpact refers to the period immediately before the onset of the event. This is
- This

different from the Preparedness Phase and applicable for hazards with warning (e.g.
Typhoon, volcanic eruption, biological emergencies}.
b. Impact - Ils the occurrence of the Incident. This phase addresses the hospital response for
emergencies and disasters to minimize the health impacts.
c. Post Impact- This phase involves continuing the operations from “during-disaster” phase
and includes activities that lead to demobilization of resources, This may overlap with
recovery phase which addresses the process of returning affected communities to its
normal level of functioning or “building back better" post emergency.

MANAGEMENT OF EVENT/INCIDENT
1. Early Warning Alert’
Response System
(EWARS)
2. Hospital Emergency
Incident Command
System (HEICS}
3.. Operation Center
4, Coordination
Mechanism

ly,
Mass Casualty Incident
(Pre-hospital. care)
2. Mass Casualty Incident
(Hospital care)
3. Surge Hospital
Capacity
4. Package of Services >

MANAGEMENT OF SERVICE PROVIDERS

1. Deployment of teams
for special events
2. Deployment of teams
for emergency/
i
..
disaster

3. Deployment of teams
for foreign assignment
4. Management of
Volunteers

MANAGEMENT OF INFORMATION SYSTEM

Data and information

management
2. Knowledge
management v
Documentation

1. Logistics management >

2. Financial management

3... Availability and

Accessibility to Lifeline
facilities

80[Page
—
REFERENCES

Department of Health. Administrative Order No. 2017-007, Guidelines in the provision of

the Essential Health Service Packages in Emergencies and Disasters. Manila, Philippines.

Department of Health. (2008). Guidelines for Health Emergency Management: Centers

for Health Development (2"9 ed.). Manila, Philippines.

Department of Health. (December 2016). Philippine Indicators: Hospital Safety Index Tool.
Manila, Philippines

Department of Health. (March 2012). Pocket Emergency Tool (4 ed.). Manila, Philippines.
Department of Health. (2015). Manual of Operations on Health Emergency and Disaster
Response Management. Manila, Philippines.
Department of the Interior and Local Government. (2015). Local Government Units
Disaster Preparedness Manual: Checklist of Minimum Critical Preparations for Mayors.
Manila, Philippines.

National Disaster Risk Reduction and Management Council. (December 2011). National
Disaster Risk Reduction and Management Plan, 2011 to 2028. Manila, Philippines.

National Disaster Risk Reduction and Management Council. (June 2014). National
Disaster Response Plan for Hydro-Meteorological Disaster. Manila, Philippines.

United Nations Children’s Fund (UNICEF). (May 2015). UNICEF's Evidence Based Planning
for Resilient Health Systems (rEBaP): An Effective Approach Towards Health Systems
Strengthening Following Typhoon Haiyan in the Philippines. Manila, Philippines.
United Nations International Strategy for Disaster Reduction (UNISDR). (May 2009). UNISDR
Terminology on Disaster Risk Reduction. Geneva, Switzerland

United Nations International Strategy for Disaster Reduction (UNISDR). (02 February 2017).
In Terminology on DRR. Retrieved from: from:
httos://www.unisdr.org/we/inform/terminology
United Nations Office for Disaster Risk Reduction (UNISDR). (n.d.}. Sendai Framework for
Disaster Risk Reduction 2015-2030. Geneva, Switzerland

World Health Organization. (2015). Hospital Safe Index: Guide for Evaluators. Geneva,
Switzerland

81|Page
DISASTER RISK RENVOTION And
MANAGEMENT FOR HEALTH WHS SHOULD BE INVOLVED IN DRRM H PLANNING! WHEN 1S ORRM H PLANNING DONE?

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priorities for the year > Local Dev't Plans Administrative Office