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Perceptions and experiences of IDPs on aid effectiveness and response with special focus on public h

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Michelle Brown (MERLIN), Dr Samarage (Ministry of Health), Prof. N.Sivarajah ... Volunteers are trained by the MERLIN. NGO/UN co-ordination at camp level ... – PowerPoint PPT presentation

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Title: Perceptions and experiences of IDPs on aid effectiveness and response with special focus on public h


1
Perceptions and experiences of IDPs on aid
effectiveness and responsewith special focus
on public health aspects of the humanitarian
response
2
Outline of presentation
  • Why do this research? What are we hoping to
    achieve?
  • Research questions
  • Research context
  • Methodology
  • Limitations of research
  • Preliminary findings
  • Implications of research
  • Support we seek

3
BMJ
  • There are often few data regarding how potential
    recipients value or prioritize the aid response.
  • Clearer conceptualization of what affected
    populations seek from the international
    humanitarian response to their needs would be
    valuable.
  • Encouraging evidence based practice

4
Encouraging evidence based practice
  • we have had a war for more than 25 years, yet we
    have very few public health studies that have
    attempted to seek the perspectives of IDPs
    following humanitarian relief and in particular
    public health interventions
  • - Prof Lalitha Mendis
  • Current Advisor on Medical Education
  • Former Dean Faculty Medicine
  • Director Post-Graduate Institute of Medicine
    Colombo

5
Research Team
  • Co-ordinating researchers
  • Kolitha Wickramage (Community Health
    Co-ordinator, MERLIN Sri Lanka and
    Conjoint-researcher, University of NSW,
    Australia)
  • R. Surentrakumar (Lecturer, Medical Faculty,
    Jaffna University)
  • K.Wickraramasinghe (Co-ordinator of Disaster
    Management unit, Medical Faculty, University of
    Colombo).
  • Research Advisors
  • Michelle Brown (MERLIN), Dr Samarage (Ministry of
    Health), Prof. N.Sivarajah (WHO), Prof A.Zwi and
    A.W.Bunde-Birouste (UNSW), Dr I.Karunathilake
    (Colombo Uni), Dr Henrikas (WHO, EHA), Kesavan
    (WHO Sri Lanka, National Consultant on Emergency
    Humanitarian Action)

6
Main Objectives of the Study
  • To explore IDP experiences and perceptions of the
    Humanitarian response, with a special focus on
    health risks, resources, access to and quality of
    health services and during their displacement
  • To explore the experiences and perceptions of
    humanitarian sector
  • To understand how the health sector responded to
    the public health needs of IDPs
  • To understand the major lessons learnt in the
    health sector response to those displaced in
    order to improve future intervention

7
This research will aim to
  • To Facilitate and document the perceptions of
    IDP in the humanitarian response in order to
    improve future service delivery and co-ordination
  • Providing new insights into voices of children
    and young people during displacement, and the
    actions they take in response to health risks in
    situations of conflict
  • Contribute to the broader field of health and
    conflict research in Sri Lanka and provide
    impetus for evidenced based public health
    research within unstable conflict affected
    contexts.

8
Context
Blue arrows 1st and 2nd Wave of population
displacement Red arrows 3rd Wave of population
displacement
9
Methodology
10
  • Mixed methodology using both qualitative and
    quantitative data methods were used
  • The data was then cross-checked and triangulated
    (via independent researchers)
  • SPSS used to analyse Quantitative data

11
Progress to date
May ?
  • STARTED study design and training of field
    researches in MAY
  • Data collection began in JUNE
  • 2 training sessions with research assistants on
    study methodology, design, ethics 2200 IDP
    questionnaires distributed to randomly selected
    camps in Batticaloa
  • 200 Camp manager/Camp volunteer health worker
    questionnaires distributed
  • 34 Focus Group Discussions (gender specific) with
    IDPs
  • 8 Child participatory research workshops across

12
IDP camps as of 14th May 2007 according to UNOCHA
release.
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Child Participatory Methods
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Preliminary Findings
  • 2200 respondents in IDP survey
  • This data only shows data from 500 respondents
  • On selected themes (due to time constraints)
  • Health node
  • Food node

25
IDP Satisfaction survey FOOD PROVISION
60.5
68.1
26
IDP Focus group discussion (Adults)
  • 32 Gender specific focus group discussions
  • Issued food should be balanced. It is also
    important to consider the special needs of people
    like infants, pregnant mothers and patients
  • Quantity is not enough. Most of the time
    vegetables are issued for cooking damaged or
    unusable. Out of 50 kg potatoes, only 15 kg
    potatoes are usable.
  • Food is not enough for 3 times per day. We ate
    enough fish.
  • We dont get enough rice. Also Special kind of
    food is not issued for patients and children.
  • Food is not cooked properly. I dont like social
    cooking.
  • Quantity is not enough. People who have money
    buy the food outside. Others cant.
  • They give one coconut per five days and one cup
    of sugar per a week. Most of the food items are
    not good enough to use. In this situation we need
    money to buy those outside.
  • When we were at home we bought or produced food
    items that are preferred by us or nutrition one.
    Here we are not consulted. They( government and
    NGOs) issue similar kind of food with poor
    quality.
  • We are not getting milk foods.

Food quality
Communal cooking
access/equity
27
Childrens perspectives of food aid
28
IDP Satisfaction survey HEALTH CARE Services
75.4
51.3
29
IDP Focus group discussion (Adults)
  • 32 Gender specific focus group discussions
  • Public health service provision at IDP camp
    level
  • Some people know the PHI but he doesnt interact
    well with people in the camp
  • PHM doesnt visit to camp. A few women know her.
  • A few people know the PHI and PHM
  • Some people know the PHI. PHM once came. There is
    no ANC Clinic
  • Immunization services are not regular
  • PHI never visited to this camp.
  • We know the PHM. She does weighing of children,
    family planning services and giving advices.

30
  • Curative care services
  • We dont have proper transport facilities to take
    them to hospital in night.
  • We cant go outside after 7 p.m.
  • We dont have medical facilities in our camp.
    When we get illness. We go to near by government
    hospital.
  • We have a Government hospital near by. But that
    doesnt open in night, also most of the time they
    asked us to by the drugs outside.
  • Earlier days mobile team visits once in a week.
    But now doctors dont visit to camp. We dont
    have money to go to hospital.
  • We get enough health facilities. Because of this
    we dont have much illnesses except one person
    with chickenpox
  • We have enough health facilities. Treatment is
    provided adequately.

protection
access and availability issues
31
Childrens perspectives of Health care services
32
Focus Group Discussion with Public Health Staff
across 5 DS Divisions
  • Site identification for latrine construction was
    an issue because various NGOs would directly
    start their constructions without obtaining
    permission from the PHIs
  • Supervision by health committee in the camps.
  • Volunteers inform Camp managers and they inform
    PHI
  • Food distribution- some times NGO distributes on
    their own with out taking proper advice e.g.
    Formula milk for breast feeding children
  • Regular activities were affected therefore may
    cause health vulnerability eg. Rabies
    vaccination, Food inspection, Health education
    program disrupted due to huge case load.
  • Chlorination done by NGOs, check 3 times per
    week, but if Hep they check daily
  • Volunteers inform Camp managers and they inform
    PHI
  • Volunteers are trained by the MERLIN

NGO/UN co-ordination at camp level
Effective use of NGO trained health volunteers
Innapropriate distribution
Regular activity affected
Poor capacity for water testing
33
  • In the initial stage one PHM was supervising up
    to 10 camps.
  • Clinics were held once a month
  • problems faced
  • Vaccination card were not available in some
    children
  • Not enough vaccine carriers (Cold boxes)
  • No adequate transport facilities
  • Some parent are not interested in giving the
    vaccines to their children (They have to go to
    collect rations in that time)
  • How did you ascertain the cold chain?
  • Cold chain was always maintained. They were able
    to manage with available vaccine carriers.
  • The coordination was satisfactory in initial
    stage. But towards the latter part it became
    unsatisfactory

34
Emerging Lessons
  • This research is in progress
  • Focus on public health action in crisis
  • Findings has implications on delivery of
    effective public health services
  • Key theme to emerge beneficiary participation
    can enhance effective public health service
    provision at camp level

35
Strengthening the Disease Surveillance system in
Batticaloa district
  • Medical Officer of Health
  • Case detection
  • Case investigation/confirmation
  • Sample collection/ Sample referral and
    confirmation
  • Outbreak response
  • Reporting
  • Vector control co-orindation
  • Co-ordination of outbreak response
  • Training of Public health staff in all aspects of
    outbreak response
  • Focal point for IDP health issues
  • Ministry of Health
  • Epidemiology unit issues out weekly
    surveillance reports
  • DPDHS office
  • Epidemiologist outbreak response and management
  • PHI
  • Case detection
  • Case investigation/ confirmation
  • Source tracing
  • Reporting
  • Sample collection
  • Isolation/containment
  • Outbreak response
  • Health promotion with IDP community
  • Water quality testing and WATSAN monitoring
  • Vector control measures (fogging, refuse
    collection)
  • SMHI

PHM Immunizations for children in IDP camps
ANC, issuing card AB if lost, ensuring Triposha
for weaning infants, CSB to pregnant and
lactating mums
Laboratory testing teaching hospital Batti (MLT)
  • Camp management focal point
  • Role in Source tracing
  • Reporting
  • Isolation/containment measures
  • WATSAN
  • Vector control support
  • Private clinics/labs
  • Role in specimen analysis during outbreaks
  • Improved Reporting/co-oridnation with DPDHS

Active surveillance
  • HV - Health volunteers/staff at Camp level
  • And
  • CBV -Community Based Volunteer
  • Health Promotion
  • Case detection (providing person, time and event
    info)
  • Source tracing
  • Maintaining simple weekly histogram charts
  • Environmental management/cleanup

Passive surveillance referral/notification of
suspect cases
District Hospital/Peripheral health centre
Internally Displaced person with disease
condition (infectious)
Mobile medical Clinics (Italian Red Cross, CAM)
visiting each camp once a week.
36
Component IV
  • Component IV
  • Using CBVs to strengten system

Batti District health promotion network
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Contact Details
  • Suren srajendira_at_yahoo.com
  • Kolitha kolwick_at_hotmail.com
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