Title: Perceptions and experiences of IDPs on aid effectiveness and response with special focus on public h
1Perceptions and experiences of IDPs on aid
effectiveness and responsewith special focus
on public health aspects of the humanitarian
response
2Outline 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
3BMJ
- 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
4Encouraging 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
5Research 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)
6Main 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
7This 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.
8Context
Blue arrows 1st and 2nd Wave of population
displacement Red arrows 3rd Wave of population
displacement
9Methodology
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
11Progress 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
12IDP camps as of 14th May 2007 according to UNOCHA
release.
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16Child Participatory Methods
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24Preliminary 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
25IDP Satisfaction survey FOOD PROVISION
60.5
68.1
26IDP 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
27Childrens perspectives of food aid
28IDP Satisfaction survey HEALTH CARE Services
75.4
51.3
29IDP 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
31Childrens perspectives of Health care services
32Focus 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
34Emerging 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
35Strengthening 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.
36Component IV
- Component IV
- Using CBVs to strengten system
Batti District health promotion network
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39Contact Details
- Suren srajendira_at_yahoo.com
- Kolitha kolwick_at_hotmail.com
-