Posted in Issue 110 - October 2008 Perspective
Following the earthquake measuring 8 degrees, on 12 May 2008 in the Province of Sichuan, the National Development and Reform Commission of the People’s Republic of China, through its Ministry of Health, requested technical cooperation from the World Health Organization (WHO) for the provision of information on the experiences of other countries and regions related to the reconstruction of health services and feasible technical recommendations which would help to ensure the recovery of functioning medical services and the reconstruction of health facilities destroyed by the earthquake.
The earthquake killed 69,170 people; left 17,426 missing, 374,159 wounded and destroyed 50% of the health facilities in the Province of Sichuan. According to official data, in 2005 the Province benefited from 23,834 health facilities. The capacity of health personnel was also affected. At least 4,000 of its members were victims of the earthquake and were either killed or wounded, a situation which required the remaining health personnel to work to the maximum to care for the wounded. The quick action of the authorities made it possible to mobilize 94,000 health professionals for response and the army set up 24 field hospitals.
Infrastructure for epidemiological surveillance, which had been modernized and equipped with computerized systems as a result of the epidemic of the Severe Acute Respiratory Syndrome, was seriously damaged and during the emergency the information network through internet had to be replaced by the use of cellular phones, a very useful alternative for notification of the health situation.
At the request of the National Commission of the Council of State, the WHO organized an inter-disciplinary mission which included the participation of experts from PAHO and which was joined by the World Bank. The mission visited China between 11 and 21 June and the agenda included a short visit to the disaster-affected zone.
The mission made a series of specific recommendations regarding public health, health services, infrastructure and reform of the health system. Others, of a more general nature, are related to the immediate needs during the transition period between the emergency and reconstruction. A summary of the suggestions is as follows:
- To adopt the necessary measures to extend free health care for the affected population for over three months, offering them both preventive and curative health services (especially for those in rural areas), as well as psychological assistance services and rehabilitation, including community-based rehabilitation. (The health system currently in force requires the user to co-finance services received).
- To take into account the importance of providing basic equipment for facilities which are in the recovery stage of their functioning, as well as means of transport for patients from rural areas, particularly in remote places.
- To consider the review and reform of the health system in force in order to ensure that the population, particularly from rural areas, has improved accessibility and health services coverage, both physical and financial. Prioritize primary health care.
- To ensure, with public financing, essential programmes for public health and strengthening of surveillance. To make the necessary efforts to offer universal coverage of basic health services.
- Given the region’s vulnerability to earthquakes, carry out a careful assessment of the health facilities in the zone affected by the earthquake and to begin planning activities on the use of land and micro-zonification before undertaking reconstruction of facilities.
- Take into consideration in the construction of new health facilities both structural concepts relating to the architectural design, as well as isolation and energy absorption techniques so that the structures can remain operational in the event of a high magnitude disaster.
- Strengthen emergency preparedness programmes, the training of health personnel and include the concepts and the putting into practice of PAHO’s “Safe Hospital” initiative.
Notwithstanding these points, it should be stressed that the government and its institutions as well as the general population in China showed significant capacity in organization, as well as in the mobilization of human resources, equipment, materials and so forth. This was complemented by solidarity and the national and international response including that provided by the WHO.
The health authorities are determined to carry out a process of careful planning to improve their health system so that it provides improved coverage for the population, taking into account efficiency and quality. With regard to reconstruction of health facilities, there is improved will to apply construction standards based on international experiences. The authorities believe that the reconstruction process will take three years.
* Prepared by Dr. José Luis Zeballos who led the WHO team in the assessment mission.