Posted in Issue 92 July 2003 Editorial
Over the course of the last two decades, the health sector in the Americas has steadily pursued a process of decentralization—shifting both responsibilities and resources from the central level to the departmental or municipal level. In its quest to transform Nicaragua’s health system, the Ministry of Health created local integrated health systems, called SILAIS, believing that health resources should be located in the communities that use them. This strategy of decentralization has allowed local authorities and health professionals to make fundamental decisions regarding individual and community health in their regions.
Likewise, disaster preparedness is most effective when conceived, planned for and executed at the local level—closest to the population at risk. In the aftermath of Hurricane Mitch, Nicaragua used this framework to promote and develop a methodology for preparing local level emergency plans for the health sector.
Two municipalities were initially selected to test the methodology: Telica, in the department of Leon and Moyogalpa in the department of Rivas. The process began by calling together the principal actors involved in disaster planning and response to begin the challenge of drafting plans for different disaster scenarios.
Nicaragua’s Ministry of Health prepared a methodology guide, which it field tested in 10 municipalities in Rivas. Bolstered by the success of this first round, the Ministry, through its health disaster office, assigned responsibility for preparing the plans to the municipal level health directors. PAHO/WHO collaborated by recruiting three field officers to plan and coordinate activities. One of their major tasks was to conduct two-day training workshops on how to develop local level emergency health plans. An average of 20 persons from a variety of organizations attended the workshops in each municipality. Through the training of municipal health directors, the preparation and implementation of local emergency health plans have become a priority for the health sector. Once the workshops were completed, field staff provided guidance during the actual preparation of the plan and helped to organize a drill to test effectiveness. When all municipalities had finalized their plans, epidemiologists used them to produce a departmental level plan. Departmental level plans, in turn, fed into the national health emergency plan.
Between November 2000 and June 2003, the initiative reached 120 of Nicaragua’s 153 municipalities and proved successful when put to the test in emergency situations such as the fires in the north of the country in 2002: the population and authorities knew the role they played and what to do during the different stages of the emergency; agreements that had been previously drawn up were quickly put into practice and there was little confusion among the different health committees.
The success of this strategy attracted the interest of other organizations working in Nicaragua such as the Red Cross and the European Union, who helped to promote the development of local level emergency health plans. Strategic alliances such as these will help guarantee sustainability and contribute to generating a critical mass throughout Nicaragua.
Contribución al éxito
It certainly helps that Nicaragua has a legal framework in place that supports the development of emergency and disaster plans. In 2000, the National Disaster System was created by law, giving credibility to the topic of disaster reduction and helping to clearly define who is responsible for what. This legal framework improved the strategy’s chances for success because disaster planning responded to a recognized need in Nicaragua. What also helped was focusing on the actual process of developing local emergency health plans rather than on the final product—which, after all, is just a paper document.
Once the strategy proved successful at the municipal level, it received backing from the higher levels of government. Today, different areas and agencies have clearly earmarked resources for the development of local emergency health plans in their budgets and work plans. Disaster preparedness is officially recognized as one of the Ministry of Health’s priorities, and the Minister frequently expresses support. However, to keep plans as up-to-date and operational as possible and to contribute to a culture of risk management, the plans must be reviewed annually.
- The health sector’s limited financial and human resources and a heavy workload made it imperative to develop a methodology that was practical and easy to manage. The concrete results of this initiative heightened commitment to a culture of risk reduction.
- Real inroads were achieved by fostering a team spirit among many institutions who shared a common objective.
- The creation of a national network involving all municipalities in Nicaragua made it possible for the least vulnerable to support the most vulnerable.
- The involvement of the Minister of Health in the strategy opened the door to many other divisions in the Ministry and was instrumental in adding disaster preparedness to the list of priorities in the Ministry’s five-year plan. This designation is projected to have an impact on all plans and budgetary allocations.
- When training on preparing and implementing emergency plans has been completed in the remaining departments, local health service personnel in all of Nicaragua’s municipalities will be ready to confront emergencies effectively—notable in a country that four years ago did not even have a Disaster Unit in its Ministry of Health, much less a comprehensive and coherent methodology for creating awareness of disaster prevention at the municipal level.
Nicaragua is made up of 14 departments, which among them have 153 municipalities that act as key responders in emergency situations and are strategic components of local level emergency health plans.
In the department of Rivas, 10 municipalities have developed excellent local health plans. The plans call for coordinated disaster preparedness measures for the health sector and strengthen coordination among all local actors.
Above, Nicaragua’s former Minister of Health, Lucia Salvo, personally presented the health sector plan to the mayors of the municipalities in the department of Rivas. Her presence and participation were a demonstration of the Mininstry’s commitment, critical to ensuring implementation and sustainability of the plans.