3.3.3 Health infrastructure, equipment and supplies

Disaster and emergencies often lead to destruction or loss of critical health infrastructure and equipment, and depletion of medical supplies, including essential drugs. International humanitarian agencies are often requested to support the restoration or resupply of health infrastructure, equipment and supplies as part of the emergency response.

These responses are best managed by national health authorities with the support of the WHO and UNFPA, particularly the supply of essential drugs, equipment, and supplies related to sexual and reproductive health, e.g. emergency obstetric care, family planning/contraceptive needs. If the national and international health authorities are unable to fulfill these needs, there are times when it is appropriate for NGOs to consider supporting rehabilitation and reconstruction of health facilities, supply of basic health equipment, supplies and medications. For example, CARE has implemented this kind of response in the West Bank and Gaza, Iraq, Indonesia, and Syria among other places.

If considering this type of response, the following must be kept in mind:

• Ongoing provision of essential supplies for the health sector must be the responsibility of national authorities (with the support of WHO and UNFPA), and any support should aim to help responsible authorities restore this capacity as soon as possible.
• Procurement of health and medical supplies requires specialist expertise and should not be undertaken by general procurement staff without a specialist health or medical procurement advisor.
• Procurement or import of drugs must be consistent with national and international laws, including the country’s approved essential drugs list. Donor governments will often also have specific regulations governing the procurement of drugs.
• Rehabilitation or reconstruction of health and medical facilities also requires specialist expertise in health and medical design and construction.

WHO and UNICEF offer standardized, pre-packaged inter-agency emergency health kits that are designed to meet the primary health care needs of a displaced population without medical facilities, or a population with disrupted medical facilities in the immediate after math of a natural disaster or during an emergency. The IEHK 2011 consists of two different sets of medicines and medical devices, named a basic unit and a supplementary unit.

Basic unit contains: essential medicines and medical devices that can be used by primary health care workers with limited training. It contains oral and topical medicines, none of which are injectable.

Supplementary unit contains: essential medicines and medical devices for 10,000 people, and is used only by professional health workers or physicians. It does not contain any medicines or devices from the basic unit and can therefore only be used when these are available as well.

It should be noted that the basic and supplementary units are not intended to enable health care workers to treat rare diseases or major surgical cases. Nor is it intended for nor is designed for immunization or nutritional programs. IEHKs can be procured from UNICEF in country or through the UNICEF Supply Division in Denmark. Alternatively, they can be procured through IDA Foundation and WHO.

Specifically in relation to sexual and reproductive health (see section 3.6) UNFPA, UNICEF and USAID often provide stocks necessary for basic sexual and reproductive (SRH) services including the Minimum Initial Service Package (MISP). UNFPA offers standardized, pre-packaged emergency reproductive health kits (RH Kits) that contain enough essential medicines, supplies and equipment to meet the needs of displaced populations without medical facilities (or where medical facilities are disrupted during a crisis) for a three month period. They are intended for use during the initial phase of an emergency.

There are 12 RH kits in total. They are divided into3 different blocks according to population size and health service delivery level. They can be procured from UNFPA in country or through UNFPA’s Humanitarian Response Branch in Denmark.

To view how the kits correspond to the various components of the MISP, refer to the MISP cheat sheet. Refer toAnnex 8.5.3 for information on how to order RH kits if they are not available locally through UNFPA or whomever is responsible for coordinating RH activities.

It must be emphasized that, although supplying medicines and medical devices in standard pre-packaged kits is convenient early in an emergency, specific local needs must be assessed as soon as possible and further supplies must be ordered accordingly. Therefore, once basic reproductive health have been established, the reproductive health coordinator should assess reproductive health needs and reorder medicines, disposables and equipment based on consumption of these items, in order to ensure that the reproductive health program can be sustained. All efforts should be made to strengthen or develop a medical supplies logistics management information system. Re-ordering should be done through regular channels (via the national procurement system, nongovernmental organizations – NGOs – or other agencies) or through the UNFPA Procurement Services Branch in Denmark.