The Horn of Africa has been exposed to periodic pandemics and major epidemics including Avian and Pandemic Influenza, Cholera, Meningitis, Yellow fever and Viral Haemorrhagic Fevers in addition to other hazards such as flood, drought and environmental pollution.
The impact on public health of these hazards has far reaching implications for individuals and countries in the Horn region. Due to its location in the Sahel zone and the rift valley, Eritrea is prone to drought and earthquake. In 1920, and earthquake destroyed Massawa and in 1920 a volcanic eruption displaced people in the southern Red Sea region. These hazards cause national emergency and security threats. Taking this into account, Eritrea has brought to the fore the urgent need to adequately prepare for and effectively respond to public health emergencies of national and international concern.
As part of efforts to strengthen the emergency preparedness and response systems, Vulnerability and Risk Assessment Mapping (VRAM) of public health emergencies in Eritrea as well as assessment of existing capacities to respond to emergencies and public health threats was undertaken from 27 to 31st May 2019. A large group of experts and stakeholders from different ministries and organizations convened to identify and assess the potential hazards Eritrea could face, validate the findings and score risks and vulnerabilities and finally make recommendations for the ministries to take preparatory measures of responding.
The event was organized by the Ministry of Health (MOH), in cooperation with the World Health Organization (WHO) and other stakeholders. The primary objective of the VRAM is to support a country strengthen its capacity to assess, visualize and analyze health risks and incorporate the results of the analysis in disaster risk reduction, emergency preparedness and response plans in line with WHO’s six-year strategy for risk reduction and emergency preparedness. At the same time, the application of the VRAM process allows for the compilation and homogenization of baseline data, information and maps to help health authorities and their partners to make informed decisions in times of crises.
“It has now become daily news on the mass media that natural and man-made disasters are negatively impacting the livelihoods and economic growth of the populations where the disasters occur. The impact is grave when countries have not identified the status of their vulnerability and risk to hazards and their capacity to respond. No country in the globe is immune to the impacts of climate change, hazards and disasters although the intensity may vary,” said Dr. Araia Brhane at the commencement of the workshop.
“Eritrea has experienced disasters in the past including epidemics such as dengue fever and natural hazards such as drought, flood, stormy rains and volcanic eruption although the impacts were mild. They have occurred when the country didn’t have a strong established system or plan to respond to such events. It is with this understanding that Eritrea has called this workshop of VRAM,” he said.
Dr. Yohannes Gebrat, on behalf of Dr. Josephine Nambose, WHO representative in Eritrea, said on the opening day that the entire African region is at risk of health emergencies and emerging and re-emerging pathogens are of particular concern and Eritrea is not an exception. In Africa, over 100 public health emergencies occur annually out of which 78% are infectious, 17% disasters and 4% caused by chemicals. Sixty human pathogens are of animal origin and 75% of emerging animal diseases can be transmitted to humans.
International trade, travel and migration have developed over the centuries, and as new, faster communication systems have developed, microbes and pathogens have progressed accordingly resulting in increased occurrence of outbreaks that turn into epidemics and even pandemics.
Health security is one of the crucial issues that countries should maintain to safeguard the wellbeing of their citizens and lead them to development.
The vision of Eritrea is to establish a nation that is secure and resilient enabling all communities to enjoy high level of security against threats to their health and well-being through an integrated “one health’ approach.
“Integration of health security in to health systems promotes sustainability, efficiency and effectiveness of a country’s preparedness efforts, while also strengthening the wider health system. Strengthening preparedness for prevention, detection, and response protects essential health services, contributes to health systems’ resilience and avoids fragmentation of health systems and health security and brings collaboration among the various relevant ministries, thus promoting an integrated approach in line with the “one health approach,” Dr. Gebrat said.
The MOH has been able to develop the National Action Plan for Health Security (NPHS) 2017 – 2021 in 2017 following the JEE as well as the Internal Assessment on IHR that had been conducted prior to the development of the plan. Since then, the MOH has been able to implement the interventions as guided by the plan.
The strategic directions identified in the NAPHS documents are grouped under the major four “Core Technical Groups” — prevention, direction, response and other IHR hazards and POE.
One of the planned activities in line with the work plan is VRAM, which helps to identify the vulnerabilities of systems and the capacities of the communities exposed to priority hazards as identified through the Strategic Tool for Assessing Risks (STAR).
The VRAM process of risk profiling is a critical step in identifying and understanding a country’s exposure to critical hazards. In addition to risk profiling, it is significantly crucial that countries conduct VRAM to better characterize the risk. VRAM helps to identify factors that determine the population’s and the health system’s vulnerability to hazards as well as the existing capacity to address gaps in emergency preparedness and response.
The VRAM process helps answer what and where the hazards are, which populations are exposed to them, and what and where the existing local capacities for emergency preparedness and response are.
Historical data on hazards were reviewed from sources such as the MOH and other related ministries and agencies to identify hazards that have health consequences. These hazards were analyzed to establish those that have the potential to result in public health emergencies. Hazard analysis was done using as a guide the pseudo equation, Hazard (H) = Probability (P) x Exposure (E) x Impact (I). In order to guide prioritization of the response interventions to the public health risks, the hazards were ranked by the public health risk they pose.
Assigning scores by individuals to mostly qualitative variables is subjective. This was the major limitation in the methodology used in the risk assessment and mapping throughout the process. The influence of subjectivity in the results was minimized through a consensus of the assessment conducted by stakeholders in group discussions. The results presented are therefore to be used as a guide for further selected unit of analysis level risk mapping.
Hazards identified as having the potential of resulting in public health emergencies include Cholera, Meningitis, Yellow Fever, Avian and Pandemic Influenza, Flood, Drought, Earthquake and Transport accidents.
These hazards may occur alone or in combination or as secondary hazards (hazards that occur as a result of another hazard such as a cholera outbreak following flooding).
When finalized, the risk mapping document will be important in enhancing the focus of public health emergency management in determining prevention, preparedness, mitigation, response and recovery activities based on risk.
The goal of the risk analysis in public health emergency management is to reduce risk level by targeting interventions aimed at reducing vulnerability and increasing coping capacities. The hazards listed as posing high risk are those that must be very high priority for prevention, preparedness, mitigation, response and recovery programs in the country and in specific zones, and attempts should be made to minimize the risks of those hazards. The hazards that are listed as secondary do pose danger but are addressed only after those hazards with high risk.
The main vulnerability factors across the country are geographic location, availability of sanitation and hygiene facilities and climate change. Not much can be done about some of the factors such as geographic location and climate change. The focus should be on reducing the other vulnerabilities and increasing coping capacities.