Nepal - World Health Organization

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Aug 6, 2015 - HIGHLIGHTS. HEALTH SECTOR. • Slightly more than one hundred days into the response, 99% of the destroyed
Photo: WHO/M.Vurens

HEALTH CLUSTER BULLETIN # 8 A mobile health clinic in Bhumlichok VDC, Gorkha.

6 August 2015

Nepal Earthquake 2015 Reporting period (3 July – 3 August 2015) 5.6 MLLION AFFECTED

7,324

2 22,309

SURGERY

HIGHLIGHTS 



DEATHS

HEALTH SECTOR

Slightly more than one hundred days into the response, 99% of the destroyed and damaged health facilities have resumed services across all affected districts; however, some services remain interrupted due to landslides and road blockage with the beginning of monsoon. Rehabilitation of people with orthopedic and spinal injuries resulting from the earthquakes continues, with step-down facilities and referral pathways in place across the country.



One of the eight stool sample collected from ward number 13 and 14 (Balkhu, Kalimati, Kuleshwor, Soltimode) of Kathmandu tested positive for vibrio cholera.



Ensuring uninterrupted access to essential and lifesaving health care for all pregnant women, mothers, new-born and children remains a priority.



National Tuberculosis Centre concluded a post disaster needs assessment (PDNA) in 11 of the 14 affected districts for TB programme, which will provide a coordinated and credible basis for recovery and reconstruction activities.



8,898

INJURED

During the reporting period, 12 Foreign Medical Teams (FMTs) continue to support existing health services, while medical camp kits have been replacing damaged and unserviceable primary health centres throughout the most affected districts.

PAGE 1

227 HEALTH CLUSTER PARTNERS 3,035 HEALTH CLUSTER ACTIVITIES MEDICINES & SUPPLIES TONNES OF MEDICINE >42 DISTRIBUTED TONNES OF MEDICINE IN IN>32 COUNTRY STORAGE PUBLIC HEALTH FACILITIES 446 FULLY DAMAGED 765 PARTIALLY DAMAGED HEALTH ACTION 103,686 CASES TREATED 31,707 ADMISSIONS EWARN 32 - 40 SENTINEL SITES FUNDING $US 45.8

% FUNDED

41.8 M

REQUESTED

Situation Update August 2, 2015 marked 100 days since the 7.8 magnitude earthquake struck Nepal, killing more than eight thousand people and injuring almost three times as many. It was one of the deadliest disasters in the history of Nepal after 82 years of 1934 earthquake. The devastating April earthquake and repeated and stronger aftershocks resulted in substantial damages to infrastructure and led to immediate health consequences to population, particularly residing in the worst affected 14 districts. A total of 446 public health facilities were completely destroyed while a total of 765 health facility or administrative structures are partially damaged. Eighteen health workers and volunteers lost their lives and 75 got injured adding further challenges in the delivery of health services. Since the day one of the earthquake, Ministry of Health and Population (MoHP) together with the health cluster partners continued tirelessly to respond to the health needs of the affected people, initially with the dedicated focus for the management of trauma cases followed, after one month, by early recovery and rehabilitation priorities, ensuring the continuity of follow up and rehabilitation care to the injured ones in the worst affected districts. Health Cluster, led by the World Health Organization (WHO), is working alongside the MoHP to support in re-establishing health services, particularly in the remote areas of the districts where most of the primary health care centres and the health posts were either damaged or totally destroyed. As of 5 August 2015, twenty nine of the 50 Medical Camp Kits (MCKs) have been established as an immediate step to resume primary health care services before the permanent structures are rebuilt. Nepal Government Policy and Programme for the fiscal year 2015-16 (2072-73 BS) presented by the President at the meeting of the Constituent Assembly/LegislatureParliament on 8 July has emphasized on the smoother service delivery “by completing repair and reconstruction of government buildings and residences, schools, health institutions, drinking water and sanitation, roads, electricity, industrial installations and structures of local bodies by using earthquake resistant technology” 1 . The government policy and programme has also pronounced an immediate launch of short-term, mediumterm and long-term plans for rehabilitation and reconstruction of the infrastructure damaged by the recent earthquake. Slightly more than one hundred days into the response, 99% of the destroyed and damaged health facilities have resumed services; however, some services remain interrupted with the beginning of monsoon: (a) Immunization services were interrupted in the northern VDCs of Gorkha, Dolakha and Rasuwa districts owing to difficulties in transporting vaccines supplies and movement of vaccinators and due to landslides, (b) most of the northern VDCs in Dhading, Dolakha and Nuwakot districts are inaccessible by road due to landslides, (c) three out of 16 health service delivery points (additional service sites arranged by districts in addition to the health facilities) remained disrupted due to the absence of health workers in 1

Policies and Programmes of the Government of Nepal for Fiscal Year 2072-73 (2015-16) Presented by Rt. Hon. President, Dr. Ram Baran Yadav at the Meeting of the Constituent Assembly/Legislature-Parliament. PAGE 2

Dhading district. Table below summarizes the status of health facilities in all 14 affected districts. Total HF damaged District

Services Resumed (# HFs) Fully No Partial Total damage

Fully

Partial

No damage

Total

Bhaktapur

6

14

5

25

6

14

5

25

Dhading

33

13

7

53

33

13

7

53

Dolakha

52

5

2

59

52

5

2

59

Gorkha

55

21

9

85

55

21

9

85

Kathmandu

8

45

13

66

8

45

13

66

Kavrepalanchok

42

49

7

98

42

49

7

98

Lalitpur

9

20

12

41

9

20

12

41

Makwanpur

15

17

14

46

15

17

14

46

Nuwakot

42 17

19 21

6 18

67 56

42 17

19 21

6 18

67

Okhaldhunga Ramechhap

25

27

3

55

25

27

3

55

Rasuwa

15

5

0

20

13

5

0

18

Sindhuli

26

21

10

57

26

21

10

57

Sindhupalchok

63

12

5

80

63

12

5

80

Total

408

289

111

808

406

289

111

806

56

99.8% Source: District Health Cluster Situation Report, updated 5 August 2015

The surveillance system for water and vector borne diseases including outbreak control measures have been in place in all the affected districts. Recently, cases of acute gastroenteritis (AGE) were being reported to Sukraraj Tropical & Infectious Disease Hospital (STIDH) in the week of 26 July to 4 August 2015. These cases were from various parts of the Valley and neighboring districts. Majority of the cases were from ward number 13 and 14 (Kuleshwor, Kalimati, Balkhu, and Soltimode) of Kathmandu. One of the eight stool sample collected by the hospital tested positive for vibrio cholera. The preliminary investigation done by Epidemiology and Disease Control Division (EDCD) and District Public Health Office (DPHO) suggests that the contaminated water source may be the reason behind the case. The pipe water samples collected from the area have been sent to National Public Health Laboratory (NPHL) for testing.

Public Health Priorities, Needs and Gaps 

More than three months into the response, the emergency medical needs have been over. As the resumption of regular health care services are moving ahead, health priorities now transition to supporting the medium and long-term health system recovery. In this light, the on-going health priorities include: o

Demolition of damaged buildings and repairing /construction of the health facilities with the provision of basic equipment and essential drugs.

o

Continue providing rehabilitation and follow up treatment support to patients who are discharged from hospital in Kathmandu as well as other affected districts.

o

Ensuring uninterrupted access to essential and life-saving health care for all pregnant women, mothers, new-born and children remains a priority. Health cluster partners PAGE 3

together with the MoHP are attempting to address this through the provision of essential drugs, medical equipment, tents, vaccines and midwifery kits. o

Strengthening surveillance systems of water and vector borne diseases including outbreak control measures and the management of non-communicable diseases, disabilities, mental health and injury rehabilitation through the provision of essential medicines and supplies, and rehabilitation of damaged health facilities.

o

Replenishing damaged equipment and supplies.



Due to the ongoing monsoon season, transportation of medicines and medical supplies to health facilities of remote area of districts becomes difficult, particularly due to road blockage following landslides and bad weather condition for the helicopter transfer. Reduction of the number of helicopter flights to transport health commodities due to the changed priorities is also hampering the timely transfer of medicines and other logistics to the remote area.



Third round of displacement tracking matrix issued by International Organization of Migration (IOM) on 16 July 2015 indicated that a total of 59,433 people from 11,100 households are living in 104 displacement sites across 13 districts. Two third (66%) of sites assessed reported having access to functioning health facilities nearby (either on-site or within 30 minutes of distance). Of these facilities, 44% were managed by government, 26% by local clinics and 10% by different non-government organizations (NGOs). The IOM reported that diarrhea was the most common health problem reported in nearly half of the sites (49%), followed by skin infections (8%). In addition, none of the sites in Kabhrepalanchok, Ramechhap and Rasuwa districts reported having latrines in ‘good condition’ and all reported evidence of open defecation. The majority of all displacement sites (74%) had no evidence of hand-washing which heightens the risk of potential disease outbreak. Below is the status of most prevalent disease at displacement sites: Diarrhea

49%

Skin infections

8%

RTI

3%

Measles

1%

Conjunctivitis

1%

Malnutrition

1%

Other

15%

None

22% 0%

10%

20%

30%

40%

50%

60%

Source: IOM/DTM-III



There is high possibility of damage of drugs stored in medical tents due to rain water and unregulated temperature in the remote area.



Tendering process for construction of semi-permanent structures taking longer than expected.



Increasing difficulty in conducting reproductive health (RH) camps due to landslides in Okhladhunga and Rasuwa districts where there is limited access to RH services. According of United Nations Fund for Population Activities (UNFPA), the cases of gender based violence survivors seeking health care services have been increasingly reported from the affected districts.



There is an on-going need to provide shelters and psychosocial support for health workers.



Disrupted delivery of essential health care services for pregnant women, mothers, new-borns and children due to physical damage of the facilities, on-going monsoon and service under the tents. PAGE 4

Health Cluster Action Health Cluster Coordination 

The MoHP continues to lead fortnightly health cluster meetings with co-leadership from WHO. The health cluster activities are concentrated in all affected districts and the district level cluster meetings continue as per the district schedule. WHO continues to coordinate medical relief and early recovery activities through Health Cluster coordination at the central level and operational clusters in the highly affected districts.

Post Disaster Recovery and Reconstruction 

As the health sector response transitions towards recovery phase, MoHP has established an early recovery working group led by the Chief of Policy Planning and International Coordination Division (PPICD) to coordinate with partners who are planning to support MoHP in the reconstruction of damaged health facilities.



The MoHP has adopted a post disaster recovery and reconstruction strategy with immediate, intermediate and medium priorities: Immediate priorities are to furnish the districts with necessary logistics and human resources to ensure follow-up treatment of those injured, resume health services, and enable the district offices and facilities to deal with foreseen risks and vulnerabilities of an immediate nature by providing necessary logistics such as drugs and supplies and a budget for preparedness and rapid response. Intermediate priorities intend to replace the temporary arrangements (for example, sheds or tent) with short-term arrangements to ensure the continuity of service delivery and provide routine services in an uninterrupted manner. This would also include demolition of damaged buildings, accomplishment of repair works and reinstitution of peripheral health facilities by setting up pre-fabricated structures. Medium term priorities include the reconstruction of the sector from a longer term perspective to build back better which would entail setting up of new physical health infrastructure. The graphs below show the intermediate need for construction/repair work and commitment from the partners (MoU).

Source: MoHP Presentation – Post Disaster Recovery Reconstruction



In line with the Government Strategy, health cluster partners and external development partners namely: America Nepal Medical Foundation-Nepal, Canadian Red Cross, Doctors for You, GIZ, Impact Nepal, International Medical Corps, Japanese Red Cross, Karuna Foundation, KOICA, MdM France, MdM Spain, MSF Belgium, NLR, Nyaya Health, Neuro Foundation Nepal, One Heart Worldwide, Save the Children, TDH, UNICEF, have either signed or are in the process of finalizing the MoU with MoHP to support the construction of prefab structures for health facilities in affected district. PAGE 5

Communicable Diseases 

Hospital Based Syndromic Surveillance: The hospital based syndromic surveillance of epidemic prone communicable diseases initiated in 14 highly affected districts is continued by EDCD under Department of Health Services in 38 hospitals and primary health care centres (PHCC). The system covers 21 public and private hospitals in Kathmandu valley and 17 district hospitals, PHCCs and private hospitals in 11 districts.



The objective of hospital based syndromic surveillance is to rapidly identify any increase in a number of outbreak prone syndromes and thus triggering alert, verification/investigation and detection of outbreaks. The surveillance includes eight syndromes: Influenza like illness (ILI), severe acute respiratory infection (SARI), acute watery diarrhoea, acute bloody diarrhoea, suspected cholera, fever with rash, fever with jaundice and fever without rash & jaundice. Besides this daily surveillance system, routine early warning and reporting system (EWARS) also exists in some of these hospitals. EWARS collects case based information on three syndromes and vector borne diseases with epidemic potential and some events of public health importance on weekly basis.



Syndromes trend in 14 districts: There was no significant increase observed in the number of acute watery and bloody diarrhea and other syndromes in all 14 districts during the month of July, and none of the districts have reported any outbreak of acute watery diarrhea during this period except in Sindhupalchowk district. Two suspected cholera cases reported during this period, but the laboratory results were negative for vibrio cholera.



Outbreak surveillance and rumour verification: EDCD is carrying out daily event monitoring. Information on outbreaks, events and rumours in earthquake hit districts are collected/received through media scanning, information from respective district health offices, daily reports from district health offices, reports received from foreign medical teams, daily telephonic follow and information received from surveillance medical officers.



All highly affected districts have enhanced their surveillance and have put all peripheral health facilities and health workers on high alert. Reports of possible outbreaks or rumors from periphery are being collected through active telephone calls and zero reporting by respective district health/public health offices.



A suspected outbreak of fever of unknown origin and diarrhea including three deaths was reported from Batase VDC, ward number 1, Sindhupalchok on 7 July. A rapid response team from district health office, Sindhupalchok was mobilized on the same day and another team from EDCD was mobilized next day to the affected village. The teams verified three deaths: a 5 days old neonate and a 2 year old child, who had fever, died at home on 5 July 2015 and a 46 years female having fever and jaundice died on the way to hospital on 6 July 2015. The teams treated 125 cases presenting with fever, jaundice, diarrhoea, cold and cough and headache. Water and blood samples were collected. One of the stool samples tested positive for Salmonella and four others serologically positive to typhoid. A district rapid response team (RRT) including water, sanitation and hygiene (WASH) team visited the affected village on 15 July with additional medicines and WASH materials. Forty more cases were seen and treated. The outbreak was under control by 22 July.

PAGE 6



Measles and Rubella vaccines campaign will start from 15 August 2015 in all 14 earthquake affected districts. The campaign will target a total of 596,757 children aged 6 months to 5 years. It will be administered together with a dose of Oral Polio Vaccine (OPV) through 8, 375 immunization booths across the affected districts.

Tuberculosis 

The National Tuberculosis Centre (NTC) and partners IOM, HERD, JANTRA and BNMT with WHO logistical and technical support has been assisting district teams (DPHO, DTLO, Health Supervisor and other key stakeholders) to undertake a Post Disaster Needs Assessment of the National Tuberculosis Program (NTP) in the 11 most affected districts namely: Bhaktapur, Dhading, Dolakha, Gorkha, Kathmandu, Kabhrepalanchowk, Lalitpur, Nuwakot, Ramechhap, Rasuwa, Sindhupalchowk. The National TB Programme PDNA is comprised of three distinct parts: o

Damage and Loss Assessment (DALA): This will provide an analysis of damages and losses to the National TB Programme (NTP).

o

Qualitative Questionnaire: This will provide a clear understanding of the needs and planning to reinstate NTP services and Build Back Better (BBB)

o

Recovery Framework: The recovery framework summaries the recovery recommendations from the district. It outlines the short, medium and longer term priorities for the NTP’s recovery.



The NTP PDNA will provide a platform for the international community to assist the Government in recovery and reconstruction of the NTP; it will provide a coordinated and credible basis for recovery and reconstruction planning, incorporating risk reduction measures and financing plans.



IOM has been supporting in tracing TB patient and NTP’s PDNA in earthquake affected districts.

Support to Health Service Delivery and Provision of Essential Services 

MoHP supported by cluster partners has been working to fulfill the vacant positions of health human resources in the affected districts. A detailed mapping of health human resources is in progress, which is a follow up of the DPNA and will detail the technical and non-technical; preventive and curative specialties required for the continuity of basic function in the district as well as the PHCCs and health posts.



Action medeor e.V. German medical aid organization donated 11 tons of medicines to the Logistic Management Division (LMD)/MoHP and some medicines and medical equipment to Kirtipur Hospital and Annapurna Hospital in Kathmandu and Amppipal Hospital in Gorkha. They also provided a forklift to Americares, who then donated to LMD/MoHP.



British Nepal Medical Trust (BNMT) conducted health camps in Dhading, Kathmandu, Makawanpur, Nuwakot and Sindhupalchok districts whereby more than 1000 individuals received free treatment and medicines. They also provided financial and technical support to DPHO Kathmandu for psychosocial support programme and organized trainings on Post-Disaster Psychosocial Counselling and Support to various NGOs and delivered counselling to more than 600 individuals in Bhaktapur, Kathmandu and Makawanpur districts.



HelpAge International Nepal has been providing rehabilitation, nursing care, physiotherapy and counselling support to 20 homeless older people affected by earthquake. In addition, they have been implementing an integrated free health camp targeting older people. The key activities PAGE 7

include: general health check-up and distribution of assistive devices such as reading glasses together with psychosocial support and counselling for stress relief in different VDCs of Kathmandu, Bhaktapur, Nuwakot and Kavrepalanchok district. So far, they completed 11 mobile health camps in three districts and reached 2,208 beneficiaries (Male: 849; Female: 1,359). Out of total beneficiaries reached 1,128 (51%) were above 60 years of age. In addition, psychosocial counseling was provided to 476 people in different VDCs. 

Japanese Red Cross Society (JRCS) completed their medical services in Melamchi on 31 July. They provided service to 13,786 patients in Melamchi PHCC and treated 1,183 patients through mobile clinics. They completed two batches of two-day workshop for health post staff on 3-4, and 5-6 July focusing on diarrheal diseases and the simple treatment of fracture and dislocation.



Nepal Red Cross Society (NRCS) has been conducting assisted referral services, psychosocial support and health and hygiene promotion activities together with the human resource and coordination support to the earthquake affected districts. The major activities include: blood bank services, first aid services, ambulance services, basic health care services; health and hygiene promotion (IEC materials distribution, community based health and hygiene activities) through volunteer mobilization; Oral Rehydration Point trainings for health post staffs and NRCS volunteers; mosquito net distribution in Kavre district; provision of Psychosocial First Aid (PFA), Child Friendly Space (CFS) and referrals.



Save the Children continues to support MoHP in reducing direct and indirect morbidity and mortality due to earthquake through targeted public health interventions, distribution of medical supplies and equipment, capacity building of health workers and community members, providing psychosocial support and facilitating the referral services in Dolakha, Gorkha, Kavrepalanchowk, Kathmandu, Lalitpur, Nuwakot, Rasuwa and Sindhupalchok districts.



Terre Des Hommes (TDH), through the mobile health camps, has been providing post-earthquake follow up service including general health check-up, dressing, physiotherapy, psychosocial counseling, maternal and child health (MCH) services, and Tetanus Toxoid (TT) vaccine and medicine distribution in Kavre and Sindhupalchowk districts. During the reporting period, a total of 9,985 persons (3,716 Male and 6,269 Female) received the services - among them 3,314 were children. Altogether 981 cases were related to injury – follow up as well as fresh injury caused in course of removing debris, 490 were MCH services and 83 psychosocial counseling.



UNICEF provided supplies, including nine emergency health kits (basic units), nine medical tents, 1,800 blankets, 700 baby suits, and 462 family hygiene and dignity kits to affected health facilities to restore primary health care for children and women. It also supported to re-establish cold chain system (e.g. walk in cooler) by repairing a total of 40 refrigerators in 14 affected districts.



World Vision International delivered 155 tents to female community health volunteers (FCVHs) in Sindhupalchowk and distributed 241 baby hygiene kits (190 in Gorkha and 51 in Sindhupalchowk). It also established Women, Adolescent and Young Children Spaces for counseling and trainings in Fulpigkot, Kubinde, Sanusiruwari of Sindhupalchowk, Dubdhanjyang, Basheswor of Sindhuli and Palumtar of Gorkha districts.



WHO received drugs donation from various donor partners namely Oman (approx. 3 tonnes), Operation USA (four 40 feet containers with medical supplies and WASH equipment) and International Health Partners (1.5 tonnes).



With the monsoons setting in, WHO is deploying 50 MCKs to the 14 worst hit districts where 85% health facilities have been damaged. The MCKs are being strategically located in the most affected districts to serve as temporary patient consultation and treatment facilities. These temporary facilities will ensure the continuity of services during the rainy season. As of 5 August, 29 of the 50 MCKs have been set up and started providing primary health care services. MCKs PAGE 8

have the basic services and facilities including provision for male and female wards, as well as staff and consultation rooms. They are solar-powered, and with water and sanitation kits as well as facilities and supplies necessary to ensure reproductive health. This effort has been collaborated with AmeriCares, FairMed, IOM, UNFPA, UNICEF and WFP.

Trauma and Injury Care 

Injury Rehab Sub cluster is working to clean the data so as to draw a clear picture in terms of the current case load (number of patients requiring follow up services per districts for example), services available in and outside Kathmandu valley etc.



Sub-cluster has been collaborating with the cluster partners and the MoHP to develop a longer term national strategy on disability prevention and injury rehabilitation. The strategy will be built on the current short and medium term strategy developed by the sub-cluster.



Handicap International continues to strive for the prevention of post fracture and surgery complication and enhance mobility and functionality of injured beneficiaries with a proper linkages and referral of beneficiaries to appropriate service provider as per their needs including to minimize psycho-social distress. They have been providing physiotherapy (indoor and outdoor patients in the hospitals), providing assistive devices (wheelchairs, crutches, toilet chairs, and walker, walking stick and elbow crutches) and providing training on rehabilitation and use of mobility devices to caregivers in addition to coordination and referral support.



International Organization for Migration has continued an assisted discharge, referral and targeted transport of the most vulnerable earthquake affected patients with severe injuries or new disabilities in addition to the psychosocial support to severely injured and disabled patients who remain in health facilities three months after the earthquake. A total of 417 severely injured and disabled patients were assisted for transfer, discharge or taken for follow-up from home or hospital or temporary settlements. IOM is planning to set up a step down care for patients requiring rehabilitation in Sindhupalchowk district. It is expected to begin service in the first week of September 2015.

Foreign Medical Teams (FMTs) 

A total of 12 FMTs have been providing services in different affected districts: SN

FMT Organization Name

Country Team

District

VDC Name

1

Buddhist Tzu Chi Foundation

Taiwan

Bhaktapur

Bhaktapur Municipality

2

Del Mundo Medicos

Spain

Ramechhap

Ramechhap

3

Canadian Red Cross

Canada

Rasuwa

Dhunche

4

Medcins Du Monde

France

Sindhupalchowk

Pangtang

5

Japanese Red Cross Society

Japan

Sindhupalchowk

Melamchi

6

Norway Red Cross

Norway

Sindhupalchowk

Chautara

7

Medecins sans Frontieres

Belgium

Dolakha

Bhimeswar Municipality

8

Resurge International

UK

Kathmandu

Kritipur Municipality

9

Thailand

Kavrepalanchowk

BHIMTAR

Thailand

Dolakha

CHANDENI MANDAN

11

Medical Emergency Response Team (MERT) Medical Emergency Response Team (MERT) German Red Cross

Germany

Dolakha

Jiri

12

German Red Cross

Germany

Dolakha

10

PAGE 9

Lamidanda Source: FMT Coordination Cell/MoHP

Reproductive Health 

The FCHV motivational package has been finalized and endorsed by the RH sub-cluster in close coordination with the Family Health Division and Child Health Division of MoHP. The procurement for the package is on-going and the distribution to affected districts will start soon. Partners have committed to delivering this package in each of the affected districts.



RH sub cluster is collaborating with the partners and the relevant divisions of the Ministry to develop uniform and standard protocol/guidelines for the transit home across the affected districts.



Adolescent Sexual Health Working Group has been developing a menstrual health package which will be integrated into the school health programme.



Medical Teams International has been supporting to restore maternal and child health services in Kari, Nalang, Dhola, Chainpur, Salang VDCs of Dhading district targeting primarily the children under five and women of reproductive age. The project also aims to train approximately 45 FCHVs on integrated management of childhood illness (IMCI). Other activities include: community IMCI training, distribution of 5,500 hygiene kits and provision of essential medicine to remote health-posts as well as the antenatal and postnatal care workshops at the community level.



UNFPA distributed a total of 208 RH kits to health facilities in 5 districts (Dolakha, Gorkha, Makwanpur, Nuwakot and Okhaldhunga) through 6 partner agencies (IMC, World Vision International, FPAN, ADRA, WHO and MIDSON) and conducted 28 mobile RH camps in 9 districts (Bhaktapur, Dhading, Gorkha, Kabhrepalanchowk, Lalitpur, Makwanpur, Okhaldhunga, Ramechhap and Rasuwa) reaching 12,571 beneficiaries, including 1,637 family planning (FP) clients. Eight transition homes have been established in Dhading, Gorkha and Makwanpur districts providing temporary shelter for 54 pregnant and postpartum women. In addition, three maternity units have been established in Dhading and Gorkha to provide RH services during the reporting time.



UNICEF established 22 shelter homes in 11 affected districts directly benefiting 2,388 women and children while waiting for labour or after delivery for recovery. With these shelter homes, estimated 26,000 women have access to a safe place to stay. This initiative to improve access to essential care among affected mothers and children is found to be instrumental in addressing inequality as more than half of the beneficiaries are from lower caste groups.



A total of 83,000 people were reached by 330 UNICEF social mobilizers with life-saving health/WASH/nutrition information and counselling in 11 most affected districts. 26 nurse midwives have been supporting 24 birthing centers (three in Sindhupalchowk, four each in Dhading, Gorkha, Nuwakot and Rasuwa, and five in Dolakha) and eight senior mentors have been covering 50 birthing centres for onsite coaching and capacity development of health workers involved in maternal, neonatal and child health (MNCH) programme. 400 private providers are trained on the revised Integrated Management of New-born and Childhood Illness (IMNCI).

Mental health and psychological support, 

WHO has been supporting Patan Mental Hospital to hire one Psychiatrist and one Psychologist to be deployed to the affected areas.



A new instruction tool for the Mental Health screening has been devised to be used by lower level paramedics and FCHVs at the community level.



FAIR MED Foundation Nepal organized home visit to provide Psychological First Aid support to people with particular focus to sick people, children, elderly, disable people, pregnant mother, post natal mother and new born. PAGE 10

Water, sanitation and hygiene and environmental health 

FAIR MED Foundation Nepal conducted training of trainers (ToT) on post disaster health education for health workers of affected areas of Kathmandu district and volunteers’ orientation in Shankharapur Municipality with the focus of promoting Hygiene and Sanitation including safe drinking, hand washing, and personal hygiene.

Training of health human resources 

EDCD, MDM and district health office, Sindhupalchok organized a-three day training on outbreak investigation to rapid response team and other health workers of DHO Sindhupalchok.

Funding status of action plan Funding requirements: 

Humanitarian partners revised the Nepal Flash Appeal extending the implementation period from three to five months to ensure linkage with the Government’s recovery programme. The revised flash appeal was re-launched on 2 June 2015. The Health Cluster component of the Flash Appeal plans to respond to the most urgent health needs of 5.6 million people. The revised funding requirements for the Health Cluster amount to US$ 41.8 million.

Funding partners: 

As at 5 August 2015, the health component of the flash appeal is 45.8 % funded. Health Cluster’s humanitarian response to the Nepal earthquake has received support from the following contributors: Australia, Brazil, Estonia, Finland, Friends of UNFPA, Italy, Japan, Netherlands, Norway, the Russian Federation, Switzerland, Thailand, and UN Central Emergency Response Fund, USAID, World Health Organization, private sector donors and foundations.

PAGE 11

Health Cluster Activities (4Ws)

PAGE 12

Health Cluster Partners per district (from 4Ws mapping) Bhaktapur Adara Development

International Medical Corps

Alliance of International Doctors

International Organization for Migration

AmeriCares Bowberos Chidos Sin Frouleros (Foundation Madrazo)

Japan-Nepal Health TB Research Association

Buddhist Tzu Chi Foundation

Korea Disaster Relief Team

Centre for Victims of Torture Nepal

Labour Women & Child Welfare Council

Child Workers in Nepal

Nepal Disaster and Emergency Medicine Center

Corps Mondial de Secours Deutsche Gesellschaft fuer Internationale Zusammenarbeit (GIZ) - HSSP

Nepal Disaster and Emergency Medicine Center

Nepal Public Health Association

Nurse Teach Reach Inc.

Midwifery Society Of Nepal

Pakistan Medical Team

Nepal Public Health Foundation

Reach Out Worldwide

Family Planning Association Of Nepal

SOS Himalaya

Handicap International

The Leprosy Mission Nepal

Health Research and Social Development Forum

Transcultural Psychosocial Organization

Helen Keller International

United Nations Children's Fund

Help Age International

World Health Organization

John Snow Research and Training Institute

Nepali Cine Artists

Indian Medical Association Dhading Adara Development

John Snow Research and Training Institute

AmeriCares

King George Medical College

Banglore Medical College

Landseed International Medical Group

British Nepal Medical Trust

Medecins sans Frontieres -Belgium

CBM International

Medical Teams International

Centre for Victims of Torture Nepal Chandrajyoti Integrated Rural Development Society (CIRDS)

Neplalese Nursing Association UK

Committed Society for Change (COSOC) Deutsche Gesellschaft fuer Internationale Zusammenarbeit (GIZ) - HSSP

One Heart World Wide, Nepal

Nepal Public Health Association

Pompiers Humanitaines Francais

Midwifery Society Of Nepal

Red Cross Society of China

New York City Medics

Patan Mental Hospital

Nepal Public Health Foundation

Seikh Mujib Medical University (Nepali doctors)

Global Outreach Doctors

Singapore Medical Team

GOAL Global

Taiwan Landseed hospital

Government of Bihar

Terre des hommes

Health Research and Social Development Forum

Hospital and Rehabilitation Centre for Disabled Children

Himalayan Health Care

United Hands Club

International Medical Corps

United Nations Children's Fund

International Nepal Fellowship

United Nations Population Fund

International Organization for Migration

World Health Organization Johns Hopkins University Center for Communication Programs

Jhpiego Dolakha

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Acts World Relief - Beth Israel Deaconess Medical Center Disaster Medical Fellowship

Maharastra Team

Centre for Victims of Torture Nepal

Medecins sans Frontieres Belgium

Child Workers in Nepal

Medecins sans Frontieres Holland

Compassionate hands for Nepal + Natan

Medical Service CenterAll Nepal Progressive Public Health Association

CWIN Nepal and TUKI

Plan International

Dutch Aid Team

The Leprosy Mission Nepal

German Red Cross

Trekmedic

Health Research and Social Development Forum

United Nations Children's Fund

Indian Air Force

World Health Organization

International Organization for Migration

World Neighbors

John Snow Research and Training Institute

Lifeline Nepal

Gorkha Adara Development Aides Actions Internationales Pompiers + Action Pompier Pour lUrgence Internationale

International Organization for Migration

AmeriCares

INTERSOS-OPPORTUNITY VILLAGE

BG Hospital and Research Center

John Snow Research and Training Institute

Canadian Medical Assistance Teams

Madhyapur Hospital, Bhaktpur

CARE Nepal

Medecins Sans Frontieres - France

COMMUNITY ACTION NEPAL

Medecins sans Frontieres Belgium

Nepal Public Health Association

Medecins sans Frontieres France

Midwifery Society Of Nepal

Medecins sans Frontieres Spain

Nepal Public Health Foundation

MountainChild

FAIRMED

Psychiatrists Association of Nepal

Good Neighbors International

Save the Children

Humanity First

Swiss Agency for Development and Cooperation

Indian Air Force

SWISS AGENCY FOR DEVELOPMENT AND COOPERATION- Humanitarian Aid

International Medical Corps

United Nations Children's Fund

International Nepal Fellowship

United Nations Population Fund

World Health Organization

Working with Local NGO

World Health Organization

World Vision International Nepal

INTERSOS

Kathmandu Adara Development

Marie Stopes International

AmeriCares

Medecins Sans Frontieres - France

Centre for Victims of Torture Nepal

Mercy Malaysia

Child Workers in Nepal

Materity hospita

Chinese Army Medical Team (Chengdu)

MSF France

Cuban Medical Brigade

Naya Goreto

Institute of Medicine

Nepali Cine Artists

Tribhuvan University Teaching Hospital

Netherlands Rescue Team

Department of Psychiatry and MentalHealth Deutsche Gesellschaft fuer Internationale Zusammenarbeit (GIZ) - HSSP

NITTE University

FAIRMED

Prosthetics Orthotics Society Nepal

Project Hope

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Family Planning Association Of Nepal

Psychiatrists Association of Nepal- America Nepal Medical Foundation

Gift of the Givers

Resurge International

Global Medics

Save the Children

Government of Karnataka

Singapore Army

Handicap International

Taiwan Root Medical Peace Corps

Health Research and Social Development Forum

Team for Chirayu

Helen Keller International

The Leprosy Mission Nepal

Help Age International

Transcultural Psychosocial Organization

Indonesia Medical Team

UK Emergency Medical Team

Indonesia-Civilian (Indonesia-BNBP) International Charitable Public Foundation for Children in Disasters and Wars

UK Emergency Medical Team

International Medical Corps

United Nations Children's Fund

International Organization for Migration

Vicente Sotto Memorial Medical Center

Interplast

World Health Organization

Israel Medical team

John Snow Research and Training Institute

Japan Ground Self Defense Force

Karisz usar and Medical Rescue team

Japanese Military

Karuna Foundation Nepal

Japan-Nepal Health TB Research Association

Leo club of Kathmandu Nanasaku

Nepal Apanga Sangh Orthopedic hospital, Jorpati

Tribhuwan University Teaching hospital

Kanti hospital

Model hospital

UMKE - Members of Turkey's national medical rescue team

Om hospital Kavrepalanchok Action Works Nepal

Johns Hopkins University Center for Communication Programs

Adara Development

John Snow Research and Training Institute

ADRA

Kelab Putera I Malaysia

America Nepal Medical Foundation

Marie Stopes International

AmeriCares Bangladesh Association of Physical Medicine and Rehabilition

Medical Emergency Response Team (MERT)

Bharatiya Jain Sanghathan

Mercy Malaysia

CBM International

Nepal Disaster and Emergency Medicine

Centre for International Studies and Cooperation Chandrajyoti Integrated Rural Development Society (CIRDS)

OATH

Chiang Mai University Maharat Hospital

Royal Melbourne Hospital

ChildFund International

Save the Children

China Medical Team Deutsche Gesellschaft fuer Internationale Zusammenarbeit (GIZ) - HSSP

Special Medical Team of University of Debrelev

Dhaka Community Hospital Center for Public Health and Environment Development

Medical Help World

Plan International

Sri Lanka Army SWISS AGENCY FOR DEVELOPMENT AND COOPERATION- Humanitarian Aid Terre des hommes

Midwifery Society Of Nepal

Thai Spinal Rehabilitation Team

Nepal Public Health Foundation Hospital and Rehabilitation Centre for Disabled Children

The Leprosy Mission Nepal

Family Planning Association Of Nepal

United Nations Children's Fund

UK Emergency Medical Team

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Health Research and Social Development Forum

United Nations Population Fund

Help Age International

World Health Organization

Himalayan Health Care

World Neighbors

International Organization for Migration

Japan International Cooperation Agency

Iri Shinkwang Presbyterian Church Lalitpur Adara Development

Indian Air Force

Al-Khair Foundation

International Organization for Migration

AmeriCares

John Snow Research and Training Institute

Bangladesh Medical Team

Nagarik Awaz

Centre for Victims of Torture Nepal

Naya Goreto

Child Workers in Nepal

Nepal Youth Foundation

China Medical Team Hospital and Rehabilitation Centre for Disabled Children

Nepali Cine Artists

Family Planning Association Of Nepal

Save the Children

Good Neighbors International

Thai Army

Gwangji-Metrocity Medical Relief Team

The Leprosy Mission Nepal

Health Research and Social Development Forum

UK Emergency Medical Team

Helen Keller International

United Nations Children's Fund

Human Care Foundation

World Health Organization

Samaritans Purse International Relief

Makawanpur Acts of Mercy

Plan International

CBM International

The Leprosy Mission Nepal

Centre for Victims of Torture Nepal

United Nations Children's Fund

Family Planning Association Of Nepal

World Health Organization

International Organization for Migration Nuwakot Adara Development

Marie Stopes International

AmeriCares

Medecins Sans Frontieres - France

Bhutan Army Team

Medecins sans Frontieres spain

British Nepal Medical Trust

Nature Care Hospital

Centre for Victims of Torture Nepal Chosum University Hospital, Hope Tree and Kwangju Metropolitan City Deutsche Gesellschaft fuer Internationale Zusammenarbeit (GIZ) - HSSP

Nursing Association of Nepal

Nepal Public Health Association

Qatar Red Crescent

Midwifery Society Of Nepal

Save the Children

Nepal Public Health Foundation

Terre des hommes

Doctors for You

The Leprosy Mission Nepal

GOAL Global

Transcultural Psychosocial Organization

Handicap International

UK Emergency Medical Team

Helen Keller International

United Nations Children's Fund

Help Age International

Vicente Sotto Memorial Medical Center

InREACH-Nepal

World Health Organization

International Organization for Migration

Italy Civil Protection

Italian Red Cross

Lions Club of Kathmandu, and Norvic hospital

Patan Mental Hospital Psychiatrists Association of Nepal

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Okhaldhunga

International Organization for Migration

SWISS AGENCY FOR DEVELOPMENT AND COOPERATION- Humanitarian Aid

Jhpiego

Transcultural Psychosocial Organization

John Snow Research and Training Institute

World Health Organization

Ramechhap Centre for Victims of Torture Nepal

Save the Children

Del Mundo Medicos

Tamakoshi Sewa Samiti, Manthali Ramechhap

Good People International

The Leprosy Mission Nepal

International Organization for Migration

United Nations Children's Fund

Medicos del Mundo Spain

World Health Organization

Metropolitan Manila Development Authority Rasuwa Canadian Red Cross Deutsche Gesellschaft fuer Internationale Zusammenarbeit (GIZ) - HSSP

International Organization for Migration Johns Hopkins University Center for Communication Programs

Kamana

Karuna Foundation Nepal

Nepal Public Health Association

Save the Children

Midwifery Society Of Nepal

The Leprosy Mission Nepal

Nepal Public Health Foundation

UK Emergency Medical Team

Family Planning Association Of Nepal

UK Fire and Rescue Service USAR

GOAL Global

United Nations Children's Fund

Helen Keller International

World Health Organization

Helen Keller InternationalMayo Hospital Lahore

Human Outreach Project

Sindhuli Centre for Victims of Torture Nepal Deutsche Gesellschaft fuer Internationale Zusammenarbeit (GIZ) - HSSP

Jhpiego

Nepal Public Health Association

Working with Local NGO

Midwifery Society Of Nepal

World Health Organization

Nepal Public Health Foundation

World Vision International Nepal

United Nations Children's Fund

International Organization for Migration Sindhupalchok Adara Development

Japanese Red Cross Society

Association of Medical Doctors of Asia- Nepal

Japan-Nepal Health TB Research Association

AmeriCares

John Snow Research and Training Institute

BRAC

Korean Red Cross

Canadian Military Disaster Response Team

Lifeline Nepal

CBM International

MAGNA children at risk

Center for Womens Right & Development

Malteser International

Centre for International Studies and Cooperation

Marie Stopes International

Centre for Victims of Torture Nepal

Medcins Du Monde

Child Workers in Nepal

Medecins du Monde France

ChildFund International

Medecins sans Frontieres Holland

Crises Relief Singapore

Medical Emergency Response Team (MERT)

Czech Medical team

Medical Teams International

Center for Public Health and Environment

Medicare National Hospital and Research Centre PAGE 17

Development Midwifery Society Of Nepal

Miral welfare foundation

Nepal Public Health Foundation

National Health Professional Association

Disaster Medics

National Medical Organization

Emergency Team Poland

New Era

FAIRMED Hospital and Rehabilitation Centre for Disabled Children

Norway Red Cross

Handicap International

NSI

Haridwar Shanti Kunj

One Heart World Wide

Heart to Heart International

Plan International

Humanitarian Medical Assistance

Psychiatrists Association of Nepal- America Nepal Medical Foundation

Humedica

Remote Area Medical

Indian Medical Association

Rotary Club of East Calcutta

International Medical Relief

Save The Children

International Organization for Migration

Sewa Foundation

Israel Forum for International Humanitarian Aid

Sustainable Development Center

Japan Disaster Relief Medical Team

Team Rubicon

Department of Psychiatry and MentalHealth

Terre des hommes

UK Emergency Medical Team

The Johanniter International Assistance

United Nations Children's Fund

The Leprosy Mission Nepal

Working with Local NGO

Transcultural Psychosocial Organization

World Health Organization

Institute of Medicine

World Neighbors

Tribhuvan University Teaching Hospital

NPO Tokushukai Medical Aid Team

World Vision International Nepal

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