Nicaragua
Municipal-level
Disaster preparedness and response for the fhealth sector : emergency plans

The Nicaraguan Showcase

In late 2000, within the framework of the Post-Mitch Project in Nicaragua, the Ministry of Health assisted us in identifying two pilot municipalities, confronting different hazards, which would serve as “laboratories” for the development of municipal-level methodologies for the drafting and validation of emergency plans. The goal was to build capacity building as close as possible to the people who suffer most directly the consequences of an adverse natural event.

An interinstitutional process was launched involving key partners such as health personnel, the staff of water and sanitation utilities, the mayor’s office, NGOs active in the health sector, and community organizations.

Participants agreed that the top priority was drafting an emergency plan that would take into account various disaster scenarios. It would consist of a preparedness plan and a response plan. We collaborated with the Ministry of Health in writing methodological guidelines on how to draft such a plan. The guidelines, which were tailored to the country’s needs, were tested in the ten municipalities of the department (province) of Rivas, in the southwest of the country.
Encouraged by the success and outstanding reception of the project at the local level, the Ministry of Health‘s Disaster Technical Liaison Unit (TLU) asked PAHO/WHO’s Emergency Preparedness and Disaster Relief Coordination Program (PED) for assistance in the implementation of these technical guidelines throughout the country.
The Impact

Between November 2000 and June 2003, the team managed to extend coverage to 120 of Nicaragua’s 153 municipalities.

In several emergencies, such as the potentially devastating wildfires that hit Northern Nicaragua in 2002, the plans, which included coordination mechanisms and other tools, showed their effectiveness. Other projects, such as Forsima (sponsored by the European Union), as well as other organizations like the Red Cross, started expressing interest in the initiative and are now actively collaborating in the implementation of the strategy. Such strategic partnerships will undoubtedly contribute to the project’s sustainability. Thousands of people belonging to a variety of organizations, from the municipal to the national level, have participated in the process, generating a critical mass throughout the country.
The Strategy

Two years ago, the Minister of Health entrusted the municipal directors and epidemiologists of the departmental coordinating units with carrying out the government’s share of the initiative, overseen at the national level by the TLU. PAHO/WHO recruited a team of three field officers who facilitated the process by:

• Programming activities;
• Running two day training workshops for some 20
members of various organizations at each municipality.
• Providing advice during the drafting of the emergency
plans;
• Disseminating the finished plans; and
• Organizing drills or simulations to test their effectiveness.
Once the plan is approved, the municipal health director distributes copies to the mayor’s office and the departmental coordination unit.

Examples can be seen (in Spanish) at PAHO/WHO’s Nicaraguan country office’s Web site, www.web.ops.org.ni, after clicking on Áreas Temáticas: Emergencias y Desastres. When all municipal plans have been completed, the departmental epidemiologists and their teams prepare departmental emergency plans that in turn will serve as inputs for the national emergency plan.

Key Factors

The sound legal framework of the country in this area helped to define responsibilities at the various levels. In this context, the strategy has proven successful because:
• It meets a widely felt need; • Its implementation is consistent from year to year;
• It has involved thousands of people who now constitute a solid core of capacity and expertise;
• It launched a process of inclusion with the involvement of the entire health sector and not just one or two institutions;
• Attention is being paid to the dynamics of the process, which is not limited to the production of a document for future reference.

Sustainability

The first challenge was for the strategy to work at the local level. Only when positive results were obtained in the field did the National Health Directorate support and institutionalize the effort. At present, the strategy has been included not only in the work plans of the various partner institutions but also their operating budgets.

Disaster preparedness is officially one of the Ministry’s top priorities, and the Minister has acknowledged her support at several public events. PAHO/WHO continues in its apacity-building efforts in order to ensure the Project’s continuity.

The goal is to establish an annual review of the response plans to enhance their operational effectiveness, and of the preparedness plans to make sure they contribute to a true culture of prevention and risk management. The Coordination Unit for the North Atlantic Autonomous Region, one of the poorest, most isolated and most disaster prone in the country, has recently incorporated emergency preparedness for the very first time as one of the priorities of its five-year plan. Eventually, decision makers at all levels will have to assign part of their financial and human resources to relevant activities in this field.

Lessons Learned

The limited resources of the health sector and the heavy workload of its staff called for an operational methodology that would prove practical and easy to manage. By improving response and planning preparedness actions, we were able to show concrete results, which raised the awareness of all participants regarding the practical value of a sustainable culture of risk management.

We have been working closely in mitigation and prevention issues with the Disaster Technical Liaison Unit (TLU), a relatively new institutions that was established in 1999. Experience has shown the importance of encouraging a team spirit in which partner organizations share the same goals. This calls for greater openness and a greater rapprochement among all the partners.

Due to the frequent turnover in personnel—not to mention the need to continue enhancing the quality of the work—it has become apparent that the effort must be renewed on a yearly basis.

Instead of working with a limited number of municipalities, as originally intended, we found that it made more sense to establish a national network spanning all of Nicaragua’s municipalities. This enables the least vulnerable municipalities to develop support plans to assist those that are most vulnerable to natural disasters. An additional advantage has been that a common technical approach has been implemented and disseminated throughout the country.

Regional Scope

Based on the success of the experience to date with this methodology, PAHO/WHO is drafting a regional technical handbook. Validation workshops have already been held in El Salvador and Costa Rica. Workshops for the Caribbean and South America are in the planning stages.

For more information contact:Steven de Vriendt
PAHO Nicaragua
devriens@ops-oms.org