Name of Funding Organization/Sponsor: World Health Organization (WHO) - Centre for Health Development
Country and Location: Makati City, Philippines
Start Date: August 2011
Completion Date: November 2011
As part of its efforts to increase the capacities of cities to address the unique challenges posed by public health crises in urban areas, the World Health Organization (WHO), through its Centre for Health Development (WHO/CHD) commissioned EMI to undertake an assessment of the health emergency preparedness and response capabilities of Makati City, Philippines as a case study of a particular urban setting. The assessment made use of a new tool developed by WHO/CHD termed Draft Checklist for Guidance on Preparation for Health Crises in Cities. The assessment had three objectives:
- To conduct an analysis of existing health emergency/disaster preparedness policies, programs and practices of Makati City as a case study of a particular urban setting;
- To examine the city’s health crisis preparedness status using a Draft Checklist for Guidance on Preparation for Health Crises in cities; and
- To provide a set of recommended actions through an indicative action plan and suggest specific mechanisms for follow-up.
In the Philippines, Makati City was selected as the site for this study based on the city’s socio-economic significance to the country, its sizable daytime population, its exposure to vector-borne diseases, natural hazards and human-induced incidents, and its previous experience with establishing a city-wide medical emergency management system. Makati City has also been a city partner of EMI for many years with proven excellent cooperation and collaboration between the two institutions, which is a significant advantage in trust and efficiency to the project.
The following activities were conducted for the assessment:
- Finalization of Assessment Research Questionnaire
- Orientation of Stakeholders on the Assessment Questionnaire
- Completion of Assessment Questionnaires by Stakeholders
- Validation of Strengths and Gaps Identified by Stakeholders
- Key Informant Interviews
- Second Validation of Responses
- Action Planning
The responses to the assessment research questionnaire provided by the participants conveyed a self-assessment that Makati City has a robust and functional system for dealing with health emergencies and disasters. The participants also identified both major and minor institutional/organizational vulnerabilities in each of the three (3) main areas and fifteen (15) sub-areas tackled by the assessment. A total of fifty four (54) distinct strengths and thirty eight (38) gaps were noted from the assessment results. Through validation with the city stakeholders, the initial list of gaps was narrowed down to nine core problems with their corresponding causes. At the conclusion of the assessment process, the participants formulated an action plan consisting of nine (9) strategies, each with specific activities and timelines, to address the core problems and enhance Makati City’s capacity for health emergency preparedness and response.
Finalization of Assessment Research Questionnaire
Preparatory to the conduct of the actual assessment, an assessment questionnaire was developed, based on the Draft Checklist of Areas for Guidance on Preparation for Health Crises in Cities provided by WHO/CHD. The items in the checklist were adapted and customized to the context of Makati City through a two-step process. The first step involved an internal review of the document by members of EMI’s technical staff. This review focused on classifying the checklist items into three tiers: (1) those which are essential in assessing health emergency preparedness in Makati City, (2) those which are not absolutely required but may be complementary to the items in the first tier, and (3) those which are not applicable or relevant to the context of Makati City. After the items had been classified according to their relevance, those which were answerable by a simple “yes” or “no” were rephrased to invite more reflection and discussion from respondents.
The next step involved presenting the revised checklist to an initial group of informed city stakeholders, at a workshop held in Makati City Hall in the first week of September, 2011. The workshop was attended by eight (8) representatives from the four (4) key city departments.
These representatives were invited as their respective city government departments play significant roles in Makati’s health emergency preparedness and response system. Individually, they also have significant first-hand knowledge and experience on the national and local-level contexts for dealing with health emergencies and disasters.
The attendees compared the revised checklist items with those in the original document and validated some of the revisions, while proposing their own changes for other items. The majority of revised items were retained, while a small number were reverted back to their original form. The participants also recommended that the questionnaire contain a section on definition of terms or that standard terminology already in use in Makati City’s health emergency system take the place of certain words in the document. The validation workshop also served as a starting point for data gathering, as certain issues relating to the city’s health emergency preparedness were discussed in the course of reviewing the questions. The participants also assisted the EMI team in identifying other city departments and external stakeholders that are relevant to the assessment.
The items in the assessment questionnaire also served as the basis for the development of guide questions, which were used during focus group discussions (FGD). The guide questions added depth to the respondents’ answers in the questionnaires and clarified issues from the statements.
EMI also requested relevant departments of the Makati City Government for copies of available documents detailing existing plans, policies and programs on health emergency and disaster preparedness. A total of 22 documents were provided by Makati City.
Orientation of Stakeholders on the Assessment Questionnaire
The validated assessment questionnaires were presented to Makati City stakeholders on at the end of September, 2011. Nineteen (19) representatives from city government departments, national government agencies, and private sector organizations were present.
This expanded set of participating city departments and external stakeholders was identified by the key informants during the first workshop as those offices or organizations undertaking primary and key support functions in the city government’s mechanisms for handling health emergencies and disasters. These attendees were briefed on the background of the project, its specific objectives and the activities to be conducted. After this, the items in the questionnaire were once again reviewed to ensure that all participating departments/organizations had a common understanding of each question’s intent and context. Those present also identified which items were applicable to all participating departments/organizations, and which specific questions should be referred to particular offices that have more information or experience in the area covered by the item.
Instructions were then provided to those present regarding the completion of the assessment forms. The majority of responses were submitted by the third week of October, 2011.
Validation of Strengths and Gaps Identified by Stakeholders
The responses to each item in the assessment were summarized in a matrix, with each statement being categorized as either a strength or a gap of the city’s health emergency and disaster risk management system.
An additional workshop was conducted in the last week of October, 2011 to allow the research participants to validate the summary. Aside from the validation, discussions during the workshop qualified the statements made by the respondents and provided additional details for each item based on the knowledge and experience of the attendees with Makati City’s health emergency and disaster risk management systems. This third workshop was attended by seventeen (17) individuals representing city government departments, national government agencies, and private sector organizations.
Each item in the assessment questionnaire, together with the corresponding answers by the respondents was reviewed. The participants were asked to comment on the accuracy of the statements and clarifications were made regarding vague or conflicting answers. Due to the active participation of the attendees and the dynamic nature of the discussion during this validation session, not all of the assessment items were qualified and validated. Only the section on Coordinating Response was completed. A second validation exercise was scheduled in the first week of November to deal with the remaining sections.
Key Informant Interviews
Separate interviews were conducted with the Executive Director of the Disaster Risk Reduction and Management Council and the City Health Officer in the last week of October. Being in charge of the city task units with jurisdiction over disaster risk management and health emergency preparedness, discussions with these two key informants were undertaken to gain further insight into existing protocols and procedures used during emergencies to supplement the information provided in the assessment forms. The interviews with these city officials provided details not mentioned in the initial validation of responses, but which served as good inputs in the continuation of the validation workshop.
Second Validation of Responses
A second workshop was conducted in the first week of November, 2011 to continue the validation of responses by the research participants. The answers to the assessment questions for the two remaining sections of the assessment, Managing Response and Public Health Crisis Communication, were qualified and validated at this workshop. A total of 18 participants representing different city departments/offices and other relevant organizations were in attendance.
The validated strengths and gaps were analyzed by EMI’s research team, in order to determine which gaps are the most significant contributors to the vulnerabilities of the city’s health emergency and disaster preparedness system. Nine core problems and their corresponding causes were identified by EMI’s experts. These were presented for validation to representatives of the different offices/organizations involved in the assessment at the action planning workshop held in the second week of November, 2011.
The first part of discussions during the workshop focused on gaining consensus among the assembled city stakeholders on the validity of the identified problems and causes. There was general agreement on the core problems, however several root causes were either rephrased or discarded during the course of the discussions. The main problems and causes were then used as starting points for identifying specific strategies and activities to address the institutional and organizational vulnerabilities in health emergency and disaster preparedness within the city. The participants were able to determine nine key strategies, each to be implemented through a series of three to four activities. The identified activities were classified according to the timeframe for their implementation.
Project Key Accomplishments
- Documentation of lessons learned in the pilot application of the WHO Draft Checklist for Guidance on Preparation for Health Crises in Cities
- Stakeholder-led identification of strengths and gaps in Makati City’s health emergency preparedness system
- Development by stakeholders of indicative action plan to address identified gaps in Makati City’s health emergency preparedness system
- Increased awareness among stakeholders of the various elements necessary to ensure preparedness for health emergencies
EMI Personnel Involved:
- Fouad Bendimerad, Ph.D., P.E., Chairman and Executive Director/Project Director
- Jerome B. Zayas, Senior Technical Manager/Principal Investigator
- Jose Mari O. Daclan, Technical Manager/Project Manager