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Developing Public Health Indicators in Complex Emergency Response

Published online by Cambridge University Press:  28 June 2012

Paul B. Spiegel ,
Frederick M. Burkle Jr. ,
Chayan C. Dey  and
Peter Salama
Paul B. Spiegel*
Affiliation:
International Emergency and Refugee Health Branch, Division of Emergency and Environmental Health Services, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
Frederick M. Burkle Jr.
Affiliation:
The Center for International Emergency, Disaster and Refugee Studies, The Schools of Medicine and Public Health,The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
Chayan C. Dey
Affiliation:
The Center for International Emergency, Disaster and Refugee Studies, The Schools of Medicine and Public Health,The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
Peter Salama
Affiliation:
International Emergency and Refugee Health Branch, Division of Emergency and Environmental Health Services, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
*
International Emergency and Refugee Health Branch, Centers for Disease Control and Prevention, Mail Stop F-48, 4770 Buford Highway NE, Adanta, GA 30341, USA E-mail: pspiegel@cdc.gov
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Abstract

During the past decade, indicators for the assessment, monitoring, and evaluation of services provided by humanitarian organizations to populations affected by complex emergencies (CEs) were developed to improve the effectiveness and accountability of humanitarian response. The quality of data used to develop individual indicators and their relationship to positive health outcomes varies greatly. This article states the essential characteristics necessary for the development and implementation of effective indicators in CE response and proposes the establishment of an evidence-based grading system. The importance of trend analysis and the modification or addition of various indicators and their thresholds, according to phase and location of CEs, are stressed. Limitations in the development, implementation, and interpretation of these indicators, including those outside of the organizations' control are discussed. More evidence-based research is needed as to the type and thresholds of indicators that lead to improved health outcomes in populations affected by CEs. The use of indicators by non-governmental organizations, and how they affect their program's decision-making in different phases and settings within CEs need further study. Finally, the establishment of a regulating body with the authority to enforce the attainment of standards by use of these indicators is necessary to avoid inappropriate humanitarian assistance causing loss of life in the future.

Keywords

complex emergenciesdisplaced personshumanitarianindicatorsmeasures of effectivenessnongovernmental organizationsrefugeetrend analysis
Type
Part II: Complex Emergencies: Research Initiatives
Information
Prehospital and Disaster Medicine , Volume 16 , Special Issue 4: Complex Emergencies , December 2001 , pp. 281 - 285
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2001

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References

1.Cobey, JC, Flanagin, A, Foege, WH: Effective humanitarian aid. Our only hope for intervention in civil war. JAMA 1993;270(5):632–634.CrossRefGoogle ScholarPubMed
2.Burkle, FM: Lessons learnt and future expectations of complex emergencies. BMJ 1999;319(7207):422–426.CrossRefGoogle ScholarPubMed
3.Goma Epidemiology Group: Public health impact of Rwandan refugee crisis: What happened in Goma, Zaire, in July 1994? Lancet 1995;345(8946):339–344.CrossRefGoogle Scholar
4.Emergency medical aid is not for amateurs. Lancet 1996;348(9039):1393. editorial.Google Scholar
5.Banatvala, N, Zwi, A: Public health and humanitarian interventions: Developing the evidence base. BMJ 2000;321:101–105.CrossRefGoogle ScholarPubMed
6.Salama, P, Buzard, N, Spiegel, P: Improving standards in international humanitarian response: The Sphere Project and beyond. JAMA 2001;286(5): 531–532.CrossRefGoogle ScholarPubMed
7.Steering Committee for Humanitarian Response and Interaction: The Sphere Project: Humanitarian Charter and Minimum Standards in Disaster Response. Oxford: Oxfam Publishing, 1998.Google Scholar
8.Spiegel, P, Lynch, E, Patel, N: Continuous quality improvement applied to outpatient health care delivery in displaced persons camps. Refugee 2000;18(5):31–38.CrossRefGoogle Scholar
9.McColl, A, Roderick, P, Gabbay, J, Smith, H, Moore, M: Performance indicators for primary care groups: An evidence based approach. BMJ 1998;317(7169):1354–1360.CrossRefGoogle ScholarPubMed
10.Hallam, A: Evaluating humanitarian assistance progammes in complex emergencies. Good Practice Review 1998;7:1–27.Google Scholar
11.Raisbeck, C: How the choice of measures of effectiveness constrains operational analysis. Interfaces 1979;9:85–93.CrossRefGoogle Scholar
12.Burkle, FM Jr, McGrady, KA, Newett, SL et al. : Complex, humanitarian emergencies: III. Measures of effectiveness. Prehosp Disast Med 1995;10(1):48–56.CrossRefGoogle ScholarPubMed
13.Hakewill, PA, Moren, A: Monitoring and evaluation of relief programmes. Trop Doct 1991;21(Suppl l):24–28.CrossRefGoogle ScholarPubMed
14.Centers for Disease Control and Prevention: Guidelines for evaluation of surveillance systems. MMWR 1988;37(S-5):1–18.Google Scholar
15.Last, J: A Dictionary of Epidemiology. New York: Oxford University Press, Inc, 1988.Google Scholar
16.UNHCR: Inter-agency Field Manual. Reproductive Health in Refugee Situations. Geneva: UNHCR, 1999:pp 1–135.Google Scholar
17.Hynes, M, Sheik, M, Wilson, H, Spiegel, P: Reproductive health indicators and outcomes of displaced persons in post-emergency phase camps. JAMA In press 2002.CrossRefGoogle Scholar
18.U.S. Preventive Services Task Force: Guide to clinical preventatwe services. 2nd ed. Baltimore; Williams and Wilkins. 1996.Google Scholar
19.Harbour, R, Miller, J: A new system for grading recommendations in evidence based guidelines. BMJ 2001;323(7308):334–336.CrossRefGoogle ScholarPubMed
20.Toole, MJ, Waldman, RJ; Refugees and displaced persons. War, hunger, and public health. JAMA 1993;270(5):600–605.CrossRefGoogle ScholarPubMed
21.Toole, MJ, Waldman, RJ: Prevention of excess mortality in refugees and displaced populations in developing countries. JAMA 1990;263(24):3296–3302.CrossRefGoogle ScholarPubMed
22.Toole, MJ, Steketee, RW, Waldman, Rj, Nieburg, : Measles prevention and control in emergency settings. Bull World Health Organ 1989;67(4):381–388.Google ScholarPubMed
23.Wyndham, C, Fellingham, S: Climate and disease. S Afr Med J 1978; 53:1051–1060.Google ScholarPubMed
24.Becker, S, Weng, S: Seasonal patterns of deaths in Matlab, Bangladesh. Int J Epidemiol 1998;27:814–823.CrossRefGoogle ScholarPubMed
25.Centers for Disease Control and Prevention: Famine-affected, refugee, and displaced populations: recommendations for public health issues. MMWR 1992;41(RR-13):1–76.Google Scholar
26.Burkholder, BT, Spiegel, P, Salama, P: Methods of determining mortality in the mass displacement and return of emergency-affected populations in Kosovo, 1998-1999. Forced Migration and Mortality. Washington, DC: National Academy Press, 2001: pp 86–101.Google Scholar
27.Spiegel, P: The evolution of public health response in emergency and post-emergency phases of complex emergencies. Refuge 2000;18(5):1–3.CrossRefGoogle Scholar
28.Spiegel, P, Sheik, M, Gotway-Crawford, C, Salama, P: Displaced persons in post-emergency phase camps: Health programs and policies that effect mortality. Lancet In press 2002.Google Scholar
29.Spiegel, PB, Salama, P: War and mortality in Kosovo, 1998-99: An epidemiological testimony. Lancet 2000;355(9222):2204–2209.CrossRefGoogle ScholarPubMed
30.Spiegel, PB, Salama, P: Emergencies in developed countries: Are aid organisations ready to adapt? Lancet 2001;357(9257):714. Letter.CrossRefGoogle ScholarPubMed
31.Watson, F, Vespa, J: The impact of a reduced and uncertain food supply in three besieged cities of Bosnia-Hercegovina. Disasters 1995;19(3):216–234.CrossRefGoogle ScholarPubMed
32.Salama, P, Spiegel, P, Van Dyke, M, Phelps, L, Wilkinson, C: Mental health and nutritional status among the adult Serbian minority in Kosovo. JAMA 2000;284(5):578–584.CrossRefGoogle ScholarPubMed
33.UNICEF: Assisting in Emergencies: A Resource Handbook for UNICEF Field Staff. New York: UNICEF, 1992.Google Scholar
34.World Health Organization: Catalogue of Health Indicators: A Selection of Important Health Indicators Recommended by WHO Programmes. Geneva: WHO, 1996.Google Scholar
34.US Preventive Services Task Force: Guide to Clinical Preventive Services. 2nd ed. Baltimore: Williams and Wilkins, 1996.Google Scholar
35.UNHCR: Handbook for Emergencies. 2nd ed.Geneva: United Nations High Commissioner for Refugees, 1999.Google Scholar
36.Médecins Sans Frontières: Refugee Health: An Approach to Emergency Situations. London: Macmillan Education Limited, 1997.Google Scholar
37.Médecins Sans Frontières: Nutrition Guidelines. 1st ed. Paris: Médecins sans Frontières, 1995.Google Scholar
38.International Rescue Committee: IRC's Bank of Health Indicators Clustered by Phase of Emergency. New York: IRC, 2000. pp 1–45.Google Scholar
39.BHR Performance Monitoring and Evaluation Technical Assistance Team: Menu of Sector-Specific Humanitarian Assistance Performance Indicators. Washington, DC: USAID, 1998. pp 1–26.Google Scholar
40.Eijkenaar, J, Telford, J: Applying Indicators for the Monitoring and Evaluation of ECHO Funded Emergency Humanitarian Aid Projects. Brussels: ECHO, 1998.Google Scholar
41.Perrin, P: Handbook on War and Public Health. Geneva: International Committee for the Red Cross, 1996.Google Scholar
42.The Sphere Project: The Sphere Project—General Information Pamphlet. Geneva: Sphere, 2001. pp 1–26.Google Scholar
43.Nduna, S, Goodyear, L: Pain Too Deep for Tears: Assessing The Prevalence of Sexual and Gender Violence among Burundian Refugees in Tanzania. New York: International Rescue Committee, 1997. pp 1–35.Google Scholar
44.Waldman, RJ: Public health in times of war and famine: what can be done? What should be done? JAMA 2001;286(5):588–590.CrossRefGoogle Scholar
45.Terry, F.: The limits and risks of regulation mechanisms for humanitarian action. Humanitarian Exchange October, 2000:20–21.Google Scholar
46.Gostelow, L. The Sphere Project: The implications of making humanitarian principles and codes work. Disasters 1999;23(4):316–325.CrossRefGoogle Scholar
47.Maxwell, S: The application of minimum standards during crisis: A practitioner's perspective, southern Sudan 1998/9. Field Exchange 2000(11):15–18.Google Scholar
48.Salama, P, Assefa, F, Talley, L, Spiegel, P, van Der Veen, A, Gotway, CA: Malnutrition, measles, mortality, and the humanitarian response during a famine in Ethiopia. JAMA 2001;286(5):563–571.CrossRefGoogle Scholar