Epidemiologists help with study design, collection and statistical analysis of data, and interpretation and dissemination of results (including peer review and occasional systematic review). Epidemiology has helped develop methodology used in clinical research, public health studies and, to a lesser extent, basic research in the biological sciences

Rabu, 28 Agustus 2013

The minimum standards

1. Water supply, sanitation and hygiene promotion (WASH)  Water supply, sanitation and hygiene promotion (WASH)


Water supply, sanitation and hygiene promotion (WASH)

The aim of any WASH programme is to promote good personal and environmental hygiene in order to protect health, as shown in the diagram below. An effective WASH programme relies on an exchange of information between the agency and the disaster-affected population in order to identify key hygiene problems and culturally appropriate solutions. Ensuring the optimal use of all water supply and sanitation facilities and practising safe hygiene will result in the greatest impact on public health.
Hygiene promotion is vital to a successful WASH intervention. The focus on hygiene promotion is general and specific. In general terms, hygiene promotion is integral to all of the sections and is reflected in the indicators for water supply, excreta disposal, vector control, solid waste management and drainage. 
More specifically, the focus narrows on two hygiene promotion standards in this chapter and relates to particular hygiene promotion activities.

Disease prevention
Hygiene improvement in emergencies
Enabling environment
Hygiene promotion
WASH standard 1: WASH programme design and implementation
WASH needs of the affected population are met and users are involved in the design, management and maintenance of the facilities where appropriate.
Key actions (to be read in conjunction with the guidance note) Identify key risks of public health importance in consultation with the affected population.  Provide and address the public health needs of the affected population according to their priority needs (see guidance note 1).
 Systematically seek feedback on the design and acceptability of both facilities and promotional methods from all different user groups on all WASH programme activities (see Core Standards 1, 3–4 on pages 55–65).
Key indicators (to be read in conjunction with the guidance note)
 All groups within the population have safe and equitable access to WASH resources and facilities, use the facilities provided and take action to reduce the public health risk (see Hygiene promotion standard 2 on page 94).
 All WASH staff communicate clearly and respectfully with those affected and share project information openly with them, including knowing how to answer questions from community members about the project. 
 There is a system in place for the management and maintenance of facilities as appropriate, and different groups contribute equitably (see guidance note 1).
 All users are satisfied that the design and implementation of the WASH programme have led to increased security and restoration of dignity.
Guidance note
1. Assessing needs: An assessment is needed to identify risky practices that might increase vulnerability and to predict the likely success of both the provision of WASH facilities and hygiene promotion activities. The key risks are likely to centre on physical safety in accessing facilities, discrimination of marginalised groups that affects access, use and maintenance of toilets, the lack of hand-washing with soap or an alternative, the unhygienic collection and storage of water, and unhygienic food storage and preparation. 
The assessment should look at resources available to the population, as well as local knowledge and practices, so that promotional activities are effective, relevant and practical. Social and cultural norms that might facilitate and/or compromise adherence to safe hygiene practices should be identified as part of the initial and ongoing assessment. The assessment should pay special attention to the needs of vulnerable people. If consultation with any group of vulnerable people is not possible, this should be clearly stated in 
the assessment report and addressed as quickly as possible 

2.Hygiene promotion

Hygiene promotion is a planned, systematic approach to enable people to take action to prevent and/or mitigate water, sanitation and hygiene-related diseases. It can also provide a practical way to facilitate community participation, accountability and monitoring in WASH programmes. Hygiene promotion should aim to draw on the affected population’s knowledge, practices and resources, as well as on the current WASH evidence base to determine how public health can best be protected. Hygiene promotion involves ensuring that people make the best use of the water, sanitation and hygiene-enabling facilities and services provided and includes the effective operation and maintenance of the facilities. The three key factors are:
1. a mutual sharing of information and knowledge 
2. the mobilisation of affected communities
3. the provision of essential materials and facilities. 
Community mobilisation is especially appropriate during disasters as the emphasis must be on encouraging people to take action to protect their health. Promotional activities should include, where possible, interactive methods, rather than focusing exclusively on the mass dissemination of messages. Hygiene promotion standard 1: Hygiene promotion implementation. Affected men, women and children of all ages are aware of key public health risks and are mobilised to adopt measures to prevent  the deterioration in hygienic conditions and to use and maintain the facilities provided.Key actions (to be read in conjunction with the guidance notes)  Systematically provide information on hygiene-related risks and preventive actions using appropriate channels of mass communication 

 Identify specific social, cultural or religious factors that will motivate different social groups in the community and use them as the basis for a hygiene promotion communication strategy
 Use interactive hygiene communication methods wherever feasible in order to ensure ongoing dialogue and discussions with those affected 
 In partnership with the affected community, regularly monitor key hygiene practices and the use of facilities provided.  Negotiate with the population and key stakeholders to define the terms and 
conditions for community mobilisers 
Key indicators (to be read in conjunction with the guidance notes)
 All user groups can describe and demonstrate what they have done to 
prevent the deterioration of hygiene conditions (see guidance note 1). All facilities provided are appropriately used and regularly maintained.  All people wash their hands after defecation, after cleaning a child’s bottom, before eating and preparing food 
 All hygiene promotion activities and messages address key behaviours and 
misconceptions and are targeted at all user groups.. Representatives from all user groups are involved in planning, training, implementation, monitoring and evaluation of the hygiene promotion work 
 Care-takers of young children and infants are provided with the means for safe disposal of children’s faeces (see Excreta disposal standard 1 on page 105 and guidance note 6). 
Guidance notes
1. Targeting priority hygiene risks and behaviours: The understanding 
gained through assessing hygiene risks, tasks and responsibilities of different 
groups should be used to plan and prioritise assistance, so that the information flow between humanitarian actors and the affected population is appropriately targeted and misconceptions, where found, are addressed. 
2. Reaching all sections of the population: In the early stages of a disaster, it may be necessary to rely on the mass media to ensure that as many people as possible receive important information about reducing health risks. Different groups should be targeted with different information, education and communication materials through relevant communication channels, so that information reaches all members of the population. This is especially important for those who are non-literate, have communication difficulties and/or do not have access to radio or television. Popular media (drama, songs, street theatre, dance, etc.) might also be effective in this instance. Coordination with the education cluster will be important to determine the opportunities for carrying out hygiene activities in schools. 

3. Interactive methods: Participatory materials and methods that are culturally appropriate offer useful opportunities for affected people to plan and monitor their own hygiene improvements. It also gives them the opportunity to make suggestions or complaints about the programme, where necessary. 
The planning of hygiene promotion must be culturally appropriate. Hygiene promotion activities need to be carried out by facilitators who have the characteristics and skills to work with groups that might share beliefs and practices different from their own (for example, in some cultures it is not acceptable for women to speak to unknown men). 
4. Overburdening: It is important to ensure that no one group (e.g. women) 
within the affected population is overburdened with the responsibility for 
hygiene promotion activities or the management of activities that promote 
hygiene. Benefits, such as training and employment opportunities, should be offered to women, men and marginalised groups.
5. Terms and conditions for community mobilisers: The use of outreach workers or home visitors provides a potentially more interactive way to access large numbers of people, but these workers will need support to develop facilitation skills. As a rough guide in a camp scenario, there should be two hygiene promoters/community mobilisers per 1,000 members of the affected population. Community mobilisers may also be employed as daily workers, on a contract or on a voluntary basis, and in accordance with national legislation. Whether workers have paid or volunteer status must be discussed with the affected population, implementing organisations and across clusters to avoid creating tension and disrupting the long-term sustainability of systems already in place. 
6. Motivating different groups to take action: It is important to realise that health may not be the most important motivator for changes in behaviour. 
The need for privacy, safety, convenience, observation of religious and 
cultural norms, social status and esteem may be stronger driving forces 
than the promise of better health. These triggering factors need to be taken into account when designing promotional activities and must be effectively incorporated into the design and siting of facilities in conjunction with the d s engineering team. The emphasis should not be solely on individual behavioural change but also on social mobilisation and working with groups. The disaster-affected population has access to and is involved in identifying and promoting the use of hygiene items to ensure personal hygiene, health, dignity and well-being. Key actions (to be read in conjunction with the guidance notes) .Consult all men, women and children of all ages on the priority hygiene items they require (see guidance notes 1, 3–4). Undertake a timely distribution of hygiene items to meet the immediate needs of the community (see guidance notes 2–3).
 Carry out post-distribution monitoring to assess use of and beneficiary satisfaction with distributed hygiene items (see guidance notes 3 and 5).  Investigate and assess the use of alternatives to the distribution of hygiene items, e.g. provision of cash, vouchers and/or non-food items (NFIs) (see Food security – cash and voucher transfers standard 1 on page 200). Key indicators (to be read in conjunction with the guidance notes) Women, men and children have access to hygiene items and these are used effectively to maintain health, dignity and well-being  All women and girls of menstruating age are provided with appropriate 
materials for menstrual hygiene following consultation with the affected opulation (see guidance notes 5 and 8). All women, men and children have access to information and training on the safe use of hygiene items that are unfamiliar to them (see guidance note 5). Infor mation on the timing, location, content and tar get groups for an NFI distr ibution is made available to the affected population (see guidance notes 3–5).

Guidance notes
1. Basic hygiene items: A basic minimum hygiene items pack consists of water containers (buckets), bathing and laundry soaps, and menstrual hygiene materials. List of basic hygiene items 10–20 litre capacity water container for transportation 
One per household 10–20 litre capacity water container for storage 
One per household 250g bathing soap One per person per month
200g laundry soap One per person per month
Acceptable material for menstrual hygiene, e.g. washable cotton cloth 
One per person 
2. Coordination: Discuss with the shelter cluster and the affected population 
whether additional non-food items, such as blankets, which are not included 
in the basic hygiene items are required (see Non-food items standard 1 on 
page 269). 
3. Timeliness of hygiene items distribution: In order to ensure a timely distribution of hygiene items, it may be necessary to distribute some key generic 
items (soap, jerrycans, etc.) without the agreement of the affected population and come to an agreement concerning future distributions following 
4. Priority needs: People may choose to sell the items provided if their priority 
needs are not appropriately met and so people’s livelihoods need to be 
considered when planning distributions.
5. Appropriateness: Care should be taken to avoid specifying products that 
would not be used due to lack of familiarity or that could be misused (e.g. 
items that might be mistaken for food). Where culturally appropriate or 
preferred, washing powder can be specified instead of laundry soap.
6. Replacement: Consideration should be given for consumables to be 
replaced where necessary.
7. Special needs: Some people with specific needs (e.g. incontinence or 
severe diarrhoea) may require increased quantities of personal hygiene items 
such as soap. Persons with disabilities or those who are confined to bed may need additional items, such as bed pans. Some items may require adaptation for sanitary use (such as a stool with a hole or commode chair).
8. Menstrual hygiene: Provision must be made for discreet laundering or 
disposal of menstrual hygiene materials. 
9. Additional items: Existing social and cultural practices may require access 
to additional personal hygiene items. Subject to availability, such items (per 
person per month) could include:
- 75ml/100g toothpaste 
- one toothbrush
- 250ml shampoo
- 250ml lotion for infants and children up to 2 years of age
- one disposable razor
- underwear for women and girls of menstrual age
- one hairbrush and/or comb
- nail clippers 
- nappies (diapers) and potties (dependent on household need).

Coordinated School Health

The Case for Coordinated School Health

Coordinated school health (CSH) is recommended by CDC as a strategy for improving students' health and learning in our nation’s schools.
Why Schools?
The healthy development of children and adolescents is influenced by many societal institutions. After the family, the school is the primary institution responsible for the development of young people in the United States.
·         Schools have direct contact with more than 95 percent of our nation’s young people aged 5–17 years, for about 6 hours a day, and for up to 13 critical years of their social, psychological, physical, and intellectual development.
·         Schools play an important role in improving students’ health and social outcomes, as well as promoting academic success.

Why School Health?
The health of young people is strongly linked to their academic success, and the academic success of youth is strongly linked with their health. Thus, helping students stay healthy is a fundamental part of the mission of schools. After all, schools cannot achieve their primary mission of education if students and staff are not healthy.
·         Health-related factors, such as hunger, chronic illness, or physical and emotional abuse, can lead to poor school performance.1
·         Health-risk behaviors such as substance use, violence, and physical inactivity are consistently linked to academic failure and often affect students' school attendance, grades, test scores, and ability to pay attention in class.2-4
The good news is that school health programs and policies may be one of the most efficient means to prevent or reduce risk behaviors and prevent serious health problems among students.5Effective school health policies and programs may also help close the educational achievement gap.6

Why Coordinate School Health?
School health programs and policies in the United States have resulted, in large part, from a wide variety of federal, state and local mandates, regulations, initiatives, and funding streams. The result, in many schools, is a “patchwork” of policies and programs with differing standards, requirements, and populations to be served. In addition, the professionals who oversee the different pieces of the patchwork come from multiple disciplines: education, nursing, social work, psychology, nutrition, and school administration, each bringing specialized expertise, training, and approaches.
Coordinating the many parts of school health into a systematic approach can enable schools to
·         Eliminate gaps and reduce redundancies across the many initiatives and funding streams
·         Build partnerships and teamwork among school health and education professionals in the school
·         Build collaboration and enhance communication among public health, school health, and other education and health professionals in the community
·         Focus efforts on helping students engage in protective, health-enhancing behaviors and avoid risk behaviors
Coordinated School Health
SHC utilizes the Center for Disease Control and Prevention’s (CDC) Coordinated School Health (CSH) guidelines as a framework for developing its school wellness program. This framework calls for an organized approach that recognizes that school health is multifaceted through eight interrelated components:

·         Healthy School Environment: The physical, emotional, and social climate and culture of the school supports and enhances the health of students, staff and families. School policies address the health of students along with academics. The school environment includes the physical, emotional, and social conditions that affect the well-being of students and staff.
·         Health Education: A comprehensive health curriculum that addresses the physical, mental, emotional and social dimensions of health. The curriculum provides knowledge and skills that help students maintain and improve their health, prevent disease, and reduce health-related risk behaviors. The curriculum includes a variety of topics such as personal and family health, community health, environmental health, sexuality, mental and emotional health, injury prevention and safety, nutrition, disease prevention and control, and substance use and abuse.
·         Physical Education: A comprehensive, sequential curriculum that provides learning experiences in a variety of activity areas. Quality physical education should promote, through a variety of planned physical activities, each student's optimum physical, mental, emotional, and social development, and should promote activities and sports that all students enjoy and can pursue throughout their lives.
·         Health Services: Services are provided for students to appraise, protect, and promote health. These services are designed to ensure access or referral to primary health care services, foster appropriate use of primary health care services, prevent and control communicable disease and other health problems, provide emergency care for illness or injury, promote and provide optimum conditions for a safe school facility and school environment, and provide educational and counseling opportunities for promoting and maintaining health.
·         Nutrition Services: Access to a variety of nutritious, appealing and affordable meals that accommodate the health and nutrition needs of all students. School nutrition programs should meet or exceed the U.S. Dietary Guidelines for Americans. The school nutrition services are designed to maximize each child’s health and education potential, and provide an environment that promotes health eating habits for all children.
·         Counseling and Psychological Services: Services are provided to improve students' mental, emotional, and social health; this includes individual and group assessments, interventions, and referrals. School counselors, social workers and psychologists contribute not only to the health of students but also to the health of the school environment. Prevention services facilitate positive learning and healthy behavior, and enhance healthy child and adolescent development.
·         Health Promotion for Staff: Opportunities for school staff to improve their health status through activities such as health assessments, health education and health-related fitness activities. These opportunities encourage school staff to pursue a healthy lifestyle that contributes to their improved health status, improved morale, and a greater personal commitment to the school's overall coordinated health program.
·         Family and Community Involvement: An integrated school, parent, and community approach for enhancing the health and well-being of students. School health advisory committees, coalitions, and broadly based constituencies for school health can build support for school health program efforts. Schools actively solicit parent involvement and engage community resources and services to respond more effectively to the health-related needs of students.
Friskila Damaris Silitonga SKep. NS.MPH