3.6. Health ministries’ role in reconstruction

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3.6.1.Organization of the ministry of health and its incorporation in the PDNA process and in reconstruction planning

3 6 1 organizacionWhen a country is affected by a disaster, the ministry of health should, from the beginning, take a very active role on reconstruction committees or councils. The definition of needs should be solidly based on the assessment of damage, losses, and the strategic approach that health authorities wish to promote to recover and improve physical infrastructure, equipment, and the operation of services affected by the disaster.

For this to occur, it is essential that the government of the affected country officially request the PDNA to be undertaken, and that it involve all national actors and communities affected. This will ensure that decision-making entities at the highest level take into account the needs of all affected sectors.

In the health sector, ministries of health can count on the technical support of the agencies of the United Nations system and other NGOs, as well as international mechanisms. These organizations, which are brought together as a group for emergency response under the leadership of WHO (and, in the Americas, PAHO), constitute the Global Health Cluster. (See section 3.2 of Module 7 for more information). The Health Cluster is a key source of up-to-date information on needs for the recovery period and suggests strategies in coordination with local and national health authorities.

To take maximum advantage of reconstruction committees and plans and participate in them effectively, the ministry of health should have information on:

  • Areas of the health system in which the authorities want to make progress during recovery, especially where public sector components are concerned.
  • The care model. For example, promoting the primary health care model could diminish the cost of hospital care by stressing cost-effective health care programs.
  • Priorities for the rehabilitation/reconstruction of health facilities.
  • Up-to-date regulations regarding building codes and operation.
  • Needs for medical and hospital equipment.
  • Resources.
  • Financial resources for the sustainable progress.

Taking the PDNA conducted for the health sector in Haiti as a frame of reference, it is clear that humanitarian assistance during an emergency may meet only a small fraction of the needs. The recovery process in Haiti had to deal with rebuilding 30 of the 40 existing hospitals in the three regions affected by the earthquake, as well as another eight in departmental capitals, including Port-au-Prince. Reconstruction costs also took into account human resources training and provision of equipment, drugs, and medical supplies. The estimated budget required in Haiti was US$380 million over an 18-month period.

In the case of the earthquake in Chile in March of 2010, according to the report submitted to the Congress by the Minister of Finance, the total estimated cost of the reconstruction process was US$24 billion dollars, of which US$2.7 billion were for reconstruction in the health sector.

3.6.2. Project execution unit

Due to their nature and time limits, reconstruction projects require earmarked funds if they are not to be affected by the changes to which the public sector is habitually subject.

Under the direction of the project manager, the principal activities to be carried out by the executing unit can be summarized as follows: 

  • Planning, organizing, managing, and monitoring execution of activities
  • Technical advice and assistance at the national, regional, and local levels as a part of post-emergency recovery activity
  • Preparation of reports to follow up on and monitor processes and programmed activities
  • Administrative actions to help achieve the expected results indicated in project proposals
  • Systematization of experiences and preservation of project documentation
  • Oversight/control unit or arrangements for independent technical audit
  • International competitive bidding for projects

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