2.2. Organization

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2 2 organizacion-engOnce disaster risk reduction is formally included in the national health sector plan, a system must be set up to establish clear links between the functions, roles, and responsibilities of all health sector institutions and levels, including each division and department in the ministry of health.

This structure of relationships should group roles and responsibilities to determine the organizational model that would work best to meet and fulfill these challenges, both within the ministry and in coordination with other institutions in and beyond the sector.

To clarify the organization and functions of the system, it would be helpful to develop an organizational chart with all relevant organizations and the minimal technical competencies required of the individuals assuming the various responsibilities.



2.2. Organization

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2.2.1. National, subnational, and local levels

2 2 1 ambito nacional

Disaster risk management in the health sector is not the exclusive responsibility of central-level health authorities. Regardless of how a country is organized administratively, the sub-national and local levels must participate in the process.

At the national level, decisions are made on policy, strategy, planning, and programs, and these decisions apply to all the country’s levels and territories. This is generally true for countries with a centralized government. However, in countries with federal systems, many of the responsibilities are handled by sub-national entities (which may go by different names—states, provinces, regions, etc.).

In centralized systems, the national health authority normally takes the leadership role strategically and in terms of policy, but may assume an operational role in events that affect national security, in which case decrees are issued providing for an exception to the general rule.

In other countries, such as Argentina, Brazil, and Mexico, decentralization is such that the management of disaster health risks is incumbent on the sub-national or municipal levels. In either case, the impact of disasters obliges all administrative levels to have mechanisms in place that allow them to be self-sufficient in the response to emergencies while support from other jurisdictions and levels inside and outside the country is on the way (if needed).

An analysis of the levels of government and their responsibilities, competencies, and capacities, will ease the way for preparing and implementing health sector policies and programs to minimize the impact of emergencies and disasters. The organization of a disaster program should be in line with the governmental structure, and each level should be strengthened, to maximize complementarity, efficiency and efficacy. This is particularly important when local or sub-national levels do not have all the resources and capacities necessary to reduce disaster risk or respond to emergencies and disasters. The EPHF 11 assessment instrument can be used to identify gaps.