44th annual convention of philippine college of physicians, may 5, 2014

1. The Yolanda Experience:The Yolanda Experience:
Lessons LearnedLessons Learned
44th Annual Convention of Philippine College of Physicians
5 May 2014
TEODORO J. HERBOSA, MD
Undersecretary of Health
Coordinator, Disaster and Rehabilitation Management Task Force

2. Outline
• Introduction
• What were prepared?
• What happened?
• What have been done?
• Specific challenges and way forward

3. Introduction
• On November 08, 2013, Typhoon “YOLANDA” made seven landfalls:
– Guiauan, Eastern Samar, 4:40am
– Dulang-Tolosa, Leyte, 7:00am
– Daanbantayan, Cebu, 9:40am
– Bantayan Island Cebu, 10:40am
– Concepcion, Iloilo, 12:00nn
– Tibiao, Antique, 3:00pm
– Busuanga, Palawan
• PAGASA’s morning bulletin recorded maximum sustained winds of 235
kph and gustiness of up to 275 kph
• Many areas have become out of reach as the typhoon destroyed power
and communication lines
• Major airports and ports closed down
• Major roads in greatly affected areas have become impassable due to
devastating effects of the typhoon

4. Typhoon “Yolanda” Landfalls

5. Typhoon “Yolanda” Storm Surges

6. Affected Areas in Eastern Visayas

7. What were prepared?
November 6:
• Alert Memorandum was issued to all CHDs
• Prepositioned logistics worth PhP 350M
November 7
• Code Blue alert was raised in the CHDs most
at risk
• CHD OpCen opened for 24 hours
• Continuous monitoring

8. Timeline of DOH Response
Nov 6 Nov 7 Nov 8 Nov 9 Nov 10 Nov 11
Alert memo
issued to all
CHDs
Logistics
prepositioned
in CHDs VI, VII,
and VIII
Typhoon
Yolanda
Landfall
DOH-CO on
Code Red
No lifelines
in affected
areas
Medical
response
teams ready to
board C130
Code Blue
raised in all
CHDs at risk
OpCen
operational 24
hours
Continuous
monitoring of
the situation
DOH personnel
on duty at
NDRRMC
No
communication
from CHD VIII;
Only
qualitative info
and pictures
from
mainstream
media
CARAGA and
Albay medical
response
teams arrived
in Tacloban
Continuous
monitoring of
the situation
Secretary Ona
and other
officials visited
Tacloban
Teams from
MM hospitals
arrived in
Tacloban
Context: Unprecedented magnitude of Typhoon Yolanda effects

9. What happened?

10. What happened?
Region Province Deaths Injured
IV-A Quezon, Batangas 3 6
IV-B Palawan 19 63
V Albay, Masbate, Camarines
Norte
6 32
VI Iloilo, Aklan, Capiz, Antique,
Negros Occidental
**285 2,733
VII Cebu, Bohol 74 22
*VIII
Tacloban City, Leyte, Samar,
Eastern Samar, Biliran
5,803 26,123
IX Zamboanga 0 1
CARAGA Surigao del Sur 0 1
Total 6,190 28,981
Note:
*NDRRMC Sitrep No. 92 as of January 14, 2014 for Region VIII.
**CHD VI reported 285 deaths while NDRRMC reported 294 deaths.
Discrepancies in figures are still subject for validation by the CHD VI.

11. What happened?
Other impactsOther impacts
People CHD personnel who reported for work in the first
week
15 out of 267 (5.6%)
Local health personnel who reported for work in
the first week
Ground estimate of 10 to 20%
Health
Infrastructure
3 Damaged offices
(Warehouse and prepositioned logistics
destroyed)
PHP 50,350,000.00
50 out of 91 assessed hospitals are damaged
(45 partial, 5 complete; 45 functional, 5 non
functional)
PHP 696,810,800.00
550 out of 1,593 assessed RHU/BHS are
damaged (354 partial, 183 complete; 350
functional, 180 non functional)
PHP 541,239,000.00
EVRMC as the only remaining functional hospital
in Tacloban with personnel on duty for 3 straight
days
250 bed hospital accommodating 60
admissions reaching 300 inpatients,
and 70 E.R. Consultations (daily
averages)

12. What happened?
Health facility status
Region /
Province
No. of
existing
HF
No. of
assessed
HF
No. of
damaged
HF
Extent of Damage Operation Status
Estimated Cost of
Damage
Partially
damaged
Completely
damaged
Functional
Non-
functional
Region
VIII 620 289 289 177 92 177 92 1,013,119,800.00
Leyte 334 195 195 153 42 153 42 665,354,300.00
Eastern
Samar 141 78 78 15 43 15 43 279,186,200.00
Western
Samar 145 16 16 9 7 9 7 68,629,300.00
Region
VII 1,007 74 71 19 52 19 52 29,930,000.00
Region
VI 1,907 1,282 418 366 52 372 44 149,675,000.00
Region
IV-B 146 42 41 41 0 41 0 100,625,000.00
Total 3,680 1,687 819 603 196 609 188 1,293,399,800.00

13. What have been done?
Logistics provided
SourceSource RecipientRecipient AmountAmount
DOH-Central Office
CHD IV A 80,640.00
CHD IV B 702,640.00
CHD V 932,658.00
CHD VI 9,736,688.26
CHD VII 8,009,607.30
Washed Out (Tacloban Airport) 1,130,897.50
CHD VIII 78,990,219.70
Sub-allotment (EAMC, V, VII, and VIII) 42,300,000.00
Total DOH Central Office logisticsTotal DOH Central Office logistics 141,883,351.00
DOH HOSPITALS CHD VIII 4,025,232.54
CHD's (I,IV-A, IV-B, V, VI, VII, VIII, X, XI,
XII, MM, CAR, CARAGA) CHD IV-A, IV-B V, VI, VII,VIII 46,882,754.10
Total DOH Central Office logistics 50,907,986.64
Local Donation CHD VI, VII, VIII 14,023,226.65
International Donation CHD VII, VIII 21,006,027.40
Total donationsTotal donations 35,347,174.05
GRAND TOTALGRAND TOTAL 228,138,511.69
Note: Logistics include essential medicines, aquatabs and ORS,
hospital and laboratory equipments, family tent and cot beds,
cadaver bags, fogging machines, generator sets, computer
equipment

14. What have been done?
• As the Health Cluster lead, DOH provided
support to 144 registered foreign medical
teams as well as other local and international
NGOs through:
– Deployment coordination
– Technical advice through provision of local
protocols and guidelines
– Health services report consolidation
– Early disease warning detection and response

15. What have been done?
• Facilitated the acceptance and quality control
of donated medicines and medical supplies
• Health promotion activities and other public
health advisories
• Provision of cadaver bags
• Assistance to NBI and LGUs in the
management of the dead

16. What have been done?
• Deployment of composite team with
toxicology experts to manage the secondary
event of oil spill in Barangay Botongan,
Estancia, Iloilo

18. What have been done?
Summary of Services
Areas of ServiceAreas of Service Specific AccomplishmentsSpecific Accomplishments
Hospital services 34,522 patients served
2,127 operations conducted
Health teams deployed
(composite teams)
298 teams (154 national, 144 international). National teams are composed of 1,827
personnel). Approximately 20% were deployed to Tacloban while the rest are
distributed across all affected areas
Public Health services 126,299 out-patient consultations
46,865 measles immunization
12,165 tetanus vaccination
No disease outbreak as of today
Nutrition services 73,730 children screened for acute malnutrition (141 cases managed)
69,764 children received supplementary feeding program
33,619 children received vitamin A supplementation
27,020 children received multiple micronutrient powder
8,876 pregnant/lactating women assessed and counseled for infant and young child feeding
No worsening of nutrition condition and no deaths related to malnutrition in the
areas
Water, Sanitation, and
Hygiene services
1,747 latrines constructed/ rehabilitated
206,051 hygiene kits distributed
199,278 water kits distributed
MHPSS services 1,196 recipients of Counseling
6,924 recipients of Psychological First Aid
12,875 recipients of Psychosocial Processing
32 advance case referrals

19. What have been done?
Hospital services
REGION
No. of Patients
served
Consultations
Admission
No. of
Operations
Conducted
Status
ER OPD
No. of
Referral
No. of
Discharged
No. of
Deaths
REGION VIII 30,375. 2,194. 30,896. 3,318. 2,046. 190. 619. 83.
Leyte 30,375. 2,123. 30,810. 3,247. 1,944. 190. 600. 83.
Eastern Samar 0. 71. 86. 71. 102. 0. 19. 0.
Western
Samar
0. 0. 0. 0. 0. 0. 0. 0.
REGION VII 2,598. 0. 2,598. 149. 60. 0. 0. 3.
REGION IV-B 155. 55. 61. 18. 21. 0. 0. 0.
NCR (Patients
from Reg.8;
Villamor
Airbase)
1,394. 690. 408. 226. 219. 10.
GRAND
TOTAL:
34,522. 2,249. 34,245. 3,893. 2,127. 416. 838. 96.

20. What have been done?
Team mobilization
PROVINCE CITY/MUNICIPALITY
DOH TEAMS
DEPLOYED (120)
OTHER LOCAL
HEALTH
RESPONDERS (34)
FOREIGN TEAMS
(124)
TOTAL (278)
NO. OF
TEAMS
NO. OF
PERSONNEL
NO. OF
TEAMS
NO. OF
PERSONNEL
NO. OF
TEAMS
NO. OF
PERSONNEL
NO. OF
TEAMS
NO. OF
PERSONNEL
LEYTE TACLOBAN 53 626 15 367 14 279 82 1272
ORMOC 4 59 8 34 8 127 20 220
OTHERS 21 263 5 39 18 248 44 550
SAMAR EASTERN SAMAR 16 147 6 142 22 289
WESTERN SAMAR 1 11 1 11
CEBU DAANBANTAYAN, MACTAN,
CAMOSTES IS., SAN REMEGIO,
TABUELAN, BORBON, TOBOGON,
BOGO, STA. FE, MEDELLIN 8 49 4 90 10 167 22 306
METRO MANILA VILLAMOR AIRBASE, PASAY 11 72 1 4 12 76
DSWD NROC 5 11 5 11
PALAWAN CULION 1 5 1 5
ILOILO, CAPIZ,
AKLAN, ANTIQUE 4 91 1 50 2 74 7 215
OTHERS 5 12 5 12

21. What have been done?
Public Health services

22. What have been done?
Nutrition services

23. What have been done?
WASH services
REGION
No. of Population Served
Provision of
Potable Water
Water Testing
Distribution
of Water
Container
Water
Treatment/
Disinfectant
Provision of
Water for
General/
Domestic
Use
Construction/
Installation of
Toilets &
Latrines
Hygiene Kits
Provided*
Jerry Cans
Provided
Others
(water
purifier,
mobile
water
tanks)
VIII 20,681,572 41,008 230,385 84,380 224,137 1,610 166,815 251,802 193
Leyte 20,681,572 14,631 230,137 84,200 224,137 1,590 142,271 249,217 171
Eastern Samar 0 20,905 248 180 0 20 20,020 2,585 22
Western Samar - 5,472 - - - - 2,709 - -
Biliran - - - - - - - - -
VII - 1,500 - - - - 3,886 - 2
VI 0 21,088 1,653 0 0 157 15,917 1,653 618
IV-B - 4,000 - - - - - - -
Total 20,681,572 67,596 232,038 84,380 224,137 1,767 184,803 253,455 813

24. What have been done?
MHPSS services
REGION
No. of Population Served
PFA
Community &
Family Support
Counselling
Psycho-
education
session
Psychosocial
processing
Stress
Management
Program
Referral of
cases
Defusing
Mental Health
Services not
specified
VIII 1,261 245 696 113 2,205 290 17 415 1,962
Leyte 1,261 245 696 113 2,193 278 17 415 1,336
Eastern Samar 0 0 0 0 12 12 0 0 626
Western Samar - - - - - - - - -
Biliran - - - - - - - - -
Northern Leyte - - - - - - - - -
VII 672 0 408 0 302 0 0 0 0
VI 0 0 0 0 9,917 0 0 0 0
IV-B - - - - - - - - -
NCR 4,991 311 92 155 451 310 15 5 15
Total 6,924 556 1,196 268 12,875 600 32 420 1,977

25. Gaps identified
In consideration of the magnitude of Typhoon Yolanda
and the new normal, there is a need to:
• Update logistics and lifeline needs for emergency
health sector response
• Ensure health facilities to remain functional during
disasters
• Enhance equipment and preparation of health
response teams (local and international)
• Update health emergency preparedness, response,
and recovery plans
• Update systems for health service delivery especially
for mega disasters

26. Some specific challenges identified
• Current procurement plan accounted mainly for non-
capital outlay needs during emergency/disaster
• Some operational issues on cash advance releases/
liquidation experienced
• Team mobilization, composition, qualifications, and
deployment not clearly defined in responding to
Yolanda
• Current policies and guidelines covering most aspects
of health emergency and disaster response lack
provisions in addressing “mega” or “new normal”
emergencies and disasters
• Current CHD and hospital response plans did not
match the surge capacities requirements contingency
and business-continuity components

27. Way forward
On February 19 to 21, top management level of the
Department of Health held a strategic planning workshop
to increase its capacity to respond to emergencies and
disasters. There were five identified strategic objectives:
1. Improve the responsiveness of policies and plans at all
levels to mega disasters
2. Institutionalize effective ICS at all levels supported by
functional OpCen and IMS
3. Enhance the logistics and financing capacities to support
response operations
4. Build-up the resiliency of hospitals and other health
facilities against mega disasters
5. Enhance the adequacy, timeliness and appropriates of
health services delivered