Emergency Health Kit Research Articles

An analysis of 1999 world health organisation (WHO) guidelines for drug donations for better donation practice in emergency situations

In disasters and emergency situations, a lot of drug and medical supplies comes to the affected area from local or international donors. But, those donations often generate more problems for the recipients. The WHO and major humanitarian organisations developed WHO Guidelines for Drug Donations in 1996. The guidelines based on four core principles which are all donation should benefit the recipient, respect for wishes and authority of the recipient, there should not be a double standard in quality, and effective communication between donor and recipient. The guidelines influenced positively to drug donation practices for several years until 2004. The drug donation practices during 2004 tsunami relief in Sri Lanka and Aceh (Indonesia) showed that the compliance with WHO Guidelines for Drug Donations was low. This study aim was to strengthen the effectiveness of WHO Guidelines for Drug Donations in disaster and emergency situations. While the objectives are to explore the strength and weakness of the WHO Guidelines for Drug Donations and to recommend how to improve the effectiveness of drug donations. In this study, the WHO Guidelines for Drug Donations were analysed using the model of health policy analysis from Walt and Gilson, which is specifically used for analysing health policies. The framework is viewed as a tool to describe the interactions and interconnections systems between content, context, process and groups of actors. The author concludes that presence of donation operator team for drug donations is needed during the emergency situations and it should be stated in the WHO Guidelines for Drug Donations. The WHO needs to encourage donors and recipients to refer to WHO Guidelines for Drug Donations when they are making their own guidelines. The guidelines can be strengthened at country level and adjusted to regulations in the countries. The WHO Guidelines for Drug Donations should state that donations are preferred in form of New Emergency Health Kit (NEHK) or cash donations, and the necessity of information and communication centre in the WHO Guidelines for Drug Donations.

The development of the noncommunicable diseases emergency health kit

The noncommunicable diseases (NCDs) emergency health kit was developed in response to the growing prevalence of NCDs in low and middle-income countries. Under conditions of conflict or following natural disasters, regular treatment of this category of diseases is often disrupted and rarely prioritized. This leads to greater morbidity and mortality both in the short and long term. The Eastern Mediterranean Region (EMR) has both a high incidence of NCDs and currently is the site of several major conflicts and hosts most of the world's refugees. Therefore, the WHO Regional Office for the Eastern Mediterranean initiated the development of the NCD emergency health kit to provide a structured set of medications, equipment and renewables to supply the needs of a population of 10 000 people over a period of 3 months following disruption of normal medical services. This report discusses the rationale and anticipated use of the NCD emergency health kit followed by the selection criteria, structure, content and quantification process of the kit. Finally, the next steps are examined, including the procurement, logistics and monitoring and evaluation process of the kit.

A refugee camp in the centre of Europe: clinical characteristics of asylum seekers arriving in Brussels

BackgroundIn the summer of 2015, the exodus of Syrian war refugees and saturation of refugee camps in neighbouring countries led to the influx of asylum-seekers in European countries, including Belgium....

Modifying the Interagency Emergency Health Kit to include treatment for non-communicable diseases in natural disasters and complex emergencies

The Interagency Emergency Health Kit (IEHK) provides a standard package of medicines and simple medical devices for aid agencies to use in emergencies such as disasters and armed conflicts. Despite...

Tackling the Rising Trends of Noncommunicable Diseases During Public Health Emergencies.

DEAR EDITOR, The 21st century has witnessed multiple public health emergencies (viz. Fukushima nuclear disaster, the Ebola outbreak in West Africa, civil wars, natural calamities, etc.), most of which are often associated with local, national, and international adverse consequences.[1,2] Further, amidst the serious deterioration of climate and other global circumstances, it is quite unlikely that in the coming years a reduction in disasters will be observed.[1,2] Simultaneously, an unexpected rise in the global magnitude of noncommunicable diseases (NCDs) has also been observed, with close to 38 million deaths being attributed to them on an annual basis, of which almost three-fourths are from low- and middle-income nations.[3] The public health emergencies and the NCDs present together as a deadly combination, with emergencies interfering with the maintenance of optimal health (owing to the presence of factors like overcrowding, interruption in the food supply/drinking water/sanitation/healthcare services, etc.), while NCDs acting as a major hurdle to ensure financial development and equity.[2,4] Furthermore, most of these determinants act together at times of disaster and either result in the rise in incidence of NCDs or facilitate the progression of the existing diseases.[4,5] Subsequently, the routine healthcare services are not only interrupted, but even there is a lack of coordination among relief agencies, resource/logistics constraints, shift of focus of health workers towards the containment of the disaster, and no capacity to monitor and evaluate the efforts.[4,5,6,7] Although, it is absolutely true that at times of acute stages of an emergency, the primary focus should be towards the effective management of the emergencies nevertheless, there should be an inbuilt mechanism or an action plan to simultaneously address the needs of people suffering from NCDs.[1,5,7] In fact, a definitive rise in NCDs associated morbidity and mortality has been reported at times of emergencies owing to the inability of the patients with NCDs to cope without access to adequate nutrition, medications, and follow-up; exacerbation of the existing NCDs leading to the development of various acute complications; and the persistence of the complications for a longer period of time in the form of disability and impact on quality of life.[5,6,7] However, till date, no precise recommendations have been proposed to comprehensively address the issue of NCDs during emergencies.[1,3,7] On a global scale, in an attempt to successfully respond to the problem of NCDs in emergencies and reduce the associated morbidity and mortality, the need of the hour is to create awareness about the significance of NCDs during emergencies, both among general population and health providers; conduct thorough review of the existing literature so that any cost-effective intervention can be identified and subsequently implemented (if needed), and to explore the morbidity/mortality pattern during and following an emergency through various research projects.[5,6,8] In addition, interventions like including different aspects of the NCDs into emergency strategies; formulating precise guidelines to enable targeted management of the NCDs during emergencies; enhancing collaboration between all the concerned sectors; and orienting health workers about different aspects of emergency through periodic training sessions, can further enhance the extent of benefit to the patients with existing NCD.[3,4,5,6] Further, an emergency health kit was developed and successfully employed in tackling the humanitarian crisis in Ukraine, and there is a definitive proposal to upscale it in the next few years.[7] To conclude, a significant rise in the NCDs associated morbidity and mortality has been observed during public health emergencies and thus extending appropriate and timely treatment to them will not only save their lives but even alleviate the risk of long-term complications. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

If you could only choose five psychotropic medicines: updating the interagency emergency health kit.

Mark van Ommeren and colleagues describe how they chose five psychotropic medicines to add to the Interagency Emergency Health Kit, which is a box with medicines and medical supplies designed to help people in major humanitarian emergencies.

Orienting psychiatrists to working in emergencies: a WPA-WHO workshop.

Orienting psychiatrists to working in emergencies: a WPA-WHO workshop.

Arrêt de la valorisation humanitaire des médicaments non utilisés : enjeux et perspectives

Since the 1970s, drugs unused by French households have been collected for humanitarian aid. In 1993, the Cyclamed system was created by pharmacists in order to manage and collect unused drugs. However, experience has shown that in developing countries unused drugs caused more problems than they solved, including: poorly adapted to the needs of the population, poor quality of the collected medicines, interferences with local pharmaceutical policies, misappropriation... As recommended by the World Health Organisation, most of the humanitarian organizations stopped unused drug donations. In France this practice has been forbidden since the 1st of January 2009. Associations that still desire to send unused drugs to developing countries must develop other approaches, such as essential generic medicines or emergency health kits.

Drug donations: what lies beneath

Drug donations are necessary and valued when they accurately meet the recipient’s needs. However, the lack of international regulation on drug donation procedures allows some entities to take an unfair advantage of the situation. WHO has repeatedly drawn attention to what is probably the main issue related to drug donations in the form of development aid and humanitarian assistance: “good procurement – getting quality medicines to people when and where needed”.1 According to WHO, “the number of different agencies involved in procuring drugs – including ministries of health, manufacturers and donor agencies – can render the process highly complex and vulnerable to inefficiency and waste”. WHO’s interagency guidelines for drug donation describe four core principles that should be respected and guaranteed: (i) maximum benefit to the recipient; (ii) respect for the wishes and authority of the recipient; (iii) no double standards in quality; and (iv) effective communication between donor and recipient.2 Regrettably, these guidelines are not international regulations. Recent accounts of emergency relief operations throughout the world reveal that all major donations of pharmaceuticals fail to meet the recipients’ real needs.3 The inappropriateness of drug donations comes primarily from their origin (industry surpluses, free medical samples, drugs collected by independent organizations or returned to pharmacies for disposal). Some drugs arrive unsorted and labelled in languages unknown to the professionals in the field. Expired drugs (at the time of their arrival) and drugs close to expiry still comprise a large proportion of donations from nongovernmental organizations, corporations, pharmaceutical industries and associations.4 This practice is defended by a sad assertion that making use of expired, partially degraded drugs is better than having none at all. It obviously raises an ethical issue about the existence of first-hand/first-class drugs and second-hand/lower-class drugs and a disturbing division between the rights and worth of different populations. Drug donations provide benefits such as tax deductions and are a very convenient way for industries to get rid of stagnant stocks without having to pay for their controlled and expensive destruction in their country of origin.5 Some entities seem to find it legitimate to send unusable drugs to nations which are not prepared to dispose of them safely and properly. The recipients receive the drugs as donations and instead are obliged to manage them as waste. Lamentably, there is no international convention to regulate the transfer of non-requested pharmaceutical products and surpluses across borders. Once received into a country, the donations cannot be returned to donors, as recommended by the guidelines, because they are considered hazardous cargo and their shipment must respect the Basel Convention on the Control of Transboundary Movements of Hazardous Wastes and their Disposal.6 This legal demand involves the existence of consented protocols between exporters and importers, and time-consuming procedures that severely compromise its feasibility. Therefore, we can clearly say that drug donations are not for free and most of the time their costs to the recipient countries surpass the very fair value of the donations. If the recipients have to pay more (for something they do not need and did not ask for) than they would by just purchasing the medicines and equipment needed, then what good are the donations? The useless medicines remaining from the process and the consequences that result from their management are self-defeating and represent a major public health problem for the local authorities. That is why the Emergency Health Kits were created by WHO in the early 1980s.7 Each kit comprises a standard set of drugs, disposable supplies and appropriate medical equipment for basic health care, and is specially conceived to quickly respond to the needs of approximately 10 000 people for 3 months. The kits are permanently stored by major relief organizations and not-for-profit suppliers and can be made available within 48 hours.8 The WHO Action Programme on Essential Drugs determined that the sustainability of the kits depends exclusively on funding by external donors.9 Therefore, cash donations are an excellent way to support relief aid and to allow the affected governments to acquire the supplies its population needs. Another advantage of cash donations is that relief organizations can save, share and distribute funds to other recipients in later crises.10 Moreover, we should keep in mind that the arrival of international assistance to disaster areas can cause socioeconomic changes such as rising inflation, making poor people even poorer and recipients dependent on more donations.11 This is why drug donations need to be better regulated, particularly in humanitarian crises. ■

The New Emergency Health Kit

The New Emergency Health Kit

Essential drug lists and health relief management.

Based on suggestions made by Simmonds and Walker in 1982 The World Health Organization developed a standard Emergency Health Kit intended for use in refugee camps during the first 3 months of an emergency by populations of 10000. The complete kit had a weight of 858 kg and a volume of 2.6 cubic meters. Among its contents was a list of the drugs and equipment it contained. The list was divided into drugs that could be used by health workers with minimal training; drugs to be prescribed only by doctors and senior health workers; and simple laboratory and clinic equipment. The kit was used in many relief settings some of which were quite different from those it was intended for. In 1986 WHO commissioned a survey of representatives of relief organizations on their experiences with the kit. 153 questionnaires were sent to 128 organizations. Based on the 55 responses from 50 organizations (36% return) the advantages of the kit were its ease of transport time savings the use of drugs familiar to most volunteers guaranteed quality and usability in establishing a national basic health unit. Disadvantages included unfamiliarity of some national staff with drug names and doses ethical dilemmas where refugees might receive better health care than native populations long receipt times high costs of transport use and storage (sometimes = to cost of kit c. US$4800) incompatibility with some national emergency drug lists a size too large for small countries or scattered populations and non-adaptability to varying local situations. Recommendations of kit revision cover decreasing kit size provision for cold storage purchase of most liquids locally and elimination of glass containers more detailed labelling and better customs and shipment procedures. The list of drugs proved to be the most valuable item for those surveyed. A WHO committee is currently implementing these suggestions and a draft document of a revised kit has been prepared.

Book Reviews : WHO Emergency Health Kit, Standard Drugs & Clinic equipment for 10,000 persons for 3 Months. Published by W.H.O., 1984. Pp. 43. Price: Sw Fr 5. Paperback. ISBN: 92 4 154174 1

Book Reviews : WHO Emergency Health Kit, Standard Drugs & Clinic equipment for 10,000 persons for 3 Months. Published by W.H.O., 1984. Pp. 43. Price: Sw Fr 5. Paperback. ISBN: 92 4 154174 1

Anti-infective drugs in the WHO emergency health kit

Anti-infective drugs in the WHO emergency health kit

7.3. Emergency health kit

DisastersVolume 5, Issue 3 p. 310-318 7.3. Emergency health kit First published: September 1981 https://doi.org/10.1111/j.1467-7717.1981.tb01021.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume5, Issue3Special Issue: Healthcare in refugee campsSeptember 1981Pages 310-318 RelatedInformation