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An Integrated Disaster Preparedness Model for Rural Population
An Experience of the IMSS SOLIDARITY Program in Southern Veracruz, Mexico

The Mexican Institute of Social Security (IMSS) has been running the SOLIDARIDAD Program with Federal funds for over 20 years. The Program is designed to provide integral health care to the country’s rural communities. To date it provides services to over 10 million low-income peasant and indigenous Mexicans through a system of 3,200 first-level Rural Medical Units (RMUs) managed by a doctor and a paramedic. The units function year round in 16 states.

In the case of the state of Veracruz, five rural hospitals and 205 RMUs serve more than 1,600,000 inhabitants, most of them peasants, and 25% of them members of indigenous groups.

The population’s low level of schooling demands that information and education efforts be based on face to face community group meetings and the use of simple didactic material, preferably audiovisual.


Community Health Organizations

The cornerstone of the IMSS SOLIDARIDAD Program is the community health organizations, which are aimed at preventive and basic health actions. Their effectiveness relies on the long tradition of community cooperation in rural areas, especially among indigenous communities. A total of 1,296 health committees have been set up in the state, and training has been provided to 1,051 rural health assistants, 9,708 rural health promoters, 589 rural midwives, and 356 traditional therapists, facilitating the carrying out of preventive and educational campaigns.

The purpose of the Program is to establish clear operational lines for acting before, during, and after an emergency. County and local teams, interdisciplinary teams, government bodies and community volunteers all know what their responsibilities are and what actions to take in the face of any type of emergency.


General Objective

The general objetive is to systematize the procedures for planning, coordinating, and executing the actions required before, during, and after any natural or manmade disaster in order to mitigate, prevent, and respond to the damage and reduce the impact on the communities.


Advances in Region One: Orizaba

Training of health personnel on the Integral Disaster Response Model began in March. They were taught a simplified symbology for drawing local risk and resource maps, more than 600 of which have been produced to date. They have proven very useful in developing contingency plans in high-risk areas and their medical units.

In addition, the Damage Assessment and Needs Analysis (DANA) Methodology, which was taught by representatives from the Office of U.S. Foreign Disaster Assistance (USAID/OFDA) during the training courses, has begun to be implemented. Moreover, six community action promoters, a zonal medical advisor, and two unit conservation chiefs have already been trained, and 1,946 volunteers have participated in regional meetings to exchange experiences and ideas.

Contact has been made with the State Civil Protection Directorate, and educational material has been received, including posters, brochures, and audiovisual materials to complement the information produced at the community level. Videos on the characteristics of various types of disasters and on initial risk assessment techniques were also received; they have been useful in helping the population to decide on the actions that must be carried out before, during, and after an adverse event.


Conclusions

Less than a year after the Integral Disaster Response Model was launched, results are encouraging, particularly the high level of participation by the communities and the great work by the RMUs, which have carried out information, guidance, and training activities at the grassroots level.

However, much remains to be done. Preparations are underway for a training program for volunteer brigades. The Autonomous University of Veracruz has agreed to collaborate with the State Civil Protection Directorate to develop a training and mutual support program to facilitate timely intervention in the event of a disaster.

 

Stages of the Model

Planning

Each community will develop a local contingency plan specifying the activities to be carried out and the strategies for responding to the various adverse events, with the participation of the local authorities, community leaders, health teams, and local inhabitants.

The plan must include the following components:

• Risk assessment
• Risk and resource map with the following information:

- Demographic information
- Epidemiological profile
- Health infrastructure
- Material resources
- Human resources
- Communications media
- List of participating institutions and bodies

It is very important at this stage to secure the participation of municipal authorities in order to coordinate support for the institutions involved in carrying out civil protection activities, as well as to maintain a liaison with health personnel on the ground.

After the assessment has been completed, special attention must be paid to high-risk areas—where drills and simulacra must be carried out—and to the training of the health teams and volunteer groups. The latter task involves taking into consideration the traditional means and ways of communication within the various social networks, the customs, and above all the cultural patterns, particularly in indigenous areas.

Implementation

This stage requires monitoring hydrometeorological phenomena and the messages from the municipal authorities and civil protection bodies so as to issue timely warnings to the population and carry out evacuations, if necessary, as well as deploying RMUs wherever they may be needed.

Immediate Communication and Information

This phase kicks in when disaster strikes. Mechanisms must already be in place to report any event and request support, including an effective wireless telecommunications network. Alternative systems, including battery-operated systems, need to be in place as well in case there should be power cuts. Alternative routes must also have been identified in case normal access should be blocked to any given community.

Immediate Implementation of The EPI-DESASTRES System

The radio stations of the National Indigenous Peoples Institute and other local radio stations broadcast information to the affected communities, including information about current events and the relief systems in place.

At this stage, as well, first- and second-level medical care, arranged by micro-regions, becomes available, including the deployment of emergency care modules to supplement the work of the normal RMUs.

Emergency supply warehouses—the location of which would have been defined in advance—spring into action and start receiving and distributing drugs, food, and other supplies in a systematic manner. Support brigades are quickly assembled and deployed.

Community Participation

Concurrent with the previously mentioned stages, community brigades assemble and receive the necessary support and equipment from the municipal authorities before engaging in search and rescue operations, shelter construction and management, and the collection and distribution of emergency supplies to the affected population. Simple epidemiological surveillance and environmental sanitation actions are carried out as needed.
The communities are kept informed of the course of the emergency and what is being done in response using the various prearranged communication channels. Local residents are encouraged to participate in the rehabilitation and reconstruction of roads, housing units, and public facilities.

Evaluation

The final report must include information about the affected population, damage estimates, health and epidemiological information, as well as an inventory of the resources used.

Benchmarks to help measure the success of the operation include the following: restoring all medical units that may have been affected by the disaster, reporting any infectious diseases detected by the medical units in the emergency shelters or the community at large, keeping mortality below one percent, and controlling in timely fashion any epidemic outbreaks.

For more information please contact:
Lic. Domingo Velázquez Reyes
Supervisor Delegacional de Acción Comunitaria
Región Uno Orizaba
licdom@prodigy.net.mx

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