Integrated Health Sector Contingency Plan

2069/70
For Immediate Public Health Response to Humanitarian
Crisis















Government of Nepal
Ministry of Health and Population
Department of Health Services
Western Regional Health Directorate
District Health Office
Arghakhanchi

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Acknowledgement

District Health Office Arghakhanchi has recently prepared this contingency plan under the
guiding policy of EDCD as a part of early prepared and response to mitigate the effect of
probable disaster within the district. For the preparation of this plan, DHO collected different
types of information and reviewed report form District Development Committee, DDRC Red-
Cross, Nepal Army, District Police Office, Women and Child Development Office Arghakhanchi
and others.
First of all, I would like to express my sincere thanks to all the participants, stakeholders, focal
persons who contributed their knowledge and skills to prepare the plan. I would also like to
appreciate the contribution of EDCD, WHO, and Planning Officer of DDC during planning
workshop. My special thanks goes to Mr. Damodar Adhikari Program Officer WHO and Mr.
Shrawan Kumar Nayak, Sr. Public Health Officer and Shambhu Bhagat , HA, from EDCD for
technical support.
I would like to acknowledge the contribution of Mr Gobinda Mani Bhurtel (CDO), Mr. Hira
Bahadur Pandey (DSP), Mr Hem Raj Bhusal (LDO), Mr. Lilaram Gautam (PHO) and Purna BK
(District coordinator UNFPA). I would like to appreciate all the participants for their active
participating in the workshop.
Finally I would also express my sincere gratitude to Mr. Anil Dhungana (PHO), Mr. Kabindra
Regmi (DACC Cordinator), Mr. Ganesh Raj Paudel (Public Health Inspector), for generous hard
work in preparing the Plan.




Dr. Yam B. Basnet
District Health Chief

Acronyms and Abbreviations
AGE Acute Gastro-Enteritis
AIDS Acquired Immuno Deficiency Syndrome
ANC Antenatal Care
APF Armed Police Force
ART Antiretroviral Therapy
ATD Anti Tubercular Drug
BEOC Basic Emergency Obstetric Care
CBO Community Based Organization
CDO Chief District Officer
CEOC Comprehensive Emergency Obstetric Care
CHD Child Health Division
DACC District AIDS Coordination Committee
DAO District Administration Office
DDRC District Disaster Response Team
DHO District Health Office
DOTS Directly Observed Treatment Center
DVO District Veterinary Office
DWSO District Water and Sanitation Office
DWASHCC District Water Sanitation and Hygiene Coordination Committee
EDCD Epidemiology and Disease Control Division
EPI Expanded Programme on Immunization
EWARS Early Warning and Reporting System
FCHV Female Community Health Volunteer
FHD Family Health Division
FP Family Planning
FPA Family Planning Assistant
FPAN Family Planning Association of Nepal
GoN Government of Nepal
HA Health Assistant
HF Health Facility
HFI Health Facility In-charge
HIV Human Immuno Virus
HMIS Health Management Information System
HP Health Post
HR Human Resource
HRI Health Right International
HSCP Health Sector Contingency Plan
HW Health Worker
IEC Information Education and Communication
INC Intra Natal Care
I/NGO International Non Government Organization
IRA Immediate Rapid Assessment
LHF Local Health Facility
LMD Logistic Management Division
LUHESCO Lumbini Health Service Cooperative Ltd
MCHW Maternal and Child Health Worker
MISP Minimum Initial Service Package
MO Medical Officer
M/WR Mid Western Region
MWRA Married Women of Reproductive Region
NFHP-II Nepal Family Health Programme-II
NRCS Nepal Red Cross Society
OPD Out patient Door
PHC Primary Health Care/ Centers
PHO Public Health officer
PNC Post Natal Care
RHD Regional Health Directorate
RMS Regional Medical Store
RRN Rural Reconstruction Nepal
RRT Rapid Response Team
RTA Road Traffic Accident
S/AHW Sr. Auxiliary Health Worker
SBA Skilled Birth Attendant
SHP Sub Health Post
STI Sexually Transmitting Diseases
U5 Under Five
VCT Volunteer Counseling Testing
VDC Village Development Committee
VHW Village health Worker
WFP World Food Programme
WHO World Health Organization


1
Table of Contents
SECTION I INTRODUCTION ....................................................................................... 2
A. Background .................................................................................................................... 2
B. District Background: ...................................................................................................... 3
C. Previous Year Epidemic and Disaster Experience ......................................................... 4
D. Possible Health Consequences ...................................................................................... 5
E. Minimum Initial Service Package for Reproductive Health (MISP) ............................. 6
D. Capacity Analysis:- ...................................................................................................... 21
E. Contingency Planning Process :- .............................................................................. 23
F. Strategic Directions .................................................................................................... 24
Section II Health Sector Contingency Plan ................................................................... 25
A. Hazard and Risk Analysis of Arghakhanchi ................................................................ 25
B. Contingency Plan ......................................................................................................... 26
Section III Hospital Emergency Preparedness Plan.......................................................... 47
SECTION IV COMMUNICATION STRATEGY ........................................................ 54
SECTION V ANNEXES .................................................................................................. 55
Annex I. Short Analysis of Critical Facilities ................................................................ 55
Annex II-Access and Distance form District Headquarter (in KM) ............................... 58
Annex III-Information on Ambulance Services ............................................................ 61
Annex IV- Important Contact Information ....................................................................... 62
Annex V Logistic Requirement Required to Respond to Disaster (Epidemic, Earth
Quake, Landslide, Dog Bite, Fire etc) .............................................................................. 63
Annex VILogistic Tracing Form .................................................................................... 64
Annex VIITalking Point Template ................................................................................. 65
Annex VIIISituation Report Template............................................................................ 66
Annex IX Training Attendance ....................................................................................... 67

2
SECTION I INTRODUCTION
A. Background
Nepal have experienced several Geophysical , climatic hazards in the past and is prone to
many kinds of natural hazards which have occurred with increasing frequency over the
previous two decades. In addition, the public health emergencies such as diarrhea
epidemic in the mid and far west hills have toll lives and other health consequences as
well. When disasters occur, several human rights come under threat, including the right to
the highest attainable standard of physical and mental health. In every disaster, the
ultimate suffering at individual and population level is, no doubt, on health status of the
population as it directly affects the performance of the district health system to respond to
its peoples need, experience shows.
The consequences of a disaster depend on the scale and population density in the affected
area. Disasters may hit remote areas of Nepal, which will pose an added challenge to
humanitarian responders in terms of the logistics and transportation requirements. On the
one hand, the lack of adequate infrastructure may exacerbate the impact of a disaster and
hence cause more challenges for the responses.
The country is relatively ranked very high in terms of vulnerability to natural calamities.
The risk is believed to be increasing very rapidly mainly due to the growth in population.
Another major factor for the increasing risk is the lack of a favorable policy and legal
environment commensurate with the present-day situation, needs, opportunities and
resource availability. In Nepal floods create the largest disasters, earthquakes are the
deadliest one, fires cause the largest material losses and civil unrest induces the heaviest
economic impede in the country.
In such scenario, Nepal has already formulated the national level policy structures to
respond to the needs of the population in emergencies in holistic approach. Ensuing it
District Health Office (DHO), Arghakhanchi has attempted to prepare its health sector
contingency plan to bring forth the immediate relief to its population during emergency
in close coordination with all the actors at district level.

3
B. District Background:
Arghakhanchi is situated between 2745 N to 286 N and 8045 east to 83 23 east.
The district covers a total of 1193 sqkm area. It is bounded by Palpa in the east Gulmi in
the north, Kapilbastu& Rupendhi district in the soth and Dang & Pyauthan in the west.
68% of its land space is located in Mahabharat range and 32% located in Siwalik region.
Total population of Arghakhanchi district is 1,97,632. The total households are 46835
1
.
(Census 2011, district profile of Arghakhanchi Nepal). Sandhikharka is its district head
quarter 300 km southwest of Nepal capital Kathmandu. Altitude of Arghakhanchi is
1090 meters from the sea level. Climatically the average temperature varies between 6.5-
40 c .The rainfall pattern is similar to national senario having average rainfall off
2200ml
2
. Politically arghakhanchi has 42 VDC and 11 Illaka and 2 electoral constituency.
Geography: Arghakhanchi lies between 27'45"N and 28'6"N latitude, and 80'45"E to
83'23"E longitude. It covers 1,193 km. The altitude of the district varies from 305 to
2515 meter above the sea level. 68% of the district is in the mountainous Mahabharat
Range and the rest is in the Siwalik Hills. Elevations range from 3052575 m above sea
level and about 40% of the total area is forested. The major rivers of the district are Bangi
khola, Bangsari Khola, Mathurabesi Khola, Banganga Khola, Durga khola, Sita khola,
Khakabesi Khola, Rangsing Khola, Ratne Khola, Jhimruk Khola, Khankbesi Khola etc..
The major lakes of the district are Thada lake and Sengleng lake.
Most of the Land structure consist of low height hills, georges (koach) and small plains
land structure. District Headquater Sandhikharka is connected to terai with 68 kilometer
blacktopped road with Mahendra Highway at Gorusinghe of Kapilbastu District.
Seasonal Muddy road connects district headquarter with all other VDCs, However during
rainy seasons most of the VDCs are hard to reach.
Unmanaged construction of road and irrigation and deforestation has increased the risk of
natural disaster such as landslide.
Population: The total household in Arghakhachi is 46835 with the total population of
197632. The district cover the area of 1193 Sq km, Population density is 166 per Sq Km.
Among the total Male population is 43.65% and female population is 56.35%. The Sex
ratio is 77.5 indicating the unbalanced population distribution among sex. Arghakhanchi

1
Census Report 2011,
2
District Profile of Arghakhachi, DDC
4
along with Gulmi and Pyuthan districts reported the highest proportion of their
population being absent (staying abroad). The total absent population is 39929, which is
20.2% of total population of the District. The following table represents population age
wise population structure of the district.
Age Group Number %
0-4 20794 10.52
5-9 24998 12.65
10-14 28253 14.30
15-19 21856 11.06
20-24 14892 7.54
25-29 12543 6.53
30-34 9985 5.05
35-39 9876 5.00
40-44 9328 4.72
50-54 8333 4.22
55-59 6958 3.53
60+ 20978 10.61

C. Previous Year Epidemic and Disaster Experience
In the recent past, there are many records of Disaster, the tragedy of the Western Region
(WR), large number of hazards such as landslide, fire, Road traffic accidents (RTA),
animal bite (esp. dog bite), avalanche, etc in the past has caused much suffering in terms
of life and property. The earthquake, yet not recorded till the date, might have vicious
impact on the population and their health.
The statistic of disaster events of past 8 years suggest occurrence of land slides, minor
epidemic, Road traffics accidents and fire
3
. These events have marginally affected the
people however the death toll from RTA is very high.



3
District Disaster Response Commitee, DDRP 2011
5
SN Disaster Problems Directly Affected Injured Death
1 Land slide 127 0 2
2 Fire 37 1 1
3 RTA 101 58 43
4 Diarrheal Epidemic 1463 1456 7
5 Animal Bite(Dog Bite) 1459 1453 6
D. Possible Health Consequences
Disaster might have abundant health consequences and impact on human health, health
facilities and other physical infrastructures. The health impact are mostly related to
reproductive health, Nutrition, HIV/AIDs, Neonatal Mortality, Diarrheal Diseases and
other communicable diseases. From the prospective of positive discrimination key
population groups such as Pregnant Women, MWRA, Neonates and Infants, under 5
children, disable and elderly health need should be focused. Therefore the minimum
initial service package is designed to address possible health consequences. These
population groups termed Standard Population according to census 2011 is shown in
following table;
SN Population group Ratio Arthakhanchi status
1 Total population - 197632
2 Adult male 20% 39526
3 Woman of reproductive age 25% 49409
4 Crude birth rate 4% 7905
5 Expected pregnancy - 5373*
6 Expected live birth - 4830*
7 Complicated preg./abortion 20% 1074
8 WRA using contraception 15% 7411
8a Oral contraception 30% 2223
8b Injectables 65% 4817
8c IUCDs 5% 370
9 Adolescent population - 47734*
10 <5 population - 23977*
11 <1 population - 4598*
* estimated on census report 2011

6
Some of the possible health consequences are enlisted below:
Increase in communicable diseases, such as dysentery and diarrheal diseases, acute
respiratory infections, eye or skin diseases.
Probable increase in spread of HIV/AIDS, tuberculosis.
Destruction, damage or inaccessibility of health clinics.
Loss of medical equipment and drugs.
Aggravated malnutrition due to acute food shortage.
E. Minimum Initial Service Package for Reproductive Health (MISP)
The Minimum Initial Service Package (MISP) for Reproductive Health (RH) is a
coordinated set of priority activities designed to: prevent and manage the consequences of
sexual violence; prevent excess neonatal and maternal morbidity and mortality; reduce
HIV transmission; and plan for comprehensive RH services in the early days and weeks
of an emergency. Neglecting RH in emergencies has serious consequences: preventable
maternal and infant deaths; sexual violence and subsequent unwanted pregnancies and
unsafe abortions; and the spread of HIV. The MISP can be implemented without a new
needs assessment because documented evidence already justifies its use.

Objectives of the MISP and activities:

1. Identify organizations and individuals to
facilitate the coordination and implementation of
the MISP by:
ensuring the overall RH Coordinator is in
place and functioning under the health
coordination team;
ensuring RH focal points in camps and
implementing agencies are in place;
making available material for implementing the MISP and ensuring its use.
2. Prevent and Manage Sexual Violence and provide appropriate assistance to survivors
by:
Objective and Activities:
1. Coordination and Implementation:

2. Prevent and manage sexual violence:

3. Reduce HIV transmission:

4. Prevent excess neonatal and maternal
morbidity and mortality:

5. Planning for Comprehensive RH
Services:
6.
7
ensuring systems are in place to protect displaced populations, particularly
women and girls, from sexual violence;
ensuring medical services, including psychosocial support, are available for
survivors of sexual violence.
3. Reduce the transmission of HIV by:
enforcing respect for universal precautions;
guaranteeing the availability of free condoms;
ensuring that blood for transfusion is safe.
4. Prevent excess maternal and neonatal mortality and morbidity by:
providing clean delivery kits to all visibly pregnant women and birth attendants to
promote clean home deliveries;
providing dignity kits (UNFPA or equivalent) to facilitate clean and safe
deliveries at the health facility;
initiating the establishment of a referral system to manage obstetric emergencies.
5. Planning for Comprehensive RH Services, integrated into primary health care
(PHC), as the situation permits by:
collecting basic background information;
identifying sites for future delivery of comprehensive RH services;
assessing staff and identifying training protocols;
identifying procurement channels and assessing monthly drug consumption.

MISP Component wise Plan:
1. Coordination and Implementation:
A qualified and experienced person is identified at district to coordinate RH activities at
the start of the emergency response. DHO, Arghakhanchi is responsible for designating
this RH Coordinator or can be also known as RH Focal Point and this person will be
supervised by DHO. Public Health Nurse, Ms Kalika Bhandari will act as the RH focal
Point



8
Objective and actions:
Terms of Reference for a RH Coordinator/ Focal Point:
Under the auspices of the overall health coordination framework, the RH Coordinator/
Focal Point should
Be the focal point for RH services and provide technical advice and assistance on
reproductive health to displaced communities and all organisations working in
health and other sectors as needed.
Liaise with District and national authorities when planning implementing RH
activities in camps, settlements and among the surrounding population.
Liaise with other sectors (protection, community services, camp management,
education, etc.) to ensure a multi-sectoral approach to reproductive health.
Create or adapt and introduce national and other standardized policies that support
the MISP and ensure that they are integrated with primary health care, for
example, policies relating to emergency obstetric care or gender-based violence
Initiate and coordinate audience-specific orientation sessions on the MISP (e.g.,
for health workers, FCHV, HFOMC members, community services officers, the
beneficiary population, security personnel, etc.);
Introduce standardized protocols for selected areas (such as medical response to
survivors of sexual violence and referral of obstetric emergencies; and, when
planning for comprehensive RH services: syndromic case management of STIs
and family planning)
Develop/ adapt and introduce simple forms for monitoring RH activities during
the emergency phase that can become more comprehensive once the programme
is consolidated.
Use standard indicators to monitor MISP outcomes.
Collect, analyze and disseminate data for use.
Report regularly to the health coordination team.





9



Standard population

Adult males 20%
Women of reproductive age (WRA) 25%
Crude birth rate 4%
o Number of pregnant women
o Number of deliveries
Complicated abortions/pregnancy 20%
Vaginal tears/delivery 15%
Caesarean sections/delivery 5%
WRA who are raped 2%
WRA using contraception 15%
Oral contraception 30%
Injectables 65%
IUD 5%

In displaced population, 4% of the total population will be pregnant at a given time
(Acute phase of Emergency: CMR > 1/10,000/day)

10





DHO, Arghakhanchi
RH Coordinator
(MISP)
#9847022788
DDRC,
Arghakhanchi
UNFPA, Arghakhanchi
Mr. Purna Bk
9857061313
WHO, Rupandehi
Mr. ..
#..........


Regional Health
Directorate,
Pokhara
B. PHC,Thada
Dr. Hari Panthi
# 9857063246

A. PHC,Balkot
Mr.Shankar Pandey
# 9847160405



1.HP Argha
Mr. Jibnarayan
# 9947396068


2. HP,Arghatosh
Mr. Buddi
Nyaupane
# 9847167950



5. HP, Narapani
Mr. Shravan
Panthi
# 9747043480
6. HP, Pokharathok
Mr. Seshkanta
Ghimire
# 9857061198

3. khana
Mr. Lekhnath
# 9847107946



4. HP,Hansapur
Mr. Bishnu
# 9847062729



7. HP ,Siddhara
Mr. Narayan
#9857061131

8.HP,Subarnakhal
Mr. Krishna
Paudel
#9847057961


A.1. SHP Wangla
Mr. Rankumar
#9847042780
A.2. SHP Kerunga
Mr. Rupalal
#9857028685
A.3. SHP Chidika
Mr. Ramprasad
#9747022482
1.1. HP Nuwakot
Mr. Devbahadur
#9847181494




2.1. SHP, Bhagawati
Mr. Bishnu paudel
#
2.2. SHP, Mareng
Mr. Madan
# 9847229582
2.3. SHP, Thulapokhara
Mr. Bishwadev
# 9847034276
2.4. SHP, Chhatragung
Mr. Kamalprasad
# 9747040845



B.1. SHP Sitapur
Mr. Bishnu
# 9847344179
B.2. SHP Dhanchaur
Mr. Shivaprakash
#9847090308
B.3.Jukena
Mr.
#
5.1. SHP, Dhatibang
Mr. Mitradev
# 9857061290




6.1. SHP, Maidan
Mr. Jagadish
# 9846606187
6.2. HP Panena
Mr. Khagaraj
# 9847000295
6.3. SHP,Patauti
Mr. Dhruba
# 98
6.4. SHP, Khimdim
Mr.
# 98



1.2. HP Dharapani
mr. Netra
#
1.3. SHP,Khilji
Mr.Yamprasad
# 9847034276
1.4. SHP, Asurkot
Mr. Suresh
# 947229582
1.5 SHP Kimdanda
Mr. Mumaram
3.1. SHP, Bangi
Mr.TRMishra 9857029339
# 98587945365


3.2. SHP Khanadaha
Mr. Netraprasad
# 9847343300
3.3. SHP, Diverna
Mr. Purna Parajuli
# 9847616047
4.1. SHP, GoKhunga
Mr. Bhabiswar
# 9747046795
4.2. SHP, Dhakabang
Mr. Bheshraj
# 9857061026



5.2. SHP, Pali
Mr. Raprasad
# 9847076217
5.3. SHP, Adguri
Mr. Bhimlal
# 9847058967
5.4. HP Khanchikot
Mr. Minraj
# 9847114776
5.5 SHP, Dhikura
Mr. Bharat
# 9847107199



8.1. SHP, Simalpani
Mr. Damodar
# 98
7.1. HP, Jaluke
Mr. Sunil
# 9847101282



MISP Coordination and Communication Chart
DHO, Arghakhanchi
11
2. Prevent and manage sexual violence:
Women and girls who have experienced sexual violence should receive health services as
soon as possible after the incident to prevent further trauma, such as unwanted
pregnancies and life-threatening infections. If left unaddressed, sexual violence has
serious negative social consequences for women and girls as well as their families and the
larger community, thus psychosocial services that help to heal and empower/ rehabilitate
women are necessary. Protection and community services staff should also be involved in
providing legal support to survivors of sexual violence.

Objective and actions:
The main objective is to prevent and manage the consequences of sexual violence.

Key actions to be undertaken
4
:
RH Officers and program staff must:
Establish a private consultation area with a lockable filing cabinet;
Put in place clear protocols and sufficient supplies and equipment;
Hire male and female service providers fluent in local languages, or, where this is
not possible, hire trained male and female chaperones and translators;
Involve women and male and female adolescents in decisions on accessibility to
services and on an appropriate name for the services;
Ensure that services and a referral mechanism to a hospital for life-threatening
complications are available 24 hours a day/seven days a week;
Once services are established, inform the community why, where and when (as
soon as possible after a rape) these services should be accessed. Use
communication channels appropriate to the setting (e.g., through midwives,
community health workers, community leaders, radio messages or information
leaflets in womens toilets); and

4
Minimum Initial Service Package (MISP) for Reproductive Health in Crisis Situations: A learning Module
developped by Somen Refugee Commission.
12
Ensure service providers are skilled. Where needed, organize information sessions
or short refresher trainings on clinical care for survivors of rape. Clinical
management of survivors of rape should include the following components:
o Supportive communication
o History and examination
o Forensic evidence collection as relevant
o Compassionate and confidential treatment, including:
Emergency contraception
Treatment of STIs
Post-exposure prophylaxis (PEP) to prevent HIV transmission
Care of wounds and prevention of tetanus
Prevention of hepatitis B
Referral for further services, e.g., health, psychological and social.

The Code of Conduct
5
:
The IASC Task Force on Protection from Sexual Exploitation and Abuse has developed
six core principles for inclusion in UN and NGO CoCs. They are:
1. Sexual exploitation and abuse by humanitarian workers constitute acts of gross
misconduct and are therefore grounds for termination of employment.
2. Sexual activity with children (persons under the age of 18) is prohibited
regardless of the age of majority or age of consent locally. Mistaken belief in the
age of a child is not a defense.
3. Exchange of money, employment, goods or services for sex, including sexual
favors or other forms of humiliating, degrading or exploitative behavior, is
prohibited. This includes the exchange of assistance that is due to beneficiaries.
4. Sexual relationships between humanitarian workers and beneficiaries are strongly
discouraged since they are based on inherently unequal power dynamics. Such
relationships undermine the credibility and integrity of humanitarian aid work.

5
Cited in InterAction, Step by Step Guide to Addressing Sexual Exploitation and Abuse, June 2010.
Available from http://www.interaction.org/document/interaction-step-step-guide-addressing-sexual-exploitation-and-
abuse
13
5. Where a humanitarian worker develops concerns or suspicions regarding sexual
abuse or exploitation by a fellow worker, whether in the same agency or not, s/he
must report such concerns via established agency reporting mechanisms.
6. Humanitarian workers are obliged to create and maintain an environment that
prevents sexual exploitation and abuse and promotes the implementation of their
code of conduct. Managers at all levels have particular responsibilities to support
and develop systems that maintain this environment.
3. Reduce HIV transmission:
Displaced populations in emergency situations are especially vulnerable to STIs and HIV.
STIs, including HIV, have the potential to thrive under crisis conditions where access to
means of prevention, treatment and care are limited.

Objective and actions:
The overall objective is to reduce the transmission on of HIV by:
Ensuring safe blood transfusions;
Enforcing respect for universal precautions;
Ensure and increase the availability of free condoms.
Continuation of ART and management of Co infection
Prophylaxis
Promotion of Safe Sexual Practice
Comprehensive Condom Programming
Behavior change communication

Key actions to be undertaken
6
:
Ensure all staff (both medical and support staff) in health care settings understand
universal precautions.
Ensure clean health center environment and Post Exposure Prophylaxis

6
Minimum Initial Service Package (MISP) for Reproductive Health in Crisis Situations: A learning Module
developped by Somen Refugee Commission.
14
Use protective barriers, such as disposable gloves, for all procedures involving
contact with blood or other potentially infected body fluids, and protective
clothing, such as waterproof gowns or aprons, masks and eye shields, where
appropriate.
Use of new, disposable injection equipment for all injections is highly
recommended; sterilizable injection should only be considered if single-use
equipment is not available and if the sterility can be documented with Time,
Steam and Temperature indicators.
Make Available of Condoms in Public Places.
Encourage for consistent Use of condom
Treat the cases of STI and make availability of Test KIT
Ensure space for an incinerator and sterilization facilities.
Clean, disinfect and sterilize medical equipment 37 using the most appropriate
techniques for the setting (e.g., pressure-steam, high-level disinfection, boiling in
water for at least 20 minutes or soaking in chemical solutions).
Treat injuries, including thorough washing of wounds, rinsing of eye or mouth
splashes and providing post-exposure therapy where warranted.
Ensure safe handling of sharp objects, including the provision of puncture-
resistant containers for sharps disposal.
Ensure that disposal grounds are fenced and not accessible to the public. Dispose
of medical waste by burning and burying sharp objects in a protected pit within
the grounds of the health facility and not in the communal dump.
Properly handle contaminated waste, including human waste and corpses.
Reduce the need for blood transfusion by training health care workers to use
volume replacement solutions where possible.
Avoid blood transfusions as much as possible at night, when there is often
insufficient light.
When blood transfusions are implemented at camp level, develop proper systems
and hold appropriate medical staff accountable for the transfusions.
Ensure that all blood for transfusion is safe by ensuring that it is screened for HIV
and other blood-borne diseases.
15
Guarantee the availability of free condoms.
Counsel the source patient regarding HIV testing and conduct an HIV test if
consent is obtained.
Post first aid measures in relevant workspaces and inform all staff how to access
treatment for exposure.
For Adolescents: Provide discreet access to free condoms at adolescent-oriented
distribution points, and ensure that health workers provide condoms to
adolescents presenting with symptoms of STIs. Ensure that adolescent-friendly
health services are available for adolescents presenting to facilities.

4. Prevent excess neonatal and maternal morbidity and mortality:
While maternal mortality is a common cause of death among women ofreproductive age
living in resource-poor emergency settings. The stressful living conditions and limited
access to skilled health providers and health facilities exacerbate the vulnerability of
displaced women during pregnancy, labor and delivery with high risk for morbidity and
mortality due to pregnancy-related complications
7
.

Objectives and Actions:
Prevent excess neonatal and maternal mortality and morbidity by:
providing clean delivery kits to visibly pregnant women or birth attendants to
promote clean deliveries;
providing midwife delivery kits to facilitate clean and safe deliveries at the health
facility;
initiating the establishment of a referral system to manage obstetric emergencies.

Key actions to be undertaken:
Coordinate with the health sector/cluster authorities to ensure a referral system
(including means of communication and transport) is established immediately (in
the first days) in a humanitarian setting. The referral system must support the

7
Inter-agency Working Group on Reproductive Health in Crises, Inter-agency Field Manual on Reproductive Health in Humanitarian
Settings, 2010. Available from http://www.iawg.net/resources/field_manual.html
16
management of obstetric and newborn complications in the displaced population
available 24 hours per day 7 days per week. It should ensure that women, girls
and newborns that require emergency care are referred from the community to a
health center where basic EmOC is available, or a hospital where basic and
comprehensive EmOC and newborn care is available.
Provide midwives and other skilled birth attendants in health facilities with
materials and drugs for essential newborn care. This will include materials for
newborn resuscitation, antibiotics for the treatment of sepsis, and supplies for the
care of low birth weight/preterm babies.
Ensure skilled birth attendants are able to provide competent essential newborn
care, including:
o Initiation of breathing;
o Resuscitation;
o Thermal protection (delayed bathing, drying, skin-to-skin contact);
o Prevention of infection (cleanliness, hygienic cord cutting and care, eye
care);
o Immediate and exclusive breastfeeding; and
o Management of newborn sepsis and care for preterm/low birth weight
babies.
Provid clean delivery kits to visibly pregnant women and birth attendants for
clean home deliveries when access to a health facility is not possible.
Avoid the Three Delays
8
;
o Delay at the household level in identifying complications and deciding to
seek care;
o Delay in reaching a treatment facility (inability to get transport, poor road
conditions, insecurity, check points, curfews, etc.); and
o Delay in receiving adequate treatment at the facility once reached (absence
or lack of qualified staff, lack of equipment/supplies, high costs of
treatment, need for down payment prior to receiving care, etc.)

8
Thaddeus, S. and D. Maine, Too far to walk: maternal mortality in context, Social Science and Medicine, April 1994.
17
For adolescents: Identify pregnant adolescents in the community and link them to
health facilities to encourage facility-based deliveries. Facilitate new adolescent
mothers participation in peer support networks following the delivery.

Immediate care after birth Continuing postnatal care
Be sure that attendants use gloves or
wash hands with soap and water before
the delivery and before tying and
cutting the cord.
Keep delivery room warm and ensure
baby is dried and warmly wrapped
immediately after birth.
Keep the head covered. Delay bathing
for at least six hours.
Use a clean (preferably sterile)
instrument to cut the umbilical cord,
and check frequently for bleeding.
Keep the baby with the mother to
ensure warmth and frequent
breastfeeding.
Pay attention to frequent hand washing
by anyone handling the baby.
Clean babys eyes immediately after
birth, and if prophylaxis is country
policy, instill drops or ointment.
Encourage Kangaroo Mother Care
9
.
Help mother with the first (within one
hour) breastfeeding
10
.
Keep the baby with the mother. Avoid
putting two babies in the same cot.
Clean the cord with soap and water and
keep it dry. Do not cover the cord with
any bandage or cloth.
Tell the mother what danger signs to
look for in the condition of the cord and
in her baby.
Be sure she knows when and where to
go for help.
Teach the mother how to keep the baby
warm.
Take the baby to the health center at six
weeks for immunizations.
Advise the mother to give her child
nothing but breast milk for the first six
months and to continue breastfeeding
up to two years or longer.

9
Kangaroo Mother Care is a universally available and biologically sound method of care for all newborns, but in particular for premature
babies, with three components: skin-to-skin contact; exclusive breastfeeding; and medical, emotional, psychological and physical support of
mother and baby without separating them.For more information, visit www.kangaroomothercare.com/ref_oprefs.html
18
5. Planning for Comprehensive RH Services:
This section outlines the steps to be taken to be ready to expand RH services when a
crisis situation stabilizes and when all the components of the MISP have been
implemented. It is important to ensure that drug supplies, including contraceptives and
drugs to treat STIs, are available and ordered in a rational and sustainable manner so that
the displaced population can have access to comprehensive RH services as soon as
possible
11
.
Objectives and Actions:
Plan for the provision of comprehensive RH services, integrated into primary health care,
as the situation permits. This includes:
collecting existing background data on maternal and neonatal mortality, STI and
HIV prevalence, contraceptive prevalence and preferred methods, and RH
knowledge, attitudes and behavior of the affected population, if available;
identifying suitable sites for future service delivery of comprehensive RH
services;
assessing staff capacity to provide comprehensive RH services and a plan for
training/ retraining staff;
Ordering equipment and supplies through routine supply lines, based on estimated
and observed consumption.

Key actions to be undertaken:
Collaborate with displaced women, youth and men, for the integration of
comprehensive, good quality RH activities into PHC as soon as possible during
the initial phase.
Prepare a plan to mitigate the RH problems and needs during and post emergency
setting.



10
For more information on breastfeeding in emergencies, visit
www.who.int/reproductivehealth/publications/conflict_and_displacement/RH_conflict_appendix2.en.html
11
Minimum Initial Service Package (MISP) for Reproductive Health in Crisis Situations: A learning Module developped by Somen
Refugee Commission.
19

Subject Area Minimum (MISP)
RH services
Comprehensive
RH services
Family Planning
12
None*
* Although family planning
is not part of the MISP,
make
contraceptivesavailable for
any demand, if possible.
Source and procure
contraceptive supplies
Offer sustainable access
to a range of
contraceptive methods
Provide staff training
Provide community IEC
Gender Based Violence
13
Coordinate systems to
prevent sexual violence
Ensure health services
available to survivors of
sexual violence
Assure staff trained
(retrained) in sexual
violence prevention and
response systems
Expand medical and
psychological and legal
care for survivors
Prevent and address
other forms of GBV,
including domestic
violence, forced/early
marriage, female genital
cutting, trafficking, etc.
Provide community IEC
Safe Motherhood
14
Provide clean delivery
kits
Provide midwife delivery
kits
Establish referral system
for obstetric emergencies
Provide antenatal care
Provide postnatal care
Train SBAs and
midwives

12
Family planning implies the ability of individuals and couples to anticipate and attain their desired number of children
and the spacing and timing of their births. It is achieved through use of contraceptive methods and the treatment of
involuntary infertility. (Working definition used by the WHO Department of Reproductive Health and Research). For
further information on family planning services in emergency settings, visit www.rhrc.org/resources/index.cfm?sector=fp
13
For further information on GBV in emergency settings, visit www.rhrc.org/resources/index.cfm?sector=gbv.
14
For further information on safe motherhood in emergency settings, visit www.rhrc.org/resources/index.cfm?sector=safe.
20
STIs, including HIV
Prevention and Treatment.
Provide access to free
condoms*
Ensure adherence to
universal precautions
Assure safe blood
transfusions
*Although STI programming
is not part of the MISP, it is
important to make treatment
available for patients
presenting for care as part of
routine clinical services.
Identify and manage
STIs
Raise awareness of
prevention and
treatment services for
STIs/HIV
Source and procure
antibiotics and other
relevant drugs as
appropriate
Provide care, support
and treatment for people
living with HIV/AIDS
Collaborate in setting up
comprehensive
HIV/AIDS services as
appropriate
Provide community IEC









21


D. Capacity Analysis:-
The Government of Nepal has inadequate financial resources available for rapid response
activities. The Disaster Preparedness and Relief Act of 1982, enacted to make provision
for the coordination and implementation of measures to alleviate effects of disasters. It
included the establishment of a Central Disaster Relief Committee and Prime Minister
Natural Disaster Relief Emergency Fund, and at district level District Disaster Relief
Committee (DDRC) to provide comprehensive support to those affected by the disaster,
but in previous years resources have only been made available after a disaster has
occurred delaying relief efforts considerably. Additionally, there is Rapid Response Team
(RRT) at DHO to provide public health response to affected population. Despite these
efforts, the Government institutions on both national, but in particular on district level
22
under the authority of the District Health Office (DHO) continue to face a number of
challenges.
Scarce financial resources for maintenance of existing protection structures
Inadequate Early Warning and Surveillance Systems (EWARS) for a number of
disasters, including floods, epidemics, and crop failures
Weak capacity to carry out risk assessments
Shortage of transport and communication facilities impeding dissemination of early
warning messages and the conduct of rapid assessments
The coordination mechanisms/structures on district as well on national level are weak
and lack both manpower, financial resources and technical skills in order to assume
an effective leading role in coordination
Lack of leadership and motivation in some Districts for effective emergency response
Lack of motivation or organization skills hindering efficient information flow in
disaster situations
District Disaster Response Committee has recently formulated the Emergency
Preparedness and Response Plan for Arghakhachi District
15
. The Health sector has been
identified as one of the important cluster in District Disaster Response Plan. Several
Non-Governmental organizations exist in the district and are ready to support in
emergency. In such scenario, Integrated District Health Sector Contingency Plan would
help the district effectively respond to the emergency in active participation of all the
health actors.
SN Health Service Status Number
1. Hospital 1
2. Primary Health Care Center 2
3. Health Post 17
4. Sub Health Post 22
5. Hospital Bed Ratio 1:5490
6. Doctor Population Ratio 1:21960


15
District Disaster Response Commitee is chaired by CDO and is the commitee of stakeholders at district
level
23
E. Contingency Planning Process :-
The planning process started with the review of existing Contingency and Emergency
Preparedness Plans formulated by district level line agencies including non-governmental
sector. Based on the review, District Health Office (DHO), Arghakhanchi organized the
three-day Contingency Planning workshop with participation of all sectors.
The District Health Office (DHO) Chief presented briefly the overall process of the
contingency planning, and set the background to initiate the planning process. All the
participants identified various kinds of the emergency and disasters that have already hit
the district and others that possibly affect the district population any time in near future.
Then after, they ranked the disasters in terms of extent of damage the identified
emergency can cause with the help of Vulnerability Assessment Tool. The workshop
identified various health facilities, health centers, and discussed about their functionality
that were tapped in terms of emergency preparedness and response. The detail
information is available in the Annex- III
In the next day the participants were grouped into 6 small groups for discussion and
preparation of contingency plan for the six prioritized hazards viz. Epidemic, Landslides,
Earthquake, Fire, Road Traffic Accident, and Dog Bite (Rabies) . On the same day, the
workshop further identified the communication strategy to ensure the fast and effective
response in emergencies. Discussion was based on, first, internal communication, the
spokespersons at each level of service delivery were identified, and second, external
communication, same spoke persons were identified.
On the third day, discussion was made on the logistic preparedness. District Health
Office Chief facilitated the overall process. Further, information was gather on access and
distance of all heath facilities from district headquarter, means of transportation and
alternative means in case of any disturbance. In addition, information was gathered on the
ambulance services and contact information of officials of all the organizations/health
facilities.
Most of the participants found that the contingency plan to be very much effective to
cope up the emergency in integrated approach. Ultimately, we shared the overall plan
developed to District Disaster Response Committee (DDRC) and made necessary
amendments on the health sector contingency planning of the Arghakanchi.
24
F. Strategic Directions
a. Purpose of the HSCP
The purpose is to serve as a mechanism for participating to work together in partnership
to harmonize efforts and use available resources efficiently within the framework of
agreed objectives, priorities and strategies, for the benefit of the affected population(s).

b. Goal
To reduce avoidable mortality, morbidity and disability, and restore the delivery of, and
equitable access to, preventive and curative health care as quickly as possible and in as
sustainable manner as possible

c. Expected Health Sector Outputs
i. Coordination and Sharing on contingency planning for public health emergencies
ii. Contingency plan for the district
iii. Clear roles and responsibilities identified for all actors
iv. Communication strategy elaborated

25
Section II Health Sector Contingency Plan
A. Hazard and Risk Analysis of Arghakhanchi
Hazard Frequency (per
year)
Number of people
affected*
Magnitude** Total***
Earthquake 1 5 5 30
Epidemics 2 5 3 21
Dog Bite 1 4 1 5
Landslide 2 3 1 5
RTA 1 4 1 5
Fire 1 3 1 4
Flood 1 3 1 4

* Number of people affected should be rated from 1-5, with the following numerations:
0-50 1; 51-100 2; 101 500 3; 501 1000 4; >1000 5.
** Magnitude should be rated from 1-5, with 5 being the highest magnitude if the
incident has affected less than 1/10 of your district (by number of people or area,
whichever is the higher indicator), than the number should be 1; it should be 2 for 1/8, 3
for 1/6, 4 for , and 5 for higher than . .
*** Total is calculated as: (Frequency +Number of people affected) x Magnitude
26
B. Contingency Plan
Earthquake (30)
Hazard
analysis
scale
Public
Health
Areas of
Intervention
Detailed
intervention
Who?
(Who
will
lead?)
When? Information Needed Resources Needed
What
information
do you need
further
How will
you get this
informatio
n
What? From where?
Earthquak
e (30)
Assessment





Situation
analysis of
the place
and
number of
people
affected
Physical
infrastruct
ure
damaged
DDRC
Securit
y
Forces
Immediatel
y
No. of
casualties and
displaced
people
Transportatio
n
Availability
of spaces for
temporary
shelters
No of health
institution
damaged
VDC, Local
HF and
health
workers,
Police,
media
Communication,
Security
transpotation
DDRC, NRCS,
DHO Local HF
and Police, Army
RRT private
hospitals other
supporting
agencies
Essential
health care
services



First Aid,
Primary
Trauma Care
DHO,
RRT
Focal
Person
Immediatel
y
No. of injured
people
Type of
injury
Capacity and
Situation of
local Health
Facility
HF
Incharge,
FCHV,
VDC
HR, First aid kits,
medicines and
DHO, DDRC,
NRCS, LHF,
Police private
hospitals other
supporting
agencies
Outbreak
control


Control of
Acute Gastro
Enteritis
(AGE) ARI,
DHO
RRT
Focal p
Immediatel
y after First
Aid
No. of people
affected
based on age
group
Local HF,
FCHV,
VDC
IV Fluids, ORS, anti-
helmintis, anti-bacterial
drugs Chlorine Tab,
IEC Materials
DDRC
DHO,EDCD,RR
T, Local HF,
DWASHCC,
27
Earthquake (30)
Hazard
analysis
scale
Public
Health
Areas of
Intervention
Detailed
intervention
Who?
(Who
will
lead?)
When? Information Needed Resources Needed
What
information
do you need
further
How will
you get this
informatio
n
What? From where?


Preventive
measures
and health
education
Condition of
Water and
Sanitation
Status of
waste
disposal
Availability
of safe food
VWASHCC
private hospitals
other supporting
agencies
Reproductiv
e health




Delivery of
ANC, INC,
PNC, and
New Born
Care
PHN
/RRT
Immediatel
y and
immediatel
y after first
aid
No. of
Expected
pregnancies
& newborn
kids
HR
Delivery kits
and safe
delivery
place,
medicine
Local HF,
FCHV,
DHO
HR with SBA, ASBA
Medicine, Delivery
Kits, ABC Manual Kits
Local HF, DHO
Nutrition





Immediate
Nutritional
needs
DDRC After first
aid, when
needed
No. of
Malnourished
people
No. of
pregnant
women & U-
5 Children
Local, HF,
FCHV,
DHO
Iron, Vit-A, Vit-K,
Iodine
Local HF, DHO
UNICEF
28
Earthquake (30)
Hazard
analysis
scale
Public
Health
Areas of
Intervention
Detailed
intervention
Who?
(Who
will
lead?)
When? Information Needed Resources Needed
What
information
do you need
further
How will
you get this
informatio
n
What? From where?
Immunizatio
n





Immunizatio
n against
IPDs
DHO Within one
5 days
No. of Target
population
(Under one and
pregnant
women),
availability of
vaccine and
HR
Local HF,
FCHV,
DHO
Vaccine, HR, Cold
Chain
DHO, Local HF
HIV/AIDS






Continuation
of control
and
preventive
measures
RRT
with
support
of
DACC
Immediate
after first
aid
No. of AIDS
patients
Availability
of condoms
Local HF,
DACC,
DHO
Condoms, Drugs,
counselor
Local HF,
DACC, DHO
TB control







Continuation
of treatment ,
control and
preventive
measures
RRT Immediate
after first
aid
No. of TB
patients
Availability
of ATD at HF
HF, DTLO,
DHO
Drugs health worker DHO, Local HF,
DTLO
Psychosocial
support


Post incident
Counseling
and
rehabilitation
DDRC Immediate
after first
aid
Social Status of
Victims
VDC, Local
HF daily
updated
assessment
Expert Counselor,
TemporaryRehabilitatio
n shelter
DDRC, NRCS,
other supporting
agencies
29
Earthquake (30)
Hazard
analysis
scale
Public
Health
Areas of
Intervention
Detailed
intervention
Who?
(Who
will
lead?)
When? Information Needed Resources Needed
What
information
do you need
further
How will
you get this
informatio
n
What? From where?
report

Epidemic (21)
Hazard
analysis
scale
Public
Health
Areas of
Intervention
Detailed
intervention
Who?
(Who will
lead?)
When? Information Needed Resources Needed
What
information
do you need
further
How will
you get this
information
What? From
where?
Epidemi
c (21)
Assessment





Verification of
diagnosis
Confirmation
of epidemic
Administration
of RHA form
Assessment of
Logistics
DHO/RRT






immediately Area and
population
affected
Trend of
diarrhea
incidence
HMIS
Previous
epidemic
reports
HR(PHO/RRT
focal person)
Communicatio
n means
District
Health
Office
Local health
facilities
Police
Essential
health care
services



Camp Setup
Triage
Treatment and
Referral
Logistics
supply
RRT focal
person
immediately Logistic stock
in local health
facility,
district stores
Local and
district Store
person
HR(Medical
personnels/
Police/Local-
district clubs)
DHO
Police
Red cross
Clubs
Outbreak
control


Medical
Treatment
Epidemiologica
l survey and
PHO simultaneously Possible
source,
cause, mode
of infection
Observation
Interview
with affected
and non
Medications
Health workers
Lab personnel
Water supply
DHO
Local health
facilities
District
30
Epidemic (21)
Hazard
analysis
scale
Public
Health
Areas of
Intervention
Detailed
intervention
Who?
(Who will
lead?)
When? Information Needed Resources Needed
What
information
do you need
further
How will
you get this
information
What? From
where?


data analysis
Environmental
factors
accessment
Water
supply
system
Hygiene
and
sanitation
condition
affected
peoples
RRA
and hygiene
related
technicians
Drinking
Water
Corporation
NGOS
Reproductive
health




Delivery and
PNC services
Security
PHN immediately No. of
estimated
pregnancies
HMIS Medical
personnel
DHO
Local health
facility
Security
bodies
Nutrition





Management of
nutritional
problems
PHO simultaneously Incidence and
prevalence of
malnutrition
and
nutritional
deficiencies
Local health
body
DHO
Local
people and
clubs
Immunizatio
n





Continue routine
immunization
through mobile
camps
Immunization to
health care
providers
Immunisatio
n officer
simulataneousl
y
Immunusatio
n records
Immunisatio
n register
Regular use
vaccines
Vaccine carrier
vaccinator
DHO
31
Epidemic (21)
Hazard
analysis
scale
Public
Health
Areas of
Intervention
Detailed
intervention
Who?
(Who will
lead?)
When? Information Needed Resources Needed
What
information
do you need
further
How will
you get this
information
What? From
where?
HIV/AIDS





Continuation of
ART
STI treatment
Condom
distribution
DACC within a Month STI and HIV
related data
DACC Condoms
ART
DHO/DAC
C
TB control







Continue DOTS
services
DTLO Within a week No. of patient
receiving
ATT
DOTS
centre/ Sub
centre
ATT Drugs
Trained
personnel
DHO
Psychosocial
support



Councelling

Councellor
from
recognized
organation
simultaneously HR related to
Psychosocial
profession
Within and
outside
district





32
3. Land Slide (5)
Hazard
Analysi
s scale
Public
Health
Interventio
n
Detailed
intervention
Who?
(Who
Lead)
When? Information Needed Resources Needed
What
information do
you need further
How will you
get this
information
What? From where?
5 Assessment Rapid
assessment of
affected areas
using Rapid
Health
Assessment
form-Annex
landslide:
magnitude and
Harm
Reduction
Situation
forms and
format
Possible
epidemic
DDRC Immediatel
y
No. of people
affected
No. of HF
affected
No. of physical
harm
No. of injured
No. of people
affected
No. of displaced
LHF,DHO,NRC
S
Police, Media,
VDC/DDC,
School
Human
Resources
Logistics
Finance
Vehicle
DHO, EDCD,
RHD, WHO,
NRCS, VDC,
DDC, HF,
DAO, Police /
Army other
supporting
agencies
33
outbreak
Essential
health care
services
First Aid and
Emergency
Care
Camp set up;
Appropriate
referral
services;


DHO immediatel
y
No. of people
injured and
health problems
Health
workers/Volunte
ers availability
Drugs,
equipment &
logistics
HF,VDC
IRA report
Media, Police,
Army and
NRCS
Drugs,
Emergency
Kit
Medical
Personnel,
Paramedics,
Nurses,
Finance
DHO
EDCD, RHD,
WHO, NRCS,
VDC.DDC,DA
O supporting
agencies
Outbreak
control
Syndromic
surveillance
Preventive
measures;
Treatment
Health
education/
awareness on
WASH.

DHO,
RRT
After risk
assessment
of possible
outbreak
Possible
outbreak
information,
cases in HF,
Sanitation status,
water resources
WASH report
D/VWASHCC,
HF, Outbreak
recording and
reporting form,
VDC
DWSO, DDC,
Local clubs.
Drugs,
Paramedics
Water quality
test kit,
Hygiene Kit
Local
Surveillance
forms and
checklist
EDCD, RHD,
WHO, NRCS,
VDC.DDC,DA
O, DHO,
UNFPA,
supporting
agencies

34
Reproductiv
e health
MISP
Review report
Temporary
birthing
centers and
delivery kit,
RH camp
STI management
DHO,
RHCC
HFI
Within 24
hrs
No. of expectant
mothers/ pregnant
women
Current users of
Contraception
What RH
problems
Local HFs,
FCHVs
DHO report
HR-SBA
Logistics and
drugs and
equipment
supply
Transportatio
n

FPAN, FHD,
CHD, Regional
Medical Store,
WHO, UNFPA
Nutrition Health
education and
Food
fortification and
supplement
Growth
monitoring
Deworming
DHO
Nutrition
focal
person
HFI
Local
clubs
Within a
week
Review
nutritional status
No. of under five
children
No. of pregnant
PHC-ORC clinics
Vitamin A, Iron,
Folic Acid, Iodine
- stock,
DHO report
HMIS data
HFI
FCHVs
Local , Udhyog
banizya
sang,Arghakhac
hi
Health
educator
Weighing
machine
Food and
milk
Nutritional
supplement
DHO
CHD
Supporting
agencies
35
Immunizatio
n
Extra EPI clinic
Enhanced EPI
clinic
Additional
vaccination for
JE, cholera,
typhoid,
Hepatitis B,
HIV
Ensure cold
chain and
vaccination
DHO
EPI focal
person
VHW,
MCHW
Within a
week
Immunization
schedule, session,
under 1 year
target population,
Cold Chain
situation
Electricity
situation
Same HR
Logistics
Finance
DHO
CHD
Supporting
agencies
HIV/AIDS Condom
promotion
VCT, ART
CABA
PMTCT
Service
DHO
DACC
coordinato
r
During the
period
VCT center, HFI,
NGOs/INGOS,
Health cluster
Meeting of
Health cluster,
surveillance,
NGO report,
DDRC
HR, Logistic,
Finance
DHO, NCASC,
Save the
Children
36
TB control Mobile DOTS
clinic
Default tracing
Added DOTS
clinic
HIV-TB co-
infection
DHO
DTLA
Immediatel
y
No. of TB
patients,
Defaulters, drugs
MDR
DHO annual
report
HMIS HFs,
Health cluster
TB surveillance
HR, Logistic,
Finance
DHO, LHF,
VDC, NRCs,
and CBOs
Psychosocial
support
Psycho-social
supportive
services
Counseling
Regular
message
dissemination
DHO Within a
week
No. of displaced
No. death
Acute traumatic
stress people

Red Cross,
DDRC
NGOs/ INGOS
Police
HFI
Same Same












37
4. RTA
Hazard
Analysis
scale
Public
Health
Intervention
Detailed
intervention
Who?
(Who will
lead?)
When? Information Needed Resources Needed
What
information
do you need
further
How will you get
this information
What? From where?
RTA=5 Assessment Site
verification
Situation
analysis
No. of
injured
Rescue-
security team/
red cross
Triage
First aid
Transportatio
n
District Police
Office

Immediately Other
commodities
victim
police/ army
media/ local
people
human
resources
vehicle
logistician
logistic
supply
DDRC
Red cross
District police
district army
entrepreneurs
association
38
Essential
health care
services
Coordination
with DDRC
Reception of
victim
Triage
Treat
accordingly
Referral if
needed
DHO
medical
superintendent
prepare for
casualty
service after
information
treatment
immediately
after
reception of
victim
No. Of
casualties
No. Of
injured
No. Of death
victim
police/army
media
rescue team
Doctors
nurse
paramedics
logistician
logistic
supply
Emergency
Kit
DHO
other nearby
health facility
Reproductive
health
No. of
pregnancy
assessment
- DHO/
RHCC
Immediately No. of
pregnancy
and Lactating
mother
Patient/ rescue team Docotors/
staffnurses
DHO/ health
facility with
birthing
center
HIV/AIDS Blood testing VCT
counselor
immediately
after
reception of
victim
HIV testing
kit
availability
Human
resources
hospital
other VCT from
other organization
VC|T|
counselor/lab
technician
Hospital and
VCT
organization
Psychosocial
support
Identify
victims
Segregate the
victim
DHO/medical
superitendent
Immediately
after
reception
No. of
victims that
need
psychosocial
Victim/subordinates Skilled
counselor
Hospital/other
39
Counseling support
Any
previous
psychiatric
problem

5. Fire (5)
Haz
a
scal
e
Public
Health
Interventio
n
Detailed
intervention
Who?
(Who
lead?)
When? Information Needed Resources Needed
What
information do
you need further
How will you
get this
information
What? From where?
Fire
= 5
Assessment Coordination
meeting at
DDRC
Information
collection and
verification
Team
mobilization
DDRC in
support
of NRCS
district
chapter
Immediatel
y
Demographic
information,
Affected
Population and
affected
household, which
community, m,
area distance from
available of
resources,
Availability of
Team visit
and
observation,
Communicati
on with local
leaders/
through
media/FM/rad
io
Army /police
NRCS local
Human
Resource,
Fund,
Transportatio
n,
Logistic
support,
Medicines,
Phone, local
resources to
control the
Govt./non Govt.
Police, Army
DDRC, DPHO,
NRCS, contact no of
Damcle DDC/VDCs ,
I/NGOs working in the
district. Schools
college
40
health institutes
and capacity,
Level of impact
potential of
vulnerable area,
Transportation
facility
information and
effective
communication
system
volunteers
Documents
review
Communicati
on &
coordination
with other
stakeholder
fire
Essential
health care
services
First Aid,
management of
Communicable
diseases
Case referral
DHO immediatel
y
Affected and
injured cases,
Stock of drugs
and supplies,
Logistic supply,
referral
mechanism,
Availability of
Human resource
Team visit
and
observation,
Communicati
on with local
leaders/
through
media/FM/rad
io
Army /police
NRCS local
Human
Resources,
fund,
transportation
,
Medicines
DHO, NRCS and
I/NGOs,DDC,VDSs,
Army and Police
41
volunteers
Documents
review
Outbreak
control
Awareness
Drinking water/
Sanitation
Surveillance and
treatment
Injured and
communicable
diseases
DHO/RR
T
Immediatel
y
Demographic
information and
affected
population
Above Above EDCD, RHD, WHO,
NRCS,
VDC.DDC,DAO,
DHO, UNFPA,
supporting agencies

Reproductiv
e health
Safe delivery
services
Family
Planning
ANC, PNC
service if
needed
DHO
/RHCC
Immedetly Data of pregnant
mothers
Post-natal
mothers
Data of MWRA,
Human
resources,
Delivery kit,
Fp methods
DHO,
DDC/VDCs,
FCHVs and
local HFs and
local leaders
and
stakeholders,
I/NGOs
As above DHO,
DDC/VDCs/HFs/I/NG
Os
42
Nutrition Nutrition status
and assessment
Rehabilitation
center
Coordination
for hygiene
food supply
Growth
monitoring
Nutrition
education
Micro Nutrition
Supplementatio
n
DHO Within one
week
Mal nourished
children
Under 5 years
children,
Pregnant mothers
DHO,HFs above Above
Immunizati
on
Conducting
Supplementary
Immunization
Ensure regular
immunization
DHO Within one
week
Under one year
children and
pregnant mothers
DHO,HFs above Above
43
HIV/AIDS Universal
precaution
Awareness
Condom
distribution
Ensuring ART
DHO Regular VCT Center
Blood Testing
Human
Resources

DHO,HFs above Above
TB control Regular
treatment
Awareness
DHO Regular No. of patient in
treatment
Lab Accessibility
DHO
Health
facilities
DOTS
Centers
Human
Resources,
fund,
transportation
,
Medicines
- DHO
- DOTS Centers
Psychosocia
l support
Counseling
Rehabilitation
Moral Support
Stress mgmt
support
- DHO
- Local
Leaders
- NGO,
INGO
Regular Classification of
seriousness
Team visit
and
observation,
Communicati
on with local
leaders/
through
media/FM/rad
io
Army /police
Human
Resources,
fund,
transportation
,
Medicines
DHO, NRCS and
I/NGOs
44
NRCS local
volunteers
Documents
review
Communicati
on &
coordination

5. Dog Bite (4)
Hazard
Analysis
scale
Public Health
Areas of
Intervention
Detailed
intervention
Who?
(Who
will
lead?)
When? Information Needed Resources Needed
What information
do you need further
How will you
get this
information
What? From
where?
dog bite=
4
Assessment Information
Collection
(Reporting)
Verification
Emergency
and Rapid
Action Risk
DHO/R
RT
Immediatel
y
Demographic
Information
Local Resources
(Medical/Non
medical)
Data on Rabid Dogs
-
Communicatio
n
(Health
Facility
Incharge,Police
-Official
Human Resource
Vaccines
syringe
Finance*
D/PHO ,
HF, VDC,
supporting
agencies
45
Minimizatio
n
Records-VDC
Essential health
care services
First Aid,
Emergency
Management
,
Post
Exposure
Vaccination
Medical
Treatment
DHO After
verrificatio
n
No. of locally
treated and referred
cases.
Vaccine status at
District and local
level.
HR
Drugs and
equipment logistics
-HF Records
(Local
+Referral
Center)
-Emergency
Drugs +
Equipments
-Vaccines
-Finance*
DHO
Supporting
agencies
Outbreak
control
Restriction
Vaccines
(Pre and post
Exposure)
Infection
Control
DDRC Post
incident
No. of rabid animals
Vaccine supply
DHO
DVO
Above+
IEC Materials
EDCD
+WHO
+DHO
+DVO
+Media
46
Health
Education
Information
on Media
Immunization Special
Vaccination
(anti Rabies
Vaccination)
DHO
DVO
EDCD
Post
incident
No. of affected + at
risk people
Same as above HR
Logistics(Vaccin
e)
DHO
DVO
EDCD
WHO
Psychosocial
support
Counseling
Mass
Education
Medical
Relief for
mental
illness
DHO
HF
Worker
s
Social
Leaders
Post
Incident
No. of effected
people
No. of counseling
needed people
HF Records
Survey/Studies
Human
Resources
(Counselor)
Logistics
Finance
DHO
HF
Stakeholder
s
47
Section III Hospital Emergency Preparedness Plan
Date:
Name of Hospital: Arghakhanchi Hospital
1. Emergency Preparedness and Response Planning Committee:
a) Chair: Medical Officer
b) Secretary: Emergency Incharge
c) Member: VDC Secretary
d) Member: Representation from DDC
e) Member: Representation from NRCS
f) Member: Representation from Hospital development committee
g) Member: PHO
h) Member: Indoor incharge
i) Member: Lab Incharge
j) Member: RRT Reporting Focal Point
k) Member: Store
l) Member: Ambulance
m) Member: Administration
n) Member: Representation from police, army, APF (3)
o) Member: Representation from CDO
p) Member: Representation from NGO federation
q) Member: District chamber of commerce and industries
r) Member: President of district journalist associations
s) Member: Representative from transportation


Definition of Operational Terms
Minor Disaster: 5 minor cases at a time
Major Disaster: more than 6 cases at a time with 1 major case
Reception area: - OPD gate
Triage area: Waiting Hall
48
Red : - Emergency room
Yellow: - Indoor
Green: OPD passage
Black: Ramp
Team leader for Triage and team
Team Leader :- Emergency In-charge On duty
Team Members:-
1. Nim Bahadur Rana SAHW
2. Yubraj Khanal HA
3. Hari Pande HA
4. Prasanta K.C. HA
5. Yadav Chhetri AHW
Composition of field hospital team
Team Leader: MO
Team Members:
1.
2.
3.
4.

2. Items in stock for Emergency use and Field Hospital
Item Location Use (Field/In
Hospital)
Gap/ Over
stock
Resource
Required








49
Communication Incharge : - On duty staff
Team:
1.
2.
3.
## Activities Job Done
1
2
3.
4
5

Reception Incharge :- On duty
Team:
1.
2.
3.
## Activities Job Done
1
2
3.
4
5.

Clinical Incharge:- MO
Team:
1.
2.
3.
## Activities Job Done
50
1.
2.
3.
4.
5.

Red area : MO
1. ( SAHW )
2. ( AHW )
3.
## Activities Job Done
1.
2.
3.
4.
5.

Yellow Area: MO
Team:
1.
2.
3.
## Activities Job Done
1.
2.
3.
4.

Green area : Staff nurse
Team:
51
1.
2.
3.
## Activities Job Done
1
2
3
4

Transport Incharge :-
Team:
1.
2.
3.
## Activities Job Done
1
2
3
4

Security /crowd controller :- Police /Guard/ Office assistant
Team:
1. Medical hall
2. Local leader
3.. Civil Society
## Activities Job Done
1
2
3
4

52
## Activities Job Done
1
2
3


Documentation Incharge : -
Team:
1.
2.
3.
## Activities Job Done
1
2
3
4

Back up for life line :
Team:
1.
2.
3.
## Activities Job Done
1
2
3
4




53
4. Network of Hospitals
Hospital Contact Number Person in Charge
District Hospital 077420257 Dr. Yam Bahadur Basnet
Arghakhachi Hospital 077420829, 077420830 Dr. Bishnu Acharya
LUHESCO 077420659
54
SECTION IV COMMUNICATION STRATEGY
The workshop identified the following strategy for the communication during the emergency period. It is further classified into two
categories.
Internal Communication:
S.N. Issue Initiator Receiver Mode Message
1 Update on current
situation
DHO EDCD Telephone/Fax/Mail

2 Reporting on
assessment result
RRT/DHO EDCD Telephone/Fax/Mail

3
Request for supplies DHO EDCD/LMD/RMS/ Telephone/Fax/Mail

4
Request for funding DHO EDCD/Partners Telephone/Fax/Mail


External Communication:
Level Spokesperson Second
District District Health Office Chief RRT reporting focal Point ( H.A.)



55
SECTION V ANNEXES
Annex I. Short Analysis of Critical Facilities


SN Type VDC
Year
built
Participation
in recent
emergency
Emergency
preparedness
plan in place
Usefulness of
emergency
preparedness
plan in recent
emergency
Number
of
workers
Status
1
District Hospital Arghakhanchi
1990
B.C.
Y Y More Useful Functional
2 Thada PHC Thada Y N - 12 Functional
3 Balkot PHC Balkot Y N - 7 Functional
4 Arghatosh HP Arghatosh Y N - 3 Functional
5 Bhagawati HP Bhagawati Y N - 5 Functional
6 Mareng SHP Mareng Y N - 3 Functional
7 Thulapokhara SHP Thulapokhara Y N - 3 Functional
8 Chidika SHP Chidika Y N - 3 Functional
9 Chhatrajung SHP Chhatrajung Y N - 3 Functional
10 Kerunga SHP Kerunga 2 Functional
11 Wangla SHP Wangla Y N - 4 Functional
12 Argha HP Argha Y N - 3 Functional
13 Dharapani SHP Dharapani Y N - 3 Functional
14 Kimdanda SHP Kimdanda Y N - 3 Functional
56
15 Nuwakot HP Nuwakot Y N - 4 Functional
16 Khilji SHP Khilji Y N - 4 Functional
17 Asurkot SHP Asurkot Y N - 3 Functional
18 Khana HP Khana Y N - 5 Functional
19 Khanadaha SHP Khanadaha Y N - 3 Functional
20 Diverna SHP Diverna Y N - 3 Functional
21 Bangi SHP Bangi Y N - 4 Functional
22 Hansapur HP Hansapur Y N - 5 Functional
23 Dhakabang HP Dhakabang Y N - 4 Functional
24 Gokhunga SHP Gokhunga Y N - 3 Functional
25 Pokharathok HP Pokharathok Y N - 6 Functional
26 Panena HP Panena Y N - 3 Functional
27 Maidan SHP Maidan Y N - 3 Functional
28 Patauti SHP Patauti Y N - 5 Functional
29 Khidim SHP Khidim Y N - 4 Functional
30 Narapani HP Narapani Y N - 6 Functional
31 Dhatibang SHP Dhatibang Y N - 2 Functional
32 Pali SHP Pali Y N - 4 Functional
33 Adguri SHP Adguri Y N - 2 Functional
34 Khanchikot HP Khanchikot Y N - 3 Functional
35 Dhikura SHP Dhikura Y N - 3 Functional
36 Suvarnakhal HP Suvarnakhal Y N - 4 Functional
57
37 Simalpani SHP Simalpani Y N - 3 Functional
38 Sitapur SHP Sitapur Y N - 3 Functional
39 Jukena SHP Jukena Y N - 4 Functional
40 Dhanchaur SHP Dhanchaur Y N - 3 Functional
41 Siddhara HP Siddhara Y N - 6 Functional
42 Jaluke HP Jaluke Y N - 4 Functional
Non Governmental Sector :-
NRCS Arghakhanchi
Nepal Army Arghakhanchi
Nepal Police
Nepal Arm PoliceForce
Arghakhanchi Hospital
Pvt.Ltd.


58
Annex II-Access and Distance form District Headquarter (in KM)

SN


Name of
VDC/Municipality
Distance from district
HQ(in KM)
Means of transportation from
district
Alternative means of transportation from
district HQ
Motorable Remarks
12 months Seasonal
1. Kacha
2. Pucca
3. Goreto
1.
District Hospital
Arghakhanchi
00 yes 2
Access from Gorusinge Kapilvastu, Palpa,
Gulmi, Pyauthan
2. Thada PHC 32 yes 2 Via Gorusinge
3. Balkot PHC 15 yes 1, Via Sandhikharka Wangla
4. Arghatosh HP 22,32 yes 1 Via Balkot
5. Bhagawati HP yes 1, Via Sandhikharka Balkot and Gulmi tamghas
6. Mareng SHP 24,34 yes 1, Via Sandhikharka arghatosh
7. Thulapokhara SHP 15 yes 1 Via Balkot
8. Chidika SHP 25 yes 1, Via Sandhikharka Balkot
9. Chhatrajung SHP 28 yes 1 Via Sandhikharka Balkot
10. Kerunga SHP yes 1 Via Sandhikharka Balkot
11. Wangla SHP 8 yes 1,2 Via Sandhikharka
12. Argha HP 11 yes 1,2 Via Sandhikharka
13. Dharapani SHP yes 1,2 Via Sandhikharka Kimdanda
14. Kimdanda SHP 8 yes 1,2,3 Via Sandhikharka
15. Nuwakot HP 9 yes 1,2 Via Sandhikharka
59
16. Khilji SHP 18 yes 1 Via Sandhikharka Nuwakot
17. Asurkot SHP 21 yes 1,2 Via Sandhikharka Nuwakot Khilji
18. Khana HP 18 yes 1,2 Via Sandhikharka Diverna
19. Khanadaha SHP 21 yes 1,2 Via Sandhikharka Diverna Khana
20. Diverna SHP 8 yes 1,2 Via Sandhikharka
21. Bangi SHP 14 yes 1,2 Via Sandhikharka Argha
22. Hansapur HP 20 yes 1,2 Via Sandhikharka Argha Bangi
23. Dhakabang HP 31 yes 1,2,3 Via Sandhikharka kindanda dharapani
24. Gokhunga SHP yes 1,2,3 Via Sandhikharka Argha Bangi Hansapur
25. Pokharathok HP 35 yes 1,2 Via Ghumti Pali Bansarukha, via palpa tansen
26. Panena HP 42 yes 1.2
Via Ghumti Pali Bansarukha pokharathok via
palpa tansen
27. Maidan SHP 32 1,2,3 Via Ghumti Pali
28. Patauti SHP 36 12,3 Via Ghumti Pali
29. Khidim SHP 38 yes 1,2 Via Ghumti Pali Bansarukha
30. Narapani HP 12 yes 1,2 Via Sandhikharka fudbang
31. Dhatibang SHP 29 yes 1,2 Via Ghumti Adguri
32. Pali SHP 20 yes 1,2 Via Ghumti Adguri
33. Adguri SHP 15 yes 1,2 Via Ghumti
34. Khanchikot HP 20 yes 1,2 Via Ghumti narapani
35. Dhikura SHP 7 yes 1,2 Via Sandhikharka
36. Suvarnakhal HP 21 yes 1,2 Via Ghumti narapani rajubash
37. Simalpani SHP 47 yes 1,2 Via thada Bhedamare
38. Sitapur SHP 27 Yes Via Ghumti narapani Deurali
39. Jukena SHP 42 Yes Via Thada Amarai
60
40. Dhanchaur SHP 21 Yes Via Thada Amarai, Sandhikharka Dhikura
41. Siddhara HP 52 Yes Via Thada Chakla
42. Jaluke HP 54 yes Via Thada Chakla Jukena

61
Annex III-Information on Ambulance Services

SN Name of the Organization
Address (including
phone, fax & email)
Types of Ambulance
Vehicles (e.g. Toyota,
TATA)
Service
Started
Year
1.

District Hospital
Arghakhanchi
077420- 257, 9857061054 Mahindra 2062
2.

Bhupu. Sanik sangh
Arghakhanchi
9847182584 TATA Sumo 2065
3.
Nepal Red Cross Society
Argh. Branch
9857061255 TATA Sumo 2065
62
Annex IV- Important Contact Information
SN Name and designation Name of Organization Tel No. Mobile Fax no. Email
address
Remark
2 Mr. Govindamani Bhurtel, CDO D.A.O 077420-133
077-420-209
9857007777
3 Mr. Hemraj Bhusal, LDO DDC 9857027828
4 Mr. Hira B. Pandey ,DSP DPO 077420-199 9857005555
5 Dr. Yam Bahadur Basnet DHO DHO 077-420-188 9857057500
6 M. Lilaram Gautam PHO DHO 077-420-213 9847087681
7 Mr. Shambhu Pokhrel, Chairman NRCS, Arghakhanchi 077-420-227 9847108125
8 Mr.shovakhar Panthi, President Nepal Patrakar
Mahasangh
077420354 9857060482
9 Mr. Surya Bhusal Radio Deurali
Arghakhanchi
077420171 9857061358
10 Mr. Bishnu Muskan Arghakhanchi F.M. 077420131 9847063953
11 Mr. Birendra KC Kantipur ,Sampadak 9847110773
12 Mr. Nim Rana EMR incharge 077420257 9847109142
14 Tilak Mahatra HA, RRT Focal
Point
DHO,Arghakhanchi 9847108610




63
Annex V Logistic Requirement Required to Respond to Disaster (Epidemic, Earth Quake, Landslide, Dog Bite, Fire etc)
SN Details
(Medicine, type of HR,
equipment name)
Quantity required* Cost per unit Total cost
(qty x cost per
unit)
Remarks (funding
source) 1. Suction Machine with catheter 15 YES
2. Portable ECG 5 YES
3. X-ray 3 YES
4. Stretcher 42*10= 420 YES
5. Fire Extinguisher 50 YES
6. SURGICAL LOGISTICS
a Cervical Collar 200 YES
b Lumbar Sacral Belt 200 YES
c Splint 200 YES
d Arm pouch and Clavicle brace 200 YES
7. Delivery Bed Partially YES
8. Ambu Bag Partially YES
9. Resustaire Partially YES
10. Chlorine Solution 4000 bottles/ 20000 tab YES
11. Diarrhoea management kits YES
12. First Aid kits YES
13. Reproductive health kits YES
14. Emergency management kits YES
15. Rabies vaccine YES
16.
17.
*Quantity required= existing Quantity- Actual Required based on total Population
64

Annex VILogistic Tracing Form
Name Title Agency Date of Arrival
Response Area
Duration of
stay
District VDC

















65
Annex VIITalking Point Template
Date:
- Place of occurrence:

Situation:
- What has occurred?

- # affected

- # dead and injured

- What are the sources of the emergency? (ex. Contaminated water, rain, broken dam etc.)

Response
- What has been done?

By whom
- What are the resources on the ground?

Gaps
- What are the gaps?

- What are the plans to fill the gaps?

Next Steps
- What are the next steps?

66
Annex VIIISituation Report Template

Highlights
- What are the main highlights? (# of people dead, missing, injured etc.)

- What is the main response?

- What are the main gaps?

Current Situation
- Are there any updates on the situation?

Response
- What is the main response?

- Who is responding, and in what area?

Gaps
- What are the main gaps in response?

Next Steps
- What are the next steps envisioned?

67
Annex IX Training Attendance
S.N. Name Office Designation Cell No.
1 Gobindamani Bhurtel D.A.O. CDO
2 Hemraj Bhusal DDO LDO
3 Hira Bahadur Pandey DPO DSP
4 Mr Ram Kaji Rana Chandan Nath Gann Karnel
5 Dr. Yam Bahadur Basnet DHO DHO
6 Dr. Bishnu Acharya DHO MO
7 Dr. Nabin Darnal DHO MO
8 Dr. Nibash Budathoki DHO MO
9 Dr. Sudarsan Koirala DHO MO
10 Dr. Laxman Sharma DHO MO
11 Mr Lilaram Gautam DHO PHO
12 Mr Anil Dhungana DHO PHO
13 Mr Tilak Mahotra DHO RRT focal Person
14 Mr Ganesh Paudel DHO PHI
15 Mr Nim Rana DHO SAHW
16 Mr Yubraj Khanal DHO HA
17 Mrs Saraswati Banjade DHO Staff nurse
18 Mr Shravan Panthi DHO HA
19 Mr Kashi Ram Panthi DHO Section Officer
20 Mr Dinesh Ruwali HRI District Co-ordinator
21 Mr Kabindra Regmi DHO DACC Co-ordinator
22 Mr Purna BK UNFPA District Co-ordinator.
23 Mrs Kalika bhandari DHO PHN
24 Mr. Uttam Koirala DHO FPO
25 Mr. Sovakar Pokhrel DHO PHI
26 Mr Thakur Adhikari Red cross
27 Mr Dhurba Giri DDC PO
28 Mr Haris Chandra Bhusal DDC SDO
68
29 Mr Madan Bhattarai DHO Na.Su.
30 Mr Thakur K. Shrestha DHO FO
31 Mr Lila Dhar Paudel DAO IO
32 Mrs Bishnu Kumari
Lamichhane
WCDO WCDO
33 Mr Sankhar Pandey Balkot PHC PHI
34 Mr Pitambar Adhikari Thada PHC PHI