D1.1.4. Preliminary conceptual model of health components that describes extreme event impacts. Deadline: May 2008, but the 1st draft should be available by February 2008. Each partners develop conceptual model for their own countries. Indonesia partner puts together and send back to all partners for comments. Debarati Guha-Sapir sends some examples for conceptual models. Conceptual models are country specific: depends on interests and characteristics of natural disasters in each country. Floods and storms can be together 
Comprehensive model and core model. Guideline from Indonesia (Mondastri) on the construction of comprehensive and core model: can be in bullet points (Deadline: 17th of Sept. 2007) 

3.2 Interactions needed within and with other Groups, e.g. communications, data needs, conceptual ideas

3.2.1. Communication rules

§   From now to February 2008, HGW organizes group meeting at least once a month using skype. Valerie organizes this. (3-4 pm in Asia, 9-10 am in
Europe) §   Project website should provides skype address for everybody.
§   When documents are sent for comments with set deadlines. If no comments are provided on time, it means that a formal agreement without comment.
§   HWG coordinator will request all partners to nominate 1 responsible contact person.
§   All partners need to keep all printed emails
§   A mailing list for HWG.
§   Valerie is the contact person for HWG when communicating with social and economic groups 

3.2.2. Interactions with other thematic groups

§  In the Social Group meeting, Terry asks social and economic groups that if Health group proposes sites, can the other two groups consider to use these sites. This allows integration protocol to be implemented. 

§  Could Terry also ask social group if they can base on preliminary result of health survey to conduct follow-up qualitative study (e.g. interviews, FGDs) to complete the data. 

3.3 Key Issues for Thematic Group discussion

3.3.1 Discussion of Integration Issues including surveys

Advantages of integration:

§   The idea of integration is great in theory. Ideally to have integrated protocol at the beginning, this is one of the purposes of Microdis. 
§   Integrated survey only captures common information at household level for all 3 groups. Each study groups may conduct separate further studies to fulfill their objectives. Data on health, social and economic impacts of natural disasters at the same sites can be linked together. 



Disadvantages: 
§   Makes 15 institutions all over the world with different expertise and interests come together, which can be difficult. 


§   Need assistant from other groups, issues of training of trainers, training for interviewers etc. Budget is not allowed to included new research members or local consultants 
§   Given the time frame, not sure if the integration team can guide this process to accomplish assigned tasks by November 2008. 


§   Each group has their own outputs, so how to integrate? E.g.: agree on the sites and the items to be done by the participatory approach? The same method could be used for all 5 sites of health impact assessment? Join investigators for household survey? How to design surveys applicable for 16 different sites? Surely a clear roadmap is critically needed for all three groups based on their own feedback. 

Future plan 


§   HWG, EWG, SWG each makes a plan, with findings and come together. HWG presents issues covered by HWG. Proposes cross cutting issues with social and economic groups. 
§   Integration Group provides guidance on how different teams work together and provide a concrete sector-by-sector guidance on crosscutting issues among 3 aspects. 


§   Integration group can produce entire research protocol based on inputs from 3 thematic groups. Lets 3 groups know clearly what variables, inputs that each group need to give the integration group. 
§   Deli February meeting helps to allow common understanding among all teams and derives concrete conclusions. 


§   Pilot integrated survey protocol in Deli February 2008 meeting to decide where the pilot study should be implemented. Use semi-structured questionnaires, rather than large structured questionnaires. 
§   Workshop or individual assistant for explaining, training the integrated protocol since the integrated protocol needs to be adapted to the local situations. 1st priority is internal resources. 2nd priority is inviting local experts. Integration group should provide recommendations/ suggestions of appropriate experts. MICRODIS has enough travel budget for members to travel to other country to assist partners if needed. 


§   Health group only analyses data on health issues. Other data on social and economic issues are analyzed by other groups. 
§   Methods and tools should be applicable to all partners 

3.3.2 Literature review – purposes, content, work allocation Bases on the contract, only 1 deliverable on literature review of economic impacts related to extreme events (e.g., households, welfare, migration, health). No deliverables for literature review on health and social impacts.

Purposes of literature review:

§   Helping to answer, amend, formulate research questions, identify gaps 
§   To provide access and inspiration to other conceptual and research frameworks in order to use them, to critic them or improve them, to help us develop our conceptual model. 


§   Assess and evaluate existing data 

Key categories: country specific 


§   Health policy and legal frameworks 
§   Baseline data for studied sites: health services (public, private): structure/input, process, output (part of survey, not belonged to literature review) 


§   Disaster management plan 
§   Emergency response (actors, stakeholders, resources) 


§   Types of disasters, impacts on health and health providers 
§   Health status data 


§   Interactions between health, social and economic aspects §   Risk factors/vulnerability 

Key words


§   Uses Cochcrane criteria to evaluate data used in the review: could limits number of documents to be used, but this is necessary. 

Sources


§   Scientific papers §   Previous research: national/international published documents, unpublished documents, data from academic institutions 
§   Governmental data (relevant ministries, e.g. MOH) 


§   NGOs, international organizations, WHO, etc. 
§   Disaster preparedness agencies 



Databases for searching information: uses Ovid Medline, etc. 

Work allocation


Heidelberg takes lead to prepare a guideline on: what to put in literature review, and assign tasks to different partner. TOR for literature review should be available to all partners by 17th of Sept. 2007 3.3.3 Primary research questions 

1.      What are the health impacts of floods, storms and earthquakes? (Each hazard has different health consequences, according to different time frames. Quantitative and qualitative questions) 


2.      What is the significant of insurance in dealing with health issues in disasters 
3.      Comparison in existing insurance systems in different countries 


4.      What factors make people become vulnerable and how to reduce these? Why some people are more vulnerable than others? (age, gender, education level, urban/rural..) 
5.      What factors reduce vulnerability through preparedness measures? 


6.      What are the impacts of natural disasters on health system/health services? 
7.      What is the significant of emergency health care in disaster response? 


8.      In preparedness, what general factors (health system) and hazard-specific factors are important (e.g. early warning system)? 
9.      Are there differences in health seeking behaviors before and after disasters? 


10.  What impacts does health status after disasters have on economic and social status? 
11.  Is there a mechanism for institutional learning in disaster preparedness? What are the barriers to the learning? 

3.3.4 Conceptual and methodological frameworks relevant to Theme

§   Contribution/inputs from each members with examples of conceptual model (Deadline: 15^th Sept. 2007)
§   Strategy for developing the conceptual model  (informal for HWG with examples) (Deadline: 30^th Sept. 2007)
§   Feedbacks from HWG (Deadline: 15^th Oct. 2007)
§   Synthesis by Indonesian group, dissemination to the HWG (Deadline: 15^th Nov. 07)
§   Conceptual model (Deadline: 30^th Nov. 2007)

3.3.5 Assessment of data requirements for thematic group to fulfill research questions (see Annex 3) 3.3.6 Crosscutting issues (see Annex 4) 
3.3.7 Preparation for surveys 

Rationale for time elapsed since disaster to be studied

All partners in HWG suggest all interesting and logistically sites for study Population based survey requires enormous preparation for baseline data: administration procedure: usually 1-3 months. Recruiting and training for interviewers. All these need 3 to 4 months. If a survey to be carried out in Summer 2008, sites’ details should be available by January-Feb. 2008. Survey should not be undertaken too closely after disasters. Should be a large, important disaster in the countries. Types of disasters are flexible, can be changed, but need to report to the meeting in Feb. 2008 in Deli. 

Requirements for selection of study sites: (a) disasters results in deaths, (b) urban and rural, (c) rich and poor areas, (d) levels of vulnerability, frequency of disasters, and predictability, (e) timeframe should be within 6 months-12 months, based on the literature review! recall period. 


No international agreements on timeframes: short, medium, long terms. HWG defines these on its own. 
Different methods can be used in different sites. Cross-sectional and prospective 


Specific attention for industrial sites in affected areas (any industrials, any scales). Descriptions of industrial sites in the affected areas: types of chemicals hazards, scales of the industry etc. 

Control sites: important, but this will double study sites, budget? Suggested solution: reduce original sample size. 



Annex studies 

1. Natural disasters and toxic hazards (Finland, India,...) 


2. Earthquake studies: Indonesia, Philippines, and India can study this. Timeframe can be extended. 

Milestones 


Month 7th M2.1.1. Identification of health assessment methodology to be analyzed. This actually is the literature review and research questions. (Milestones are less important; the most important things are deliverables) 
Month 12th M2.1.2. Selection of assessment methodologies and tools 


Month 15th Deliverable D2.1.1 Field protocol for health impact assessment 
In February meeting in Deli, each partners of health group brings along with all tools already available to assess health impacts of natural disasters. 



3.3.8. Preparations for Deli Meeting in February 2008 

At least 4 technical presentations and 1 general presentation on annual group activities 


§   1 presentation on lepto from Indonesia 
§   1 presentation on flood from Vietnam. 


§   1 presentation from Heidelberg on conceptual framework. 
§   Marita reports on industrial hazards in natural disasters Finland 


§   Leader of HWG delivers a short presentation on annual activities including group meeting 

Request for a special session (half day) specific case scenario and discussion on integration issues. 


§   Case scenario to be prepared by Indian group, with supports from Heidelberg. 
§   Selects a case, India prepares a presentation on background information of the event. 


§   All thematic groups will discuss on if it is appropriate to apply integrated protocol, advantages, and disadvantages of this approach. 
§   HWG must prepare what are expected from other 2 thematic groups if integration approach is used. 


§   HWG feels that 2 days MICRODIS meeting is not long enough, so suggests 1 day thematic meeting prior the whole project meeting. 
§   Needs to get an idea from PC on what he expects from us and from other thematic groups on Deli meeting. 


§   Scientific presentations, thematic group presentations, steering committee meeting in the evening (1 person from each institution) 
§   PC Joshi and Debarati Guha-Sapir (coordinators) provide draft Deli meeting agenda 

4. CONCLUSIONS AND PLAN OF ACTION

Activities/Deliverables 
 
Responsible partners/persons 
 
Supportive partners/persons 
 
Deadlines 
 
D1.1.1. Report on thematic health group workshop, Hanoi 30-31 August 2007 
HSPH 
(Nhu Ha, Hanh Tran) 
All partners of HWG; Terry Cannon 
1st draft by 15/9/07 
Final draft by 28/9/07 
D1.1.2.  Literature review 
TOR for literature review 
Heidelberg 
All partners of HWG 
17th Sept. 2007 
D1.1.3. Report on industrial development in disaster prone areas (3-5 pages) 
Finland -Marita Luotamo 
Debarati 
Deli meeting Feb.2008 
Provide examples of conceptual models 
All partners of HWG 
All partners of HWG 
15th Sept. 2007 
Strategy for developing the conceptual model 
Indonesia and Heidelberg 
30th Sept. 2007 
Feedbacks from HWG on conceptual model 
All partners of HWG 
All partners of HWG 
15th Oct. 2007 
Revised the conceptual model based on comments 
Indonesian partner 
All partners of HWG 
15th Nov. 2007 
1st draft of conceptual model 
Indonesian partner 
HWG 
30/11/07 
D1.1.4. Final version of  conceptual model 
Indonesia 
(Debarati) 
All partners of HW 
May/08 
HGW organizes group skype meeting at least once a month. 1 person from each partners 
Heidelberg 
Valerie Louis 
All partners of HWG 
Monthly, to Feb. 2008 
Ask possible interactions with other thematic groups, e.g. on selection of studied sites, data collection ... 
Integration group 
Terry Cannon 
3 thematic groups 
 
EWG meeting, Nov. 07 
Guidelines for integration 
Integration group 
Terry Cannon 
3 thematic groups 
Prior Deli meeting 
M2.1.1. Identification of health assessment methodology to be analyzed /literature review 
Heidelberg 
 
All partners of HWG 
 
Month 7th 
 
M2.1.2. Selection of assessment methodologies and tools 
All partners of HWG 
All partners of HWG 
Month 12th 
Deliverable D2.1.1 Field protocol for health impact 
University of Indonesia 
All partners of HWG 
Month 15th 
Preparation for Deli Meeting in Feb 2008 
§     Presentation on leptospirosis 
§     Presentation on flood 
§     Presentation on conceptual model §     Presentation on industrial hazards in natural disasters 
§     A short presentation on annual activities 
§     Prepare a case scenario 
Indonesia 
Vietnam 
Heidelberg
Finland - Marita 
Leader of HWG 
Indian group 
 
Heidelberg 
 
Feb. 2008