Essential health services standard 1: Prioritising health services
People have access to health services that are prioritised to address the main causes of excess mortality and morbidity.
Key actions (to be read in conjunction with the guidance notes)
Collect and analyse data on health problems and risks with the aim of targeting the major causes of excess mortality and morbidity, in coordination with local health authorities (see Core Standard 3).
Identify vulnerable people (e.g. women, children, older people, persons with disabilities, etc.) who may be at particular risk (see Protection Principle 2).
Prioritise and implement health services that are appropriate, feasible and effective to reduce excess morbidity and mortality, in coordination with local health authorities (see guidance note 1).
Identify barriers that impede access to prioritised health services and establish practical solutions to address them (see guidance note 2).
Implement priority health services in coordination with all other sectors and/or clusters and cross-cutting themes (see Core Standard 2).
Key indicators (to be read in conjunction with the guidance notes)
The crude mortality rate (CMR) is maintained at, or reduced to, less than double the baseline rate documented for the population prior to the disaster (see guidance note 3).
The under-5 mortality rate (U5MR) is maintained at, or reduced to, less than double the baseline rate documented for the population prior to the disaster (see guidance note 3).
- Priority health services are essential health services that are effective in addressing the major causes of excess mortality and morbidity. They vary according to the context, including the type of disaster and its impact. As far as possible, priority health services should be based on the principle of evidence-based practice, and have a demonstrated public health benefit. Once mortality rates have declined to near-baseline levels, a more comprehensive range of health services can be introduced over time (see Core Standard 4).
- Access to health services should be based on the principles of equity and impartiality, ensuring equal access according to need without any discrimination. In practice, the location and staffing of health services should be organised to ensure optimal access and coverage. The particular needs of vulnerable people should be addressed when designing health services. Barriers to access may be physical, financial, behavioural and/or cultural, as well as communication barriers. Identifying and overcoming such barriers to the access of prioritised health services are essential (see Core Standard 3 and Protection Principle 2).
- Crude mortality rate and under-5 mortality rate:The CMR is the most useful health indicator to monitor and evaluate the severity of an emergency situation. A doubling or more of the baseline CMR indicates a significant public health emergency, requiring immediate response. When the baseline rate is unknown or of doubtful validity, agencies should aim to maintain the CMR at least below 1.0/10,000/day.
The U5MR is a more sensitive indicator than CMR. When the baseline rate is unknown or of doubtful validity, agencies should aim to maintain the U5MR at least below 2.0/10,000/day (see Appendix 3: Formulas for calculating key health indicators).