Disease Early Warning Systems - Key Aspects of the 2010 Pakistan Flood Response
April 28, 2011
Deputy Assistant Administrator for the Bureau for Democracy, Conflict and Humanitarian Assistance (DCHA) at USAID & Career Minister in the Senior Foreign Service
Disease Early Warning System – Key Aspects of the 2010 Pakistan Flood Response
The 2010 floods were by far the worst natural disaster in Pakistan’s history. Flooding of almost biblical proportions ultimately affected more than 20 million people and covered one-fifth of the country’s territory. More than eight million people were displaced. The extraordinary international and Pakistani relief effort reached millions with emergency shelter, food and clean water, but many more could only find refuge on higher ground along highways and river embankments.
The massive population displacement, coupled with damage and disruption to infrastructure, raised urgent public health issues. Waterborne diseases are already a concern in Pakistan. According to the World Health Organization (WHO), in an average year diarrheal diseases are the fourth most common cause of death in Pakistan, accounting for roughly 9 percent of all deaths countrywide. And this was no average year.
For USAID’s Office of U.S. Foreign Disasters Assistance, our highest strategic priority was avoiding an epidemic outbreak of cholera, a disease already endemic in Pakistan. But while we faced a huge challenge, we had already tucked an ace up our collective sleeve, called the Disaster Early Warning System, or DEWS.
In 2008, USAID, along with Pakistan’s Ministry of Public Health and the WHO, funded a disease surveillance system of permanent and mobile health clinics and laboratories to track individual cases and respond rapidly to treat and isolate communicable cases from the surrounding populace. If a villager in Dadu District in Sindh Province had acute watery diarrhea, health workers could quickly determine if it was cholera, isolate the patient and his family, step up public health messaging throughout the community, and treat the local water source. An outbreak in one village would not spread inevitably to the next, and appropriate resources could be focused where more cases where reported. DEWS was initially put in place in 37 districts judged earthquake and flood-prone, with the aim to expand it to other high risk districts and build the capability of health personnel at the most peripheral level for early detection of epidemics.
At the onset of the emergency, USAID and the WHO expanded the system rapidly. Within two weeks, the DEWS network had more than tripled its coverage and the number of patients seen in medical facilities had increased six-fold. In the first month of the flooding, with data tracked through DEWS, we saw a rising trend of acute watery diarrhea cases, well outside normal seasonal trends. Recognizing the dangers of an epidemic outbreak, we worked to establish diarrhea treatment centers immediately in the most at-risk districts, setting up 63 centers in 41 districts. In three months, more than 60,500 patients were treated and 15,000 were admitted for longer term care at DTCs, and among those admitted, only 58 diarrhea-related deaths were recorded.
As a result of DEWS and a lot of hard work, we avoided a large-scale disease outbreak in Pakistan in 2010. The investment in disaster risk reduction made two years earlier was the key to this achievement. An ounce of prevention bought much more than a pound of cure.
Mark S. Ward is the Deputy Assistant Administrator for the Bureau for Democracy, Conflict and Humanitarian Assistance (DCHA) at the U.S. Agency for International Development (USAID) in Washington, DC and a Career Minister in the Senior Foreign Service. He focuses on disaster preparedness and response and civil-military cooperation. Prior to his current assignment, Mr. Ward was Acting Director of the Office of U.S. Foreign Disaster Assistance at USAID.