United Nations humanitarian reform introduced the “cluster” or sectoral approach, which is a group of humanitarian agencies and organizations that work together to achieve more coordinated, more efficient, and more appropriate response for a country affected by disaster. Assistance is organized by areas or sectors that are led by one agency, always in support of and in collaboration with the authorities of the country concerned. The cluster is meant to strengthen, never replace, existing coordination mechanisms in the sector. Health cluster coordination is the responsibility of the World Health Organization (WHO).

In the case of the earthquake in Haiti, PAHO, the Regional Office for WHO, led and coordinated the cluster. The cluster provided national authorities mechanisms for communicating with the international community. Due to enormous difficulties in communication and coordination, information on the magnitude of the event and about specific needs was initially slow and inadequate.

The international community’s response to the disaster was overwhelming, and there is no doubt that this aid was well-intentioned and spontaneous. This influx of assistance posed a major challenge for the cluster. Humanitarian aid agencies arrived in stages, varying widely in size, funds, logistical capacity, and levels of self-sufficiency. More than 390 health sector actors, including NGOs, international, and bilateral teams arrived in Haiti. By the end of March, there were some 553 agencies on the ground, most of them international.

It should be noted that organizations working in Haiti before the crisis suffered major losses from the earthquake, both in terms of people and property. Qualified local personnel were in short supply and largely absent because they had been personally impacted by the earthquake. Many of the agencies that arrived after the event were initially disoriented, and because most of their staff did not speak the language, their relationship with local authorities, patients, and communities was made more difficult.

To have a more effective response, working groups were created in the following areas:

• Primary care and mobile clinics (in March, 55 NGOs were managing some 160 mobile clinics)
  
• Hospitals and trauma care (in March, 2,000 beds were available and 43 hospitals were functional)
  
• Mental health and psychosocial support
  
• Disabilities: more than 20 NGOs are participating in this subgroup, which is led by Handicap International
  
• Medical supplies: Because of the delay in the arrival of flights,  many agencies initially needed the support of PROMESS, Haiti’s Central Procurement Agency for drugs and medical supplies, which is managed by PAHO
  
• Early warning and communicable diseases.

One of the first actions of the cluster, in coordination with the Haitian government, was to determine the status of health institutions. This included establishing whether or not these facilities were fully or partially functional, indentifying available health personnel, determining whether these facilities were receiving external support, and identifying that support. This process has helped to identify the biggest gaps between needs and capacities, and establishes priorities for assistance.

The health cluster played a key role in coordination. Incoming groups may have had skills but lacked logistical support; foreign health experts arrived who were not associated with an agency. Some were not self-sufficient in matters of their own food, drink, shelter, or supplies, or they simply could not find partners. The ability to provide guidance to such organizations was one of the successes of the health cluster.

Another area of success was in matching up needs and capacity. For example, the cluster was able to connect a group of doctors from Bangladesh that had arrived without equipment and a Belgian group that was departing from Haiti and leaving equipment behind in a particular hospital.

Recognizing the shortage of skilled human resources, the health cluster called on agencies to build local capacity—working not only for Haitians, but with Haitians.

One weak point of the cluster was in managing the information needed to guide and facilitate decisions. For example, information was needed about the most common diseases: whether these illnesses were increasing or decreasing, whether there was risk for epidemics and public health risk, whether local surveillance structures were operating, and if so, to what extent.

Now that the acute phase of the crisis has passed and steps are being taken toward restoring services, it is important that Haiti progress can be sustained. This will happen only if national institutions continue to be strengthened with the support of NGOs and other organizations that are working or plan to work in Haiti for the long term. At present, the country does not need short-term visits from health personnel, except in very particular specialties, and then only when requested.

There are important lessons that the international community should learn from this disaster:

• Individuals willing to assist a country affected by a disaster must travel with institutional backing.
  
• The only way to be part of the solution and not a burden is to be self-sufficient. A place devastated by a disaster, everything becomes a problem: accommodation, logistics, water, food, transportation, communication, etc.  This same message is intended for small organizations, countries, and university health teams.
  
• It is important to be involved with the community and local professionals. The local people are the first responders and will be there after everyone else has gone. The importance of involving and working with local doctors, nurses, and health authorities to achieve results cannot be overemphasized.
  
• It is important to have local language skills. It is also important to go where the displaced population has genuine needs, which means being prepared to leave the capital cities and travel to remote areas.

In short, the Haitian disaster has reinforced the importance of effective coordination in the health sector in support of a government that is completely overwhelmed by a disaster. Managing the health cluster in similar situations requires a team specialized in various disciplines (logistics, information technology, communications) to manage coordination and information. At the same time, the cluster team must operate independently of the routine activities of the PAHO/WHO national office.
For more information contact Dr. Dana Van Alphen: This email address is being protected from spambots. You need JavaScript enabled to view it..